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Prudential is one of the country’s oldest insurance companies. You are likely familiar with decades of the company’s advertisements because they tout their stability and reliability. That all ends the moment that you need to file a claim. The trademark “rock” that Prudential wants to build the most is its own balance sheet. Therefore, it will use many tactics to deny your claim when you file for long-term disability benefits under your company’s plan.
At Prudential Long-term Disability Insurance Lawyer, we take on powerful companies just like Prudential on behalf of our clients. We hold them accountable when they wrongfully deny you the benefits you deserve. We stand up to major corporations and regularly obtain full disability benefits for our clients, including settlements or verdicts in the six and seven-figure range.
If you need to file a disability claim with Prudential or appeal a claim denial, you want our firm on our side. We have been helping people in your shoes for more than 25 years, and we can assess the best course of action when it comes to your Prudential disability claim.
People usually sue Prudential for two reasons relating to ERISA long-term benefits:
There are often federal court decisions where judges reverse Prudential’s denial of benefits. Reading these decisions, you have to wonder how, in good conscience, an insurance company can say that someone is not disabled or does not deserve benefits.
Companies like Prudential go to any length to argue that you can work, regardless of the pain or medical condition that you are experiencing. For example, (and this comes from a real-life case), Prudential can say that you can work through excruciating neck pain using a phone headset and an ergonomic chair.
In reality, Prudential uses several reasons to deny claims like yours when you sorely need the benefits. It does not matter to them that you have a policy that legally entitles you to disability benefits if you meet the requirements. They toughen the conditions as a reason to say no.
Here are some common reasons why Prudential will deny a long-term disability claim:
Either way, while insurance companies may get to deny your claim initially, they do not have the only say in whether you can get benefits. Claimants sue companies like Prudential all the time for denying benefits. Long-term disability benefit denials are the most common form of ERISA litigation.
First, you must go through Prudential’s own appeals process before taking the case to federal court. When Prudential denies your claim, they must provide you with a detailed reason for the denial and the records used to justify it.
Federal rules recently changed to require the insurance company to be more transparent when denying your claim. Of course, they cannot tell you that they denied your claim because they simply do not want to write the check.
While it seems highly unlikely that Prudential will reverse its denial, you at least get a chance to add more information to your claim and address the insurance company’s reasons for the denial.
In some cases, Prudential will grant an appeal, although denial is far more common. Prudential says that it assigns a different person to review the appeal than the employee who rejected your claim in the first place. However, we are aware of cases where the same Prudential employee who denied the claim also rejected the appeal.
Nonetheless, ERISA says that you must engage in the insurance company’s appeals process before going to federal court. For you, this must be more than just going through the motions because you cannot add any evidence to the record after the insurance company’s appeal. Unless one of the very limited exceptions applies, the federal judge cannot consider any additional evidence.
Whether the federal judge uses a de novo standard of review (starting the case essentially from scratch) or an abuse of discretion standard (looking to see if the insurance company’s decision was unreasonable), they will look closely at what Prudential did.
While approval of a claim does not guarantee future benefits permanently, a long-term disability insurance company cannot wrongfully terminate benefits. Many examples exist of claimants successfully suing Prudential to reinstate their terminated claims.
In one recent case, a federal judge took Prudential to task for cutting off benefits for a woman who had suffered from excruciating pain after a car accident. The woman had a history of scoliosis before the accident.
In issuing a detailed and scathing opinion against Prudential, the court found that the company:
From this case, you can get a sound idea of what companies like Prudential do to deny or cut off benefits, anything that they have to, so they can avoid paying you the money that you are entitled to receive under your policy. For them, how they do business means that they will be on the wrong end of these decisions now and then. The key is not to let Prudential get away with it when they have broken the law.
However, Prudential is not all-powerful. Even though it has the first cut at deciding your appeal, it does not have the final say when it chooses to cut off benefits. Federal judges like this one can and do hold companies like Prudential in sharply worded decisions that call the company to task for wrongful behavior.
However, ERISA law is woefully short on actual punishments for long-term disability companies for acting like this, so you will continue to see these types of cases all the time. Even if you have received benefits, you should be prepared for hardball tactics to take those benefits from you in the future.
The thing that you need most when dealing with a company like Prudential is an experienced ERISA attorney who knows how to stand up for you. Prudential has an entire infrastructure that it has built up over many decades to protect the company’s interests and bottom line.
You have little chance of succeeding on your own if you have to take on Prudential. An experienced long-term disability attorney knows how to help you build your case with arguments that may persuade a judge.
Here is how an ERISA long-term disability attorney may help you:
You must be prepared to go the entire distance with the insurance company if you want to get the benefits you need. ERISA long-term disability claims can be worth a significant sum of money because they can pay a large part of your salary for the rest of your working years.
Prudential takes these cases seriously because each claim can be worth millions of dollars, and the company is looking for a way to save money. The more claims they deny and benefits they terminate, the more money they make. No matter how much they sell the vision of security, Prudential is not trying to help you.
Here are some answers to questions that clients ask us about ERISA long-term disability issues:
The law states that you have 180 days to appeal a benefits denial. The speed of your appeal depends on several factors. Take the time to address the insurance company’s concerns and build the record you need to have a chance at receiving benefits. This part of your claim is not something that you should rush. However, you must also start receiving benefits, and the sooner you appeal, the quicker that process can begin. You can find yourself in a years-long battle to obtain benefits.
Absolutely. If you win your appeal, Prudential must pay you back from the date you initially filed your claim. They will also need to pay you interest on the amount they should have paid you. Depending on the case result, courts have sometimes allowed victorious appellants to seek and recover their legal fees against Prudential on more than one occasion.
Federal regulations give an insurance company 45 days to decide on your benefits. They can get a 30-day extension if they give you a date by which they expect to issue a decision on your claim. The appeals deadline begins to run when the insurance company notifies you of the denial, so you should check all mailboxes and email inboxes (including your spam folder).
You cannot leave anything to chance when filing a claim for long-term disability benefits. Whether your claim is approved will make a lifelong difference in your standard of living.
You can turn to J. Price McNamara ERISA Insurance Claim Attorney to help when you prepare your claim or when the company denies your benefits. We will fight hard for you, working to turn the tables when a powerful company like Prudential thinks that they can push you around. For your initial consultation, you can reach out to us online or call us at (504) 420-6962.
This has been a very difficult time for myself and my family. Mr. Mcnamara did his best to be as empathetic and compassionate as possible. He is very knowledgeable and a man of great integrity.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded the Law Offices of J. Price McNamara, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts