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.
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Why Claimants Often Sue Prudential?People usually sue Prudential for two reasons relating to ERISA long-term benefits:
- Prudential often denies claims improperly, ignoring strong medical evidence to keep claimants from getting the benefits that they deserve under their plan.
- Prudential has acted very aggressively about finding reasons to cut off further benefits, even after initially approving the claim.
The Tactics That Prudential Uses to Deny Your ClaimCompanies 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.
Reason for Prudential Claim DenialsHere are some common reasons why Prudential will deny a long-term disability claim:
- You do not meet the plan’s definition of “disability” - ERISA itself does not have a definition of disability. The initial plan documents will provide the definition. Long-term insurance providers like to change the rules in the policy’s plain language, even after you have already begun to receive benefits.
- You are not disabled - Companies like Prudential are not legally obligated to give any deference to the opinion of your treating physician when they give a statement that describes your condition and says that you are disabled. These companies can use their own medical opinions to evaluate your claim. They hire supposedly “independent medical professionals” (who are on their payroll) to make decisions about claims.
- You can still work - Your insurance company, as you saw from the above case, will find any justification to support the fact that you can still earn a living. They do not know you and your situation. They know their financial interests.
- You suffer from a pre-existing condition - A long-term disability policy does not cover them. You need a "new" condition to qualify for benefits.
- You missed deadlines, or some of your paperwork included with your application is incomplete.
You Have the Right to Appeal Prudential’s DenialFirst, 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.
You Need to Engage at All Steps of the Appeals ProcessNonetheless, 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.
Prudential Sometimes Wrongfully Terminates BenefitsWhile 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:
- "Cherry-picked slivers of information" to support its predetermined result that the woman would not receive benefits.
- Invented new rationales for denying benefits that it used for the first time at trial
- Improperly relied on its own nurse employees’ medical review
- Failed to ask the claimant to undergo an independent medical examination
Prudential Does Not Get the Final Say Over Your BenefitsHowever, 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.
Why You Need an Experienced ERISA Long-Term Disability Insurance Attorney?Here is how an ERISA long-term disability attorney may help you:
- Review your plan language to understand the definition of “disability” that Prudential uses and the paperwork requirements and deadlines
- Counsel you on how to build the most substantial claim and help you prepare your documentation
- Closely review any coverage denial and figure out how you may address the insurance company’s concerns on appeal
- Prepare the appeal for the insurance company and build the record of appeal with your medical information and statements and testimony about your condition.
- Appeal your case to the federal district court if you lose your appeal at the insurance company phase
- Take your case to the federal court of appeals in your circuit if the district court judge does not rule in your favor
FAQs About Long-Term Disability Claims Against PrudentialHere are some answers to questions that clients ask us about ERISA long-term disability issues:
How long do I have to appeal the denial of my ERISA claim?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.
Will Prudential need to pay back benefits if they wrongfully deny my claim?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.
How long does Prudential have to issue a decision on my claim?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).
Contact a Prudential Long-Term Disability Insurance AttorneyYou 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. Nicole