With practically $1 billion in in-force premiums, Prudential Monetary (by way of its subsidiary, Prudential Insurance coverage Firm of America) is among the 10 largest suppliers of long-term incapacity insurance coverage in america.
Additionally they, like many massive insurers, have an extended historical past of unfairly denying authentic claims. Courts have needed to maintain them accountable many occasions, together with a $40 million settlement in 2014 after Prudential denied full dying advantages to fallen troopers’ households. They have been additionally pressured to revise their life insurance coverage practices in 2023 after the U.S. Division of Labor discovered that they’d denied lots of of claims resulting from policyholders not offering proof of insurability, although they’d been paying premiums for years.
In case you’ve not too long ago had a long-term incapacity declare denied by Prudential, don’t let that be the ultimate phrase. Official claims are denied on a regular basis.
If you need one of the best probability at a profitable enchantment, you need to contact an skilled long-term disability lawyer as quickly as doable. You will have a restricted period of time to file, and just one alternative so as to add proof to report.
RELATED: What to Look for in a Prudential Long-Term Disability Lawyer – Bryant Legal Group (bryantlg.com)
First Step: Decide If You Have an ERISA Plan
Whether or not or not your long-term incapacity insurance coverage plan is topic to ERISA regulation will decide the enchantment procedures and authorized choices obtainable to you.
Typically, your plan is ruled by ERISA if:
- You bought a bunch incapacity insurance coverage coverage by your employer.
- Your employer just isn’t a non secular group or authorities entity.
Then again, should you purchased long-term incapacity protection immediately from the insurance coverage firm, your coverage just isn’t ruled by ERISA.
The vast majority of Prudential long-term incapacity plans are ERISA plans, however should you aren’t certain, give us a call.
Breaking Down the Prudential Appeals Course of Underneath ERISA
Rigorously Assessment Your Denial Letter
When Prudential denies a declare, they’re legally required to offer policyholders with an in depth declare denial letter. At minimal, this letter ought to clearly reveal:
- Prudential’s motive for denying the declare. Widespread causes embrace lack of supporting medical proof, excluded situations (for instance, due it being pre-existing), or failure to fulfill the plan’s definition of incapacity.
- Attraction procedures and pointers. Each insurance coverage firm has their very own distinctive administrative appeals course of—and sadly, Prudential’s tends to be extra complicated than most. That stated, as with all ERISA plans, you’ll have at most 180 days to file an enchantment, otherwise you’ll lose your proper to take additional authorized motion.
Request a Copy of the Claims File
If Prudential didn’t already offer you a duplicate of your claims file, request it instantly. The claims file ought to embrace the entire medical data and data that they’ve in your case, and used to make their dedication. In brief, you have to know what they’ve on you so you may determine what’s lacking, or been incorrectly evaluated.
Contact a Lengthy-Time period Incapacity Lawyer
Remember that, whereas Prudential is obligated to offer you details about find out how to file an enchantment, they definitely aren’t going to educate you on finest practices for submitting a profitable one. In reality, they’ll in all probability make it sound less complicated and fewer irritating than it truly is.
Why? The truth is that you’ll in all probability want plenty of proof and a really well-prepared case to efficiently overturn their denial. And in case your administrative enchantment continues to be lacking key proof, you received’t be capable of embrace it even should you take them to court docket.
Due to the strict deadlines and large quantity of threat concerned, you need to contact a long-term incapacity lawyer and have them evaluation your denial letter and claims file as quickly as doable.
Collect Proof
As soon as your legal professional has had an opportunity to evaluation Prudential’s denial letter and claims file, they are going to assist you to collect related proof and documentation proving your incapacity. This may embrace:
- Lacking or new medical data that help your prognosis.
- Extra medical opinions and letters of help out of your medical crew that affirm a dedication of incapacity.
- Useful evaluations and different testing that confirms your bodily and/or cognitive limitations.
- Vocational evaluations that present detailed, sensible projections of your future employability and incomes capability.
- Letters of help from colleagues, acquaintances, relations, and different individuals who can describe your circumstances each pre- and post- incapacity.
- Private images, movies, and journal entries documenting your each day experiences.
- Different proof and documentation as decided by your long-term incapacity lawyer.
Write an Attraction Letter
As soon as the proof has been gathered, your lawyer will write an in depth enchantment letter. This letter will define the precise determinations that you’re contesting, why you disagree with the choice, and new proof you’re supplying to help your enchantment.
Submit Your Attraction and Anticipate a Response
Your legal professional will submit the enchantment letter and all the extra proof to Prudential. The insurance coverage firm will then have as much as 45 days to reply. They’ll additionally request a one-time extension of 45 extra days, so you could have to attend as much as 90 days to seek out out in case your enchantment has been accepted.
Subsequent Steps If Your Attraction Is Denied
In case your enchantment is denied, discuss along with your long-term incapacity lawyer about what choices can be found.
As famous above, every insurance coverage firm has its personal inner insurance policies and procedures for administrative evaluation. Prudential is one in all a handful of insurance coverage corporations that will require you to undergo two full rounds of administrative evaluation earlier than you may file a lawsuit.
If all of your necessary administrative cures have been exhausted, and your declare has nonetheless not been permitted, the ultimate step is to take Prudential to court docket.
Taking Your Case to Courtroom
In case you nonetheless imagine that Prudential’s denial was in error, you have got the correct to make your case in federal court docket.
ERISA circumstances are normally heard by a choose, relatively than a jury trial. The choose can be solely allowed to evaluation no matter proof is already in your claims file after your closing administrative enchantment. No new proof could be submitted.
The Appeals Course of for Non-ERISA Plans
In case your plan just isn’t ruled by ERISA, then it’s ruled by your state’s contract legal guidelines.
The place we primarily apply (Illinois), policyholders can file a lawsuit towards Prudential at any time—there is no such thing as a requirement to make use of the complete administrative evaluation course of. Moreover, you have got the correct to request a full jury trial, and you may search unhealthy religion damages on prime of your promised advantages should you imagine that Prudential acted with willful negligence or malicious intent.
As a result of you have got so many extra choices with non-ERISA appeals, there is no such thing as a one commonplace appeals course of. Contact a long-term incapacity legal professional in your state as quickly as doable to debate your case and decide which of your authorized choices makes essentially the most sense in your circumstances.
RELATED: Appealing Denied Private Disability Insurance Claims – Bryant Legal Group (bryantlg.com)
Did Prudential Deny Your Lengthy-Time period Incapacity Declare? Contact Bryant Authorized Group In the present day
Prudential is a enterprise. Their objective is to generate profits. Don’t assume that they’ve your finest pursuits at coronary heart simply since you’re a “buyer” and have paid your premiums faithfully. When you file a incapacity declare, they’re incentivized to search for any motive to disclaim it. They received’t provide the advantage of the doubt in case your claims file isn’t hermetic.
Bryant Authorized Group has earned a robust status for dealing with incapacity claims and appeals all through Illinois. To schedule your free session with our legislation agency, name us in the present day at 312-561-3010 or full our online form.
