With almost $1 billion in in-force premiums, Prudential Monetary (through its subsidiary, Prudential Insurance coverage Firm of America) is among the 10 largest suppliers of long-term incapacity insurance policy in america.
In addition they, like many massive insurers, have a protracted historical past of unfairly denying professional claims. Courts have needed to maintain them accountable many instances, together with a $40 million settlement in 2014 after Prudential denied full loss of life advantages to fallen troopers’ households. They have been additionally compelled to revise their life insurance coverage practices in 2023 after the U.S. Division of Labor discovered that that they had denied lots of of claims as a result of policyholders not offering proof of insurability, regardless that that they had been paying premiums for years.
In case you’ve just lately had a long-term incapacity declare denied by Prudential, don’t let that be the ultimate phrase. Authentic claims are denied on a regular basis.
If you’d like the perfect likelihood at a profitable attraction, you must contact an skilled long-term incapacity lawyer as quickly as potential. You’ll have a restricted period of time to file, and just one alternative so as to add proof to report.
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 attraction procedures and authorized choices obtainable to you.
Usually, your plan is ruled by ERISA if:
- You bought a gaggle incapacity insurance coverage coverage by your employer.
- Your employer shouldn’t be a spiritual group or authorities entity.
Alternatively, in the event you purchased long-term incapacity protection immediately from the insurance coverage firm, your coverage shouldn’t be ruled by ERISA.
Nearly all of Prudential long-term incapacity plans are ERISA plans, however in the event you aren’t certain, give us a name.
Breaking Down the Prudential Appeals Course of Below ERISA
Rigorously Evaluation 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 cause 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 tips. 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 attraction, otherwise you’ll lose your proper to take additional authorized motion.
Request a Copy of the Claims File
If Prudential didn’t already give you a replica of your claims file, request it instantly. The claims file ought to embrace all the medical information and knowledge that they’ve in your case, and used to make their dedication. Briefly, you want to know what they’ve on you so you’ll be able to work out what’s lacking, or been incorrectly evaluated.
Contact a Lengthy-Time period Incapacity Lawyer
Remember the fact that, whereas Prudential is obligated to give you details about file an attraction, they actually aren’t going to teach you on greatest practices for submitting a profitable one. In actual fact, they’ll most likely make it sound less complicated and fewer tense than it truly is.
Why? The fact is that you’ll most likely want quite a lot of proof and a really well-prepared case to efficiently overturn their denial. And in case your administrative attraction remains to be lacking key proof, you gained’t be capable to embrace it even in the event you take them to court docket.
Due to the strict deadlines and big quantity of threat concerned, you must contact a long-term incapacity lawyer and have them evaluate your denial letter and claims file as quickly as potential.
Collect Proof
As soon as your lawyer has had an opportunity to evaluate Prudential’s denial letter and claims file, they’ll enable you collect related proof and documentation proving your incapacity. This would possibly embrace:
- Lacking or new medical information that help your analysis.
- Further medical opinions and letters of help out of your medical crew that verify a dedication of incapacity.
- Purposeful 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, members of the family, and different individuals who can describe your circumstances each pre- and post- incapacity.
- Private pictures, movies, and journal entries documenting your day by 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 attraction 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 attraction.
Submit Your Attraction and Anticipate a Response
Your lawyer will submit the attraction letter and all the extra proof to Prudential. The insurance coverage firm will then have as much as 45 days to reply. They will 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 attraction has been accepted.
Subsequent Steps If Your Attraction Is Denied
In case your attraction is denied, discuss together with your long-term incapacity lawyer about what choices can be found.
As famous above, every insurance coverage firm has its personal inside insurance policies and procedures for administrative evaluate. Prudential is considered one of a handful of insurance coverage firms which will require you to undergo two full rounds of administrative evaluate earlier than you’ll be able to file a lawsuit.
If all of your necessary administrative cures have been exhausted, and your declare has nonetheless not been authorised, the ultimate step is to take Prudential to court docket.
Taking Your Case to Courtroom
In case you nonetheless consider that Prudential’s denial was in error, you’ve the suitable to make your case in federal court docket.
ERISA circumstances are often heard by a choose, relatively than a jury trial. The choose can be solely allowed to evaluate no matter proof is already in your claims file after your ultimate administrative attraction. No new proof will be submitted.
The Appeals Course of for Non-ERISA Plans
In case your plan shouldn’t be ruled by ERISA, then it’s ruled by your state’s contract legal guidelines.
The place we primarily observe (Illinois), policyholders can file a lawsuit towards Prudential at any time—there isn’t any requirement to make use of the complete administrative evaluate course of. Moreover, you’ve the suitable to request a full jury trial, and you’ll search dangerous religion damages on high of your promised advantages in the event you consider that Prudential acted with willful negligence or malicious intent.
As a result of you’ve so many extra choices with non-ERISA appeals, there isn’t any one customary appeals course of. Contact a long-term incapacity lawyer in your state as quickly as potential to debate your case and decide which of your authorized choices makes essentially the most sense to your circumstances.
Did Prudential Deny Your Lengthy-Time period Incapacity Declare? Contact Bryant Authorized Group As we speak
Prudential is a enterprise. Their purpose is to become profitable. Don’t assume that they’ve your greatest 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 cause to disclaim it. They gained’t provide the good thing about the doubt in case your claims file isn’t hermetic.
Bryant Authorized Group has earned a powerful status for dealing with incapacity claims and appeals all through Illinois. To schedule your free session with our regulation agency, name us at present at 312-561-3010 or full our on-line kind.
