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 the USA.
Additionally they, like many giant insurers, have a protracted historical past of unfairly denying respectable 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 compelled to revise their life insurance coverage practices in 2023 after the U.S. Division of Labor discovered that they’d denied a whole lot of claims on account of policyholders not offering proof of insurability, though they’d been paying premiums for years.
Should you’ve just lately had a long-term incapacity declare denied by Prudential, don’t let that be the ultimate phrase. Reliable claims are denied on a regular basis.
If you need the perfect probability at a profitable enchantment, it’s best to contact an skilled long-term incapacity lawyer as quickly as doable. You could 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 enchantment procedures and authorized choices obtainable to you.
Usually, your plan is ruled by ERISA if:
- You bought a gaggle incapacity insurance coverage coverage by way of your employer.
- Your employer just isn’t a spiritual group or authorities entity.
Alternatively, when 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 when you aren’t positive, give us a name.
Breaking Down the Prudential Appeals Course of Beneath ERISA
Fastidiously Overview Your Denial Letter
When Prudential denies a declare, they’re legally required to supply policyholders with an in depth declare denial letter. At minimal, this letter ought to clearly reveal:
- Prudential’s cause for denying the declare. Frequent causes embrace lack of supporting medical proof, excluded circumstances (for instance, due it being pre-existing), or failure to satisfy the plan’s definition of incapacity.
- Enchantment procedures and tips. Each insurance coverage firm has their very own distinctive administrative appeals course of—and sadly, Prudential’s tends to be extra advanced than most. That mentioned, 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 give you a duplicate of your claims file, request it instantly. The claims file ought to embrace all the medical information and data that they’ve in your case, and used to make their dedication. In brief, you should know what they’ve on you so you may determine what’s lacking, or been incorrectly evaluated.
Contact a Lengthy-Time period Incapacity Lawyer
Understand that, whereas Prudential is obligated to give you details about the best way to file an enchantment, they definitely aren’t going to educate you on finest practices for submitting a profitable one. The truth is, they’ll in all probability make it sound easier and fewer annoying than it truly is.
Why? The fact is that you’ll in all probability want a variety 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 gained’t be capable of embrace it even when you take them to court docket.
Due to the strict deadlines and big quantity of threat concerned, it’s best 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 lawyer has had an opportunity to evaluation Prudential’s denial letter and claims file, they are going to aid you collect related proof and documentation proving your incapacity. This may embrace:
- Lacking or new medical information that help your prognosis.
- Further medical opinions and letters of help out of your medical staff that verify a dedication of incapacity.
- Useful evaluations and different testing that confirms your bodily and/or cognitive limitations.
- Vocational evaluations that present detailed, reasonable 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 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 Enchantment Letter
As soon as the proof has been gathered, your lawyer will write an in depth enchantment letter. This letter will define the particular determinations that you’re contesting, why you disagree with the choice, and new proof you’re supplying to help your enchantment.
Submit Your Enchantment and Anticipate a Response
Your lawyer 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 will have to attend as much as 90 days to search out out in case your enchantment has been accepted.
Subsequent Steps If Your Enchantment Is Denied
In case your enchantment 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 evaluation. Prudential is considered one of a handful of insurance coverage corporations which 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 authorized, the ultimate step is to take Prudential to court docket.
Taking Your Case to Courtroom
Should you nonetheless imagine that Prudential’s denial was in error, you could have the proper to make your case in federal court docket.
ERISA circumstances are often heard by a choose, quite than a jury trial. The choose can be solely allowed to evaluation no matter proof is already in your claims file after your last administrative enchantment. No new proof will 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 observe (Illinois), policyholders can file a lawsuit towards Prudential at any time—there isn’t a requirement to make use of the complete administrative evaluation course of. Moreover, you could have the proper to request a full jury trial, and you’ll search unhealthy religion damages on prime of your promised advantages when you imagine that Prudential acted with willful negligence or malicious intent.
As a result of you could have so many extra choices with non-ERISA appeals, there isn’t a one customary appeals course of. Contact a long-term incapacity lawyer in your state as quickly as doable to debate your case and decide which of your authorized choices makes probably 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 aim is to earn money. 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 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 fame 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 on-line type.
