What to Look for in a Prudential Long-Term Disability Lawyer
The Prudential Insurance Company of America or Prudential Financial (often called “Prudential” for short) is one of the world’s largest and most successful financial services and insurance companies. Although the company is best known for offering life insurance and investment planning services, Prudential (via its subsidiary, Prudential Insurance Company of America) takes in an estimated $830 million per year from group long-term disability (LTD) premiums paid in the United States. That amount makes Prudential’s LTD business the sixth largest in the country.
Insurance companies do not get to be the size of Prudential by being generous or making the claims and appeals process simple for long-term disability claimants. Prudential has a well-deserved reputation for putting profit first, placing long-term disability claims under a microscope, and using the company’s massive financial resources to fight claims aggressively.
But even when you are up against a big company like Prudential, you can fight back. In this article, our attorneys will describe some key differences between Prudential and other common disability insurance companies. In addition, we will explain how an experienced disability insurance attorney can help you with your long-term disability claim.
Need to File a Long-Term Disability Claim With Prudential? You Can Expect These Challenges
If you are currently pursuing long-term disability benefits, there are certain hurdles you must clear regardless of which disability insurance company holds your policy. For example, you will always have to provide medical records, physician letters, and other evidence to demonstrate your disability.
However, every insurance company operates differently and offers its own unique challenges to people with disability claims. Prudential is no different. Here are some of the extra wrinkles you can expect from Prudential.
Most Prudential Disability Insurance Claims Require a Two-Level Administrative Review Process
Most employer-provided long-term disability plans fall under the Employee Retirement Income Security Act of 1974 (ERISA). This federal law stipulates that when an insurance company denies a long-term disability claim, the claimant must go through an administrative review process directly with their insurance company before filing a lawsuit in court.
Each insurer has their own administrative review process, but Prudential’s process tends to be more complex than most since it includes two levels of internal review before a final claim denial.
It is critically important to understand how the ERISA law works in terms of claims and lawsuits. ERISA says that if you do file a lawsuit, you cannot introduce any new evidence that was not included in your administrative appeal. So, it is essential during the administrative review process to build a strong argument for benefits and introduce all the evidence you need to prove your case.
Prudential Brings in the Hired Guns for Medical Review
As one of the nation’s largest disability insurance providers, Prudential can afford to fight claims aggressively. One of the ways the company fights claims is by contracting a huge number of medical review physicians to examine claims, especially during the appeal process.
The medical review physician’s job is to carefully review your medical records, identify any errors or gaps, and determine whether a ruling of disability is justified based on the diagnosis, symptoms, and recommended treatment plan.
A medical review physician (also called a medical consultant) will never meet with you, so they have no firsthand experience with you or your symptoms. They do not examine you. They are not even necessarily an expert in the specific condition or conditions you have been diagnosed with. The medical review physician simply makes a judgment based on whatever medical records and evidence they are given to review.
Medical review physicians are supposed to be impartial and are obligated to uphold certain standards of professional ethics and conduct. However, a doctor who is being paid by the insurance company has an obvious conflict of interest. And as you might expect, these medical consultants tend to interpret the facts in ways that are favorable to the insurance company.
Prudential Does Not Have Your Best Interests at Heart
Prudential has the same goal as every insurance company: they want to maximize profits, which means minimizing payouts. The company has every incentive to deny as many claims as possible—whether the person at the other end is genuinely disabled or not.
In recent years, Prudential has attracted public scrutiny and legal action for specific mishandling of disability claims. For example:
- In 2019, Prudential faced a class-action lawsuit from employees of Tufts University over allegedly illegal premium rate hikes on long-term disability policies.
- In 2018, the company paid to settle a class-action lawsuit over insufficient life insurance payouts.
- In 2014, Prudential paid to settle a class-action lawsuit after unfairly denying death benefits to the families of 67,000 U.S. soldiers.
At Bryant Legal Group, we have represented claimants in suits against Prudential for many years, and we have personally seen many more examples of the company delaying, denying, or mishandling legitimate insurance claims.
Choosing an Attorney to Handle Your Prudential Disability Claim
Long-term disability claims are complicated. Every policy and insurance carrier works differently. Also, the rules and regulations that govern those policies vary depending on whether ERISA applies or not.
Successfully navigating all the rules, limitations, and deadlines—especially after receiving an initial denial letter—can be disorienting and frustrating for anyone going through the disability claims process. And this is not an accident. In fact, the LTD claims process is designed to confuse claimants so they will settle cases quickly and cheaply. The insurance company will not provide help, and they would love for you to make a mistake, take a lowball settlement, or just get frustrated and give up.
An experienced attorney can help you understand your policy and fight back against the insurance company’s tactics to get the disability insurance benefits you deserve.
But even if you have decided to hire an attorney, you may have various options to choose from. So, how do you decide which attorney or firm is right for your case? As you go through the process of selecting an attorney, here are a few questions to ask.
What Is Your Experience With the Long-Term Disability Regulations That Apply to My Case?
While most Prudential disability claims are governed by ERISA, Prudential also offers group coverage to government employees and private insurance policies to individuals—and those policies are governed by state law. These laws can be very different from state to state.
For example, in our firm’s home state of Illinois, people who have a private disability insurance policy can sue immediately after a claim denial without going through administrative appeal. Private claimants can even demand a jury trial in the case of bad faith claims. With claims that fall under ERISA, Illinois residents still need to go through the administrative review process before they can file a lawsuit.
What Is Your Experience With Conditions or Medical Histories Similar to Mine?
Each disability case is unique, but an attorney who has experience with similar claims and medical conditions is usually a good choice for your case. If your attorney has a track record of handling and winning similar cases to yours, that should give you more confidence that they have the experience, know-how, and resources to handle your claim.
As an example, the disability benefits case for a person who recently underwent a limb amputation will look very different than the case for someone dealing with a mental health crisis, a rare diagnosis, or a complex medical history with potentially complicating pre-existing conditions.
How Often Do You Represent Long-Term Disability Claimants Against Prudential?
The more experience an attorney has dealing with a specific insurance company’s policy contracts, legal tactics, and attorneys, the better. Every disability insurance company is different, so knowing how to prepare and what to expect ahead of time can be a major benefit for your case.
For example, Prudential tends to use medical review physicians extensively throughout the appeals process. So, you will want an attorney who knows how to read and respond to these physicians’ file reviews.
If your attorney has not handled a Prudential insurance claim in a long time, or only occasionally dabbles in disability law (rather than concentrating on it full time), they may not be as prepared to handle your case.
Looking for Personalized Advice From an Insurance Lawyer?
Bryant Legal Group: Chicago Disability Insurance Attorneys You Can Rely On
You rely on your disability benefits to help you if you can no longer work. Unfortunately, profit-driven insurance companies deny legitimate claims all the time.
There is an appeal process for denied LTD claims, and you may have the opportunity to file a lawsuit. But the cost of mistakes, errors, and omissions is exceedingly high. If you miss critical deadlines or forget to include important evidence in your administrative appeal, you do not get a “do-over.” You could potentially lose your only source of income on a technicality.
That is why you should always contact an experienced attorney for a free consultation to discuss your disability claim. At Bryant Legal Group, our attorneys have earned an exceptional reputation for our thorough approach, client-centered mindset, and long track record of success. We are happy to review your policy and talk with you about your legal options.