With nearly $1 billion in in-force premiums, Prudential Financial (via its subsidiary, Prudential Insurance Company of America) is one of the 10 largest providers of long-term disability insurance plans in the United States.
They also, like many large insurers, have a long history of unfairly denying legitimate claims. Courts have had to hold them accountable many times, including a $40 million settlement in 2014 after Prudential denied full death benefits to fallen soldiers’ families. They were also forced to revise their life insurance practices in 2023 after the U.S. Department of Labor found that they had denied hundreds of claims due to policyholders not providing proof of insurability, even though they had been paying premiums for years.
If you’ve recently had a long-term disability claim denied by Prudential, don’t let that be the final word. Legitimate claims are denied all the time.
If you want the best chance at a successful appeal, you should contact an experienced long-term disability lawyer as soon as possible. You may have a limited amount of time to file, and only one opportunity to add evidence to record.
RELATED: What to Look for in a Prudential Long-Term Disability Lawyer – Bryant Legal Group (bryantlg.com)
First Step: Determine If You Have an ERISA Plan
Whether or not your long-term disability insurance plan is subject to ERISA regulation will determine the appeal procedures and legal options available to you.
Generally, your plan is governed by ERISA if:
- You purchased a group disability insurance policy through your employer.
- Your employer is not a religious organization or government entity.
On the other hand, if you bought long-term disability coverage directly from the insurance company, your policy is not governed by ERISA.
The majority of Prudential long-term disability plans are ERISA plans, but if you aren’t sure, give us a call.
Breaking Down the Prudential Appeals Process Under ERISA
Carefully Review Your Denial Letter
When Prudential denies a claim, they are legally required to provide policyholders with a detailed claim denial letter. At minimum, this letter should clearly reveal:
- Prudential’s reason for denying the claim. Common reasons include lack of supporting medical evidence, excluded conditions (for example, due it being pre-existing), or failure to meet the plan’s definition of disability.
- Appeal procedures and guidelines. Every insurance company has their own unique administrative appeals process—and unfortunately, Prudential’s tends to be more complex than most. That said, as with all ERISA plans, you’ll have at most 180 days to file an appeal, or you’ll lose your right to take further legal action.
Request a Copy of the Claims File
If Prudential didn’t already provide you with a copy of your claims file, request it immediately. The claims file should include all of the medical records and information that they have on your case, and used to make their determination. In short, you need to know what they have on you so you can figure out what’s missing, or been incorrectly evaluated.
Contact a Long-Term Disability Lawyer
Keep in mind that, while Prudential is obligated to provide you with information about how to file an appeal, they certainly aren’t going to coach you on best practices for filing a successful one. In fact, they’ll probably make it sound simpler and less stressful than it really is.
Why? The reality is that you will probably need a lot of evidence and a very well-prepared case to successfully overturn their denial. And if your administrative appeal is still missing key evidence, you won’t be able to include it even if you take them to court.
Because of the strict deadlines and huge amount of risk involved, you should contact a long-term disability lawyer and have them review your denial letter and claims file as soon as possible.
Gather Evidence
Once your attorney has had a chance to review Prudential’s denial letter and claims file, they will help you gather relevant evidence and documentation proving your disability. This might include:
- Missing or new medical records that support your diagnosis.
- Additional medical opinions and letters of support from your medical team that confirm a determination of disability.
- Functional evaluations and other testing that confirms your physical and/or cognitive limitations.
- Vocational evaluations that provide detailed, realistic projections of your future employability and earning capacity.
- Letters of support from colleagues, acquaintances, family members, and other people who can describe your circumstances both pre- and post- disability.
- Personal photos, videos, and journal entries documenting your daily experiences.
- Other evidence and documentation as determined by your long-term disability lawyer.
Write an Appeal Letter
Once the evidence has been gathered, your lawyer will write a detailed appeal letter. This letter will outline the specific determinations that you are contesting, why you disagree with the decision, and new evidence you are supplying to support your appeal.
Submit Your Appeal and Wait for a Response
Your attorney will submit the appeal letter and all the additional evidence to Prudential. The insurance company will then have up to 45 days to respond. They can also request a one-time extension of 45 more days, so you may have to wait up to 90 days to find out if your appeal has been accepted.
Next Steps If Your Appeal Is Denied
If your appeal is denied, talk with your long-term disability lawyer about what options are available.
As noted above, each insurance company has its own internal policies and procedures for administrative review. Prudential is one of a handful of insurance companies that may require you to go through two full rounds of administrative review before you can file a lawsuit.
If all your mandatory administrative remedies have been exhausted, and your claim has still not been approved, the final step is to take Prudential to court.
Taking Your Case to Court
If you still believe that Prudential’s denial was in error, you have the right to make your case in federal court.
ERISA cases are usually heard by a judge, rather than a jury trial. The judge is also only allowed to review whatever evidence is already in your claims file after your final administrative appeal. No new evidence can be submitted.
The Appeals Process for Non-ERISA Plans
If your plan is not governed by ERISA, then it is governed by your state’s contract laws.
Where we primarily practice (Illinois), policyholders can file a lawsuit against Prudential at any time—there is no requirement to use the full administrative review process. Furthermore, you have the right to request a full jury trial, and you can seek bad faith damages on top of your promised benefits if you believe that Prudential acted with willful negligence or malicious intent.
Because you have so many more options with non-ERISA appeals, there is no one standard appeals process. Contact a long-term disability attorney in your state as soon as possible to discuss your case and determine which of your legal options makes the most sense for your circumstances.
RELATED: Appealing Denied Private Disability Insurance Claims – Bryant Legal Group (bryantlg.com)
Did Prudential Deny Your Long-Term Disability Claim? Contact Bryant Legal Group Today
Prudential is a business. Their goal is to make money. Don’t assume that they have your best interests at heart just because you’re a “customer” and have paid your premiums faithfully. Once you file a disability claim, they are incentivized to look for any reason to deny it. They won’t give you the benefit of the doubt if your claims file isn’t airtight.
Bryant Legal Group has earned a strong reputation for handling disability claims and appeals throughout Illinois. To schedule your free consultation with our law firm, call us today at 312-561-3010 or complete our online form.
