You pay your long-term disability (LTD) insurance premiums monthly, hoping to use the benefits as a safety net if you face health challenges. However, the harsh reality is that people can face insurance denials even when their claims are valid and genuine. Facing a denial is not just a legal challenge; it is a personal one laden with frustration and uncertainty.
As you stand at the crossroads of your long-term disability claim, know that we at Kantor & Kantor are people helping people and will act as legal advocates and compassionate allies. We understand the impact of this denial on your life and your family.
We understand the intricacies of the law, the nuances of insurance policies, and, most importantly, the genuine need for the benefits you rightly deserve. Let us stand with you as tireless advocates, committed to turning the tide in your favor and ensuring justice prevails in your LTD case. Contact us at 818-886-2525 for a free consultation.
We offer a free case evaluation to discuss how our attorneys can assist you. Contact us now at 818-886-2525 for a free consultation.
What Is Prudential Insurance?
The Prudential Insurance Company of America, a major player in the insurance industry, holds a prominent position as one of the largest insurance companies in the United States. In 2020, Prudential secured the 53rd spot on the Fortune 500 list and has consistently maintained similar rankings in preceding years. Operating globally, Prudential generates billions in revenue and offers LTD insurance to individuals directly, as well as through their employers, to protect them when facing job incapacity due to disabling health conditions. This insurance aims to provide financial support by covering a portion of earnings during unemployment.
Regrettably, Prudential, along with other comparable insurance entities, does not always act solely in the best interests of its policyholders. These companies prioritize their business interests, actively seeking ways to minimize claim payouts. Prudential has a track record of settling class-action lawsuits, paying substantial amounts to resolve allegations of wrongful claim denials. However, Prudential may absorb such penalties due to its size and financial strength, escaping accountability for various transgressions against unknowing claimants.
Consequently, denials of righteous LTD claims and subsequent appeals are common. When submitting a claim or initiating an appeal, it is crucial to thoroughly understand your Prudential LTD policy and ensure compliance with all necessary requirements. If your claim or appeal is governed by ERISA, the appeal process may represent your sole opportunity to introduce evidence into the record before litigation. A robust and strategically precise appeal is essential to maximize the possibility of a positive outcome and avoid the possibility of repeated denial.
Possible Reasons Prudential Denied Your Otherwise Righteous LTD Claim
Prudential may deny a claim because the claimant does not meet the policy’s definition of disability. Most policies, within the first two years, will define this as the individual’s ability to perform their occupation, and, thereafter, the ability to perform any occupation. Prudential frequently denies righteous LTD insurance claims for one or more of several key reasons, such as:
Substantive Denial
- “Insufficient” Medical Evidence: Denials often occur due to an alleged lack of sufficient documentation illustrating the claimant’s medical condition, restrictions, and limitations.
- An Alleged Lack of Objective Testing: One such example is migraines. There is no definitive way to ‘prove’ migraines exist nor how severe they are through medical testing, as such tests do not exist. In this example, a claimant is suffering from daily and inhibitive pain but could face a denial because the insurance company has deemed there to be insufficient evidence to speak to this pain.
- Ignoring Your Doctor and/or Downplaying Your Evidence: Prudential may disregard the opinion of your own doctor in favor of an in-house physician who naturally concludes in an outcome favorable to Prudential.
- Ignoring Evidence That Is Not Explicitly Stated: Prudential may ignore evidence that is not explicitly stated, but which would be assumed by a reasonable person. One example of this would be medication side effects. Such side effects may not be explicitly stated in any documentation, however, still exist and can be assumed.
- Social Media Scrutiny and Surveillance: Prudential will, at the very least, observe and scrutinize your online presence on social media to find evidence contradicting your disability claim. This is something that every claimant should be aware of. Further, more intrusive forms of surveillance, such as may occur; however, this is less common than social media scrutiny. Active forms of surveillance are typically only a concern when a claimant has understated their abilities. Despite this, claimants should always assume that the actions they perform will be viewed by their insurance company.
Policy-Related Denials
- Pre-existing Conditions Exclusions: While pre-existing condition exclusions have been forbidden in the health insurance context, they are still alive and well when it comes to LTD policies. If you file your claim within a certain amount of time of obtaining your coverage — usually within a year – the insurance company will look back in the months preceding you getting that coverage to see whether or not you received medical treatment, care, or services. This depends on how the policy is defined, and whether or not you have received any kind of medical treatment, care, or services related to the disabling condition upon which your claim is currently based.
- Unfair Application of Policy Limitations: There are several different kinds of limitations in LTD policies that vary in frequency and details. Almost all policy limitations limit the policy benefits in such a way that the insurance company only provides a total of 24 months of benefits under such a limitation. This is another reason claimants should always review their policy language.
Policy limitations include:- Mental Health Limitations: Commonly referred to by insurance companies and in policy documents as ‘Mental/Nervous Limitations,’ these limitations will only pay claimants for 2 years if they are disabled “as a result of” a mental health condition. The language in policies varies, which impacts how a mental health limitation may affect your claim. Some mental health limitations will outline that it limits a claimant if their condition is caused or contributed to by a mental health issue, whereas other policies require that your mental health is primarily or solely disabling in order to limit a claimant under the policy.
- An Objective Evidence Limitation: If this, if this clause exists in your policy, insurance companies will try to argue that the evidence you have submitted does not constitute “objective evidence” because it, in some way, relies on your subjective reports of pain or other symptoms. These clauses are often poorly worded, and insurance companies use them far too broadly.
- Fatigue Syndrome Limitations: These limitations are rare, but, if they are in your policy, it is important to note whether or not the policy defines ‘Fatigue Syndrome,’ and, if they have, how they have defined it. Given the obscurity and ambiguity of this limitation, it is vital to contact an attorney for further information on this limitation in your policy if you are impacted by it.
If Prudential has denied your LTD insurance claim, contact Kantor & Kantor’s Prudential LTD insurance claim denials attorney today for assistance.
How to Appeal a Denied Claim
When faced with a denied LTD claim by Prudential, filing an appeal is the initial course of action. The appeal process allows you to present additional evidence, address discrepancies, and build a compelling case advocating for the approval of your claim. Here are crucial steps to follow when filing an appeal:
1. Understand the Denial Letter
Thoroughly examine Prudential’s denial letter to understand the reasons behind the rejection. This insight is essential for pinpointing areas to focus on during the appeal process. Make sure you address specific arguments made in the denial letter, especially if those arguments are based on inaccuracies.
2. Compile Supporting Documentation
Gather all pertinent medical records, test results, doctor’s statements, and other evidence substantiating your disability claim. Ensure these documents vividly illustrate the severity of your condition and its impact on your ability to work. If Prudential has rejected your claim, citing insufficient medical evidence, consider undergoing additional examinations or seeking opinions from other specialists. This can provide additional proof substantiating your disability.
3. Input From Your Treating Physician
Medical records might not comprehensively capture the extent of your health condition. A written report from your physician can emphasize symptoms of your impairment not fully explained in records. Your doctor can articulate how these symptoms affect your daily functioning, emphasizing the importance of transparent communication about your condition.
4. Vocational Experts’ Opinions
If Prudential denied your claim based on the belief that you can still perform essential job duties, especially under the “any occupation” definition, obtain an opinion for your appeal. Seeking outside vocational experts without affiliations to Prudential can help assess your ability to perform required duties impartially.
5. Write an Appeal Letter
Draft a compelling appeal letter that directly addresses each outlined reason for denial. Whether composed by you or your attorney, the letter should articulate why Prudential should reverse its denial, providing sufficient and targeted evidence to bolster your arguments.
6. Timely Submission of the Appeal
Pay close attention to the deadline for submitting your appeal. Failure to meet this deadline will almost certainly result in forfeiting your right to appeal and thus your right to litigate. According to ERISA law, claimants typically have 180 days from receiving notice of Prudential’s denial to file an appeal. Adhering to this time frame is crucial for a valid appeal process.
There is only one chance to submit a Prudential appeal, and it must be drafted strategically. We will help you draft the appeal, highlighting why your claim should be approved.
Why Choose Kantor & Kantor?
Choosing legal representation is a critical decision that can significantly impact the outcome of your LTD claim. Here are some reasons to choose us.
- Specialization in Disability Insurance Claims: Our law firm handles disability insurance claims, including those denied by Prudential. Our Prudential LTD denial attorneys understand the complex and ever-evolving landscape of disability insurance law. This allows us to stay abreast of industry trends, legal precedents, and the nuances of disability insurance policies, providing our clients with a distinct advantage in their cases.
- Proven Track Record: We have a history of achieving favorable outcomes for our clients. We have successfully represented numerous individuals against major insurance companies, including Prudential. Our track record includes securing settlements, reversal of denials, and obtaining the rightful benefits for our clients. Our commitment to delivering positive results speaks to our expertise and dedication to client success.
- Experience With Major Insurance Companies: Navigating the appeals process with major insurance companies like Prudential requires a nuanced understanding of their tactics, procedures, and legal strategies. Our firm’s extensive experience in handling cases against prominent insurers equips us with invaluable insights into how these companies operate. We leverage this knowledge to build robust cases and effectively counter the arguments put forth by insurance carriers during the appeals process.
- Client-Centered Approach: Our clients are at the center of everything we do. We recognize the emotional and financial toll a denied disability insurance claim can take on individuals and their families. Our compassionate and client-focused approach ensures that you receive personalized attention throughout the legal process. We take the time to listen to your concerns, answer your questions, and keep you informed at every stage.
- Aggressive Advocacy: We are known for our aggressive and strategic advocacy on behalf of our clients. When challenging Prudential’s denial, we leave no stone unturned in thoroughly investigating the facts of your case, challenging unfair tactics, and presenting a compelling argument for the approval of your LTD benefits.
A History of Winning Cases Against Prudential
We have a history of success against Prudential in various legal settings. Our legal victories include cases where Prudential’s denial tactics were rigorously contested and we emerged triumphant. These successes illustrate our prowess in dismantling Prudential’s defense strategies and advocating effectively for our clients. Here are some cases we have won against Prudential:
- Murphy v. Prudential & California Physicians Service, 2017 WL 1330636 (USDC N.D. CA 2017)
- Placido v. Prudential Ins. Co. of America, 2010 WL 334744, (USDC N.D. CA 2010)
- Perkins v. Prudential Ins. Co. of America, 417 F.Supp.2d 1149 (USDC N.D. CA 2006)
- Porco v. Prudential Ins. Co. of America, 682 F.Supp.2d 1057(USDC N.D. CA 2010).
If Prudential has denied your LTD insurance claim, contact Kantor & Kantor Insurance claim denials attorney today for assistance.
How We Can Help with Your Case
Navigating the complexities of a Prudential LTD insurance claim denial requires a dedicated and knowledgeable legal team. At Kantor & Kantor, we offer a range of services to assist you in challenging Prudential’s denial and securing the benefits you deserve.
Thorough Evaluation of Your Case
Our experienced LTD lawyers will thoroughly evaluate your case to determine the strength of your claim. We will review your insurance policy, medical records, and other relevant documentation to assess your eligibility for benefits.
Strategic Claim Preparation and Submission
Preparing and submitting an LTD claim requires attention to detail and thorough documentation. We will assist you in gathering the necessary evidence and completing the required paperwork to ensure your claim is submitted accurately and on time.
Claim Denial Appeals
If your claim is denied, we will not hesitate to challenge the decision through appeals. Our attorneys have extensive experience in handling claim denial appeals. We will thoroughly review the denial letter, identify the reasons for denial, and develop a strong appeal strategy. Whether it involves providing additional evidence, challenging the insurer’s decision, or filing a lawsuit, we will do whatever it takes to fight for the benefits you deserve.
Litigation Support
In some cases, litigation may be necessary to secure the benefits you deserve. If negotiations with the insurance company are unsuccessful, we are prepared to take your case to court and present a compelling argument on your behalf.
Our attorneys at Kantor & Kantor will help you gather all medical records and other documentation to help you fight your Prudential Insurance claim denial.
Contact a Prudential LTD Denial Attorney Today
Time is of the essence when dealing with insurance claim denials. If Prudential has denied your LTD claim, do not hesitate to contact us. Our lawyers for Prudential LTD insurance claim denials are ready to provide the legal support you need. Schedule a consultation today at 818-886-2525 to discuss your case and explore your options. We are people helping people, and we will fight until we get you the compensation you deserve.
Attorney Glenn R. Kantor
Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]
