Prudential Long-Term Disability Denial Attorney: Your Rights And Legal Options Explained

Last Updated: October 3, 2024 | Reviewed and Edited by: Ortiz Law Firm

The Prudential Insurance Company of America (Prudential) is a division of Prudential Financial. It is one of the largest disability insurance companies in the United States that offers group disability and life insurance policies. Insurance companies like Prudential prioritize their financial gains over the well-being of policyholders. Unfortunately, this can lead to wrongful Prudential long-term disability denials, leaving claimants in challenging situations.

Prudential’s history of unfair practices and denial of legitimate claims has sparked nationwide investigations. If Prudential has denied your long-term disability claim, you must understand your rights and explore your legal options. By seeking assistance from experienced legal professionals, like the Ortiz Law Firm, you can fight against Prudential’s decision and pursue the benefits you rightfully deserve.

At the Ortiz Law Firm, we have a long history of success handling claims with Prudential. Over the years, we’ve managed hundreds of cases involving appeals, lawsuits, and settlements, giving us a deep understanding of the inner workings of Prudential. We know their playbook inside and out—the strategies they use to deny claims, the defenses they rely on, and the methods they use to delay payments. This knowledge allows us to craft the strongest possible case for our clients.

Attorney Nick Ortiz has also developed strong professional relationships with the defense attorneys regularly hired by Prudential. In fact, Nick communicates with many of these lawyers several times a week, allowing him to cut through the red tape and get straight to productive discussions. With their personal contact information on hand, including cell phone numbers, he can connect with these attorneys directly to push negotiations forward. This level of access gives our clients a distinct advantage when it comes to resolving their claims.

When you choose the Ortiz Law Firm, you’re choosing a team that has battled Prudential time and time again—and we’re ready to do it again for you. Don’t accept “no” as the final answer—take action now to protect your financial stability.

Get a Free Case Review

The Role of Prudential in Long-Term Disability Claims

In long-term disability claims, Prudential plays a significant role as one of the leading insurance providers. Prudential acts as an administrator for long-term disability benefits, processing and managing the claims submitted by policyholders. Their objective is to verify the accuracy of the information provided and ensure that the disability meets the policy’s requirements.

Understanding Unfair Prudential Disability Denials

Receiving a denial of your long-term disability claim from Prudential can be devastating. Still, it is essential to understand the reason for denial, which can help you navigate the appeal process more effectively.

Prudential often denies long-term disability insurance claims for one of several key reasons:

• Insufficient medical evidence is a common cause for denial. Prudential requires detailed and objective documentation demonstrating the claimant’s medical condition and limitations.
• Failure to meet the policy’s definition of disability can result in denial. Prudential evaluates the claimant’s ability to perform their occupation and may deny claims if they believe the individual can still work.
• Incomplete or inaccurate claim forms and missing documentation can also lead to denial. Submitting all required information accurately and promptly is crucial.
• Prudential utilizes a team of doctors, examiners, and experts to assess your disability, even if you provide medical evidence to support your claim. These professionals may be biased toward Prudential, and their findings could potentially harm or work against your claim.
• Prudential may hire investigators to observe and document your daily activities through video surveillance so that they can use the footage to challenge the validity of your disability claim.
• Social media often portrays the best aspects of our lives while concealing our challenges. Prudential may scrutinize your online presence to find any evidence that contradicts your disability claim.
• Pre-existing conditions or policy exclusions can be grounds for denial. Prudential may deny claims if the disabling condition is pre-existing or excluded from coverage.

If Prudential has denied your claim for disability benefits, don’t hesitate to contact us and schedule a free consultation. We work closely with our clients to develop their claim files. We will review your claim to determine why it was denied and what evidence is most crucial for your appeal.

Top Reasons Why Prudential Denies Long-Term Disability Insurance Claims

Recognizing Bad Faith in Disability Insurance Claims

When Prudential denies a valid disability claim without proper justification, it may be considered a breach of the principle of good faith and fair dealings, known as acting in bad faith. Disability insurance carriers must act in good faith when handling claims and not unreasonably deny valid claims.

The principle of good faith implies that insurance companies should investigate claims thoroughly, fairly evaluate the medical evidence provided, and make decisions based on the claim’s merits. Denying a claim without a proper and valid reason may constitute a bad faith denial.

When Prudential unfairly denies a disability claim, it violates the trust between the policyholder and the insurance company. It goes against the principles of fairness and accountability. Policyholders can recover the benefits they are owed by challenging these denials.

What To Do After a Prudential Long-Term Disability Denial

If Prudential has denied your long-term disability claim, do not give up. It can be a frustrating and overwhelming experience, but it’s important to remember that you have options and rights. Becoming familiar with the specific laws that apply to your case can provide valuable insights into the next steps you should take.

ERISA Law

One aspect of disability insurance that comes into play when your claim is denied is ERISA law. The Employee Retirement Income Security Act (ERISA) is a federal law. It governs most employer-sponsored disability insurance policies. Under ERISA, there are specific procedures and deadlines that you must follow to appeal the denial of your claim.

It’s essential to review your policy and consult with a qualified ERISA lawyer to ensure you adhere to these requirements. Navigating the complexities of ERISA can be challenging, but having an expert on your side can significantly increase your chances of successfully challenging the denial.

What If ERISA Does Not Govern My Claim?

If you have an individual disability income policy, your claim may be exempt from ERISA and governed by state law. Claims by church or government employees may also be exempt from ERISA law. If so, you may not have to file an appeal before filing a lawsuit.

State laws regarding disability insurance claims and appeals can vary, so it’s essential to research and understand your specific state’s regulations. Consulting with a knowledgeable disability insurance attorney well-versed in state law can provide valuable guidance tailored to your situation.

Whether you have a group or individual policy, our experienced disability lawyers are here to help. We will protect your interests from Prudential’s bad-faith dealings while we fight to overturn your denial. We have experience with disability law and will ensure that your LTD insurance carrier acts in good faith.

“I was fighting a long-term disability company whose policy I had bought and who refused to pay any of my benefits after I became disabled. Nick agreed to take my case and though there were many hoops he had to jump through, he never gave up. I will always be grateful to Nick and his staff for all the work they did on my behalf.” – Teacher in North Carolina with a Denied Disability Claim

How to Appeal a Denied Claim

When faced with a Prudential long-term disability denial, the first step is to file an appeal. The appeal process allows you to present additional evidence, address discrepancies, and provide a strong case for why your claim should be approved. Here are some critical steps to follow when filing an appeal:

1. Understand the denial letter: Carefully review the denial letter from Prudential to understand why Prudential denied your claim. The specific reasons for the denial will help you identify the areas to focus on during the appeal process.
2. Gather supporting documentation: Collect all relevant medical records, test results, doctor’s statements, and any other evidence that supports your disability claim. Ensure that these documents demonstrate the severity of your condition and its impact on your ability to work. If ERISA governs your claim, this may be your only opportunity to submit additional evidence.
3. Craft a strong appeal letter: Write a persuasive appeal letter that addresses each reason for denial outlined in the letter. You or your attorney should explain why Prudential should overturn its denial, providing detailed evidence to support your arguments.
4. Submit the appeal within the deadline: Be mindful of the deadline for submitting your appeal. Missing this deadline could result in the forfeiture of your right to appeal. Under ERISA law, claimants usually have 180 days after they receive notice that Prudential has denied their claim to file an appeal.

RELATED POST: LTD Appeal Guide: How to Appeal a Long-Term Disability Denial

Additional Evidence to Support Your Appeal

Additional evidence that you can gather to support your appeal against Prudential includes:

1. Additional medical examinations: If Prudential denied your claim due to insufficient medical evidence, it would be beneficial to undergo further examinations or consult other specialists to provide further proof of your disability.
2. Reports from your treating physician: Medical records may not always fully document the extent of your health condition. A written report from your physician can help highlight symptoms of your impairment that your records may not fully explain. Your physician can also describe how these symptoms affect your daily functioning. Being open with your doctor about your condition is crucial to ensure they do not overlook any details about your symptoms.
3. Expert opinions from vocational experts: Prudential may have denied your claim because they concluded that you can still perform the essential duties of your job or any similar job if your policy uses the “any occupation” definition. Prudential may have based its decision on the opinion of an expert they hired, so it is essential to obtain an unbiased opinion for your appeal. Seeking outside vocational experts who can evaluate your occupation without bias can help determine whether you are genuinely unable to perform the required duties.
4. Testimonials from family, friends, and coworkers: Statements from individuals close to you can provide insight into how your condition affects your daily life. They may have observed firsthand how your impairment impacts your personal life and work performance in ways that doctors may not have. Such statements can strengthen your appeal by providing additional evidence of how your disability hinders your home life and impairs your ability to work.

Considering a Prudential Lawsuit

Sometimes, filing an appeal may not be enough to secure the long-term disability benefits you deserve. When faced with persistent denials or unreasonable tactics from the insurance company, legal action against Prudential may be necessary. Here are some key points to consider if you are contemplating filing a lawsuit:

1. Evaluate the strength of your case: Consult with an experienced long-term disability attorney to assess the strength of your case. They can help you determine if you have a valid claim and if pursuing a lawsuit is in your best interest.
2. Determine any deadlines: There is typically a statute of limitations for filing a lawsuit. Each policy has different timeframes within which you must file your claim, so it’s crucial to be aware of the deadlines to avoid losing your right to seek legal recourse.
3. Building a solid case: Work closely with your lawyer to gather and organize all necessary evidence, including medical records, employment history, and any correspondence with Prudential. This evidence will be crucial in building a strong case against Prudential.
4. Seeking legal representation: Engage the services of an experienced disability insurance attorney specializing in long-term disability claims. If ERISA governs your claim, ensure they are familiar with ERISA. They can guide you through the legal process, negotiate, and advocate for your rights.

Remember to consult with an experienced long-term disability lawyer who can provide personalized guidance based on your unique situation.

Federal Court Cases Against Prudential

Although we were not involved in the federal court cases listed below, we have summarized them to help claimants better understand how disability law is interpreted and how the Court decides such claims.

• Paquin v. Prudential – Insurer Wrongfully Disregarded Opinions Of Treating Physicians
• Seese v. Prudential – Court Rules ADA Claim Against Prudential Must Be Dismissed
• Nieves v. Prudential – Prudential Failed to Provide a Full and Fair Review
• Maher v. Prudential – Court Rules LTD Denial Was Not Arbitrary & Capricious
• Doe v. Prudential – Court Rules That The Mental Illness Limitation Doesn’t Apply
• Cowern v. Prudential – Vocational Expert Not Permitted To Consider All Records
• Ampe v. Prudential – Engineer’s Case Remanded For Further Review

The Role of Lawyers in Long-Term Disability Denial Cases

Having a long-term disability claim denied can be a frustrating and overwhelming experience. In this situation, seeking a Prudential Disability Insurance Claim Denial Lawyer’s assistance can prove invaluable. A knowledgeable disability insurance attorney can provide guidance and support throughout the appeals process and help navigate the legal actions necessary to combat a denial of benefits.

Having a legal professional on your side means having someone who understands the complexities of disability law and can navigate the intricate procedures involved in appealing a denial. They can gather and review all the necessary evidence, ensuring that your medical records and relevant documentation are up to date and presented in the best light.

Additionally, legal representation serves as a powerful advocate for your rights. Your attorney can communicate directly with Prudential, negotiating on your behalf and leveraging their legal knowledge to hold the insurance company accountable for any unfair denials. An attorney’s expertise can help level the playing field and protect your rights.

Assistance in Filing Appeals

When faced with a denied LTD claim, one of the first steps is to file an appeal. This crucial stage allows you to present additional evidence and arguments to support your claim. However, navigating the complexities of the appeals process can be challenging, especially when dealing with insurance companies and their legal teams.

A long-term disability lawyer can provide you with the expertise needed to strengthen your appeal. They can analyze the reasons for the denial, review your medical records, gather supporting evidence, and craft persuasive arguments to present to the insurance company. With their assistance, you can have a comprehensive and well-prepared appeal that increases your chances of success.

“Ortiz Law Firm has done an amazing job keeping me updated on every step of the process, which helped relieve some of my stress. It was also tremendously helpful to no longer have to personally deal with the anxiety created by the constant bombardment of arguments and requests from the insurance company.” – Analytics Consultant in Iowa with a Denied Disability Claim

Navigating Lawsuits against Prudential

The litigation process is where the expertise of a Prudential Disability Insurance Claim Denial Lawyer truly shines. They will have experience with the applicable laws and regulations, such as ERISA. They will present compelling arguments and work tirelessly to secure a favorable outcome.

By enlisting the help of a Prudential Disability Insurance Claim Denial Lawyer to protect your rights, you can level the playing field throughout the appeals process and potential legal action against Prudential.

A Long-Term Disability Attorney at Ortiz Law Firm Can Help with Your Claim

If Prudential has denied your long-term disability claim, you must understand that you have options. You don’t have to face this challenge alone. Ortiz Law Firm is dedicated to fighting for your rights and recovering the benefits you deserve.

Remember, overturning a denied LTD claim can be complex and challenging. Seeking legal assistance early on can provide you with the knowledge, guidance, and support needed to navigate this intricate process and increase your chances of a successful outcome.

Our Case Results

Don’t accept a denial without a fight. We have a proven track record and have recovered millions in benefits for clients with denied disability claims. Below are some of the Prudential disability claims we have brought to a favorable resolution.

• Prudential Reverses Denial for Bank Employee: A banking professional with physical and cognitive impairments had their long-term disability claim denied by Prudential due to a lack of sufficient medical evidence. After our firm prepared a comprehensive appeal with additional medical records, physician statements, and a vocational analysis, Prudential overturned its decision and approved the claim.
• Successful Claim for RN with Migraines: A registered nurse with migraine headaches had their long-term disability claim initially denied by Prudential due to a lack of objective medical evidence and reliance on the claimant’s self-reported symptoms. Despite providing updated medical evidence in our appeal, the denial was upheld. We filed an additional appeal, and Prudential ultimately deemed the claimant eligible for benefits and reinstated the claim.
• Claim for Mental Health and Insomnia Approved: A Client Service Administrator with depression, PTSD, anxiety, and insomnia had their long-term disability claim denied by Prudential. After two appeals, a peer review, and an independent medical evaluation (IME), the claimant was found to be disabled.

To get started, call (888) 321-8131 or fill out our contact form for a free case review. Don’t let Prudential’s denial stand in the way of your rightful benefits. Take action today to protect your financial stability and secure the compensation you are entitled to.

FAQs: Prudential Long-Term Disability Denials