Prudential denied your long-term disability claim? Learn the top reasons for denial and what to do.
Quick Facts
- Knowing the reasons Prudential denies disability claims—like lack of medical evidence and non-compliance with treatment—can help you win your appeal.
- After denial, gather more medical evidence, see your doctor and review the denial letter to prepare for appeal.
- Hiring a long-term disability lawyer can help you win your appeal by handling the process and building your case.
Prudential Insurance and Long-Term Disability
Founded in 1875 and headquartered in Newark, New Jersey, Prudential Insurance Company is one of the largest disability insurance companies in the US. They offer group long-term disability insurance which allows employers to provide income protection to their employees if they become sick or injured and can’t work for an extended period of time as well as individual policies. Long-term disability insurance is a financial safety net for employees who rely on it while they are unable to work and can’t earn their regular income.
When short-term benefits run out, long-term disability coverage kicks in and provides ongoing financial help through long-term disability benefits. Knowing how Prudential’s long-term disability policies work can help you navigate the claims process with more confidence.
Reasons Prudential Denies Long-Term Disability
Getting a denial letter from Prudential can be tough. By knowing the common reasons for denial, you can get benefits reinstated. Claims are usually denied for lack of medical evidence. Non-compliance with treatment and policy limitations or exclusions also play a role in denials. If monitoring activities or discrepancies found through social media contradict the impairments you claimed, it will deny your claim.
By knowing these common reasons:
- Lack of medical evidence
- Not following treatment protocols
- Policy limitations or excluded conditions
- Surveillance finding conflicting information with claimed impairments
You can navigate this process better.
Remember insurance companies will use tricks such as shortcuts when reviewing cases, delay on claims decisions and administrative issues with incomplete paperwork as reasons to deny claims. Knowing these tactics can help you avoid common pitfalls and build your case more.
Lack of Medical Evidence
One of the top reasons Prudential denies disability claims is lack of medical evidence. When filing a claim you must provide a full set of medical records as Prudential requires objective proof including clinical exams, lab tests and imaging results. They have an in-house staff of doctors and nurses who review the medical evidence. In our opinion, based on over 25 years of representing claimants, Prudential’s doctors and nurses are trained to find reasons to deny claims.
To avoid denials due to errors on claim forms, make sure to fill out all required paperwork completely. Since incomplete or unclear documentation can give Prudential reasons to deny a claim during the initial review, make sure your medical records are clear and complete. Also, make sure your claim matches what your medical records say.
Non-Compliance with Treatment Protocols
If you don’t follow the prescribed treatment plans, it can be a reason for your claim to be denied. Proper management of your condition by following treatments as recommended is key to determining eligibility. If Prudential finds out that you’re not managing your health due to neglected prescribed treatments, your claim may be invalid.
Policy Exclusions and Limitations
Prudential’s long-term disability policies have many exclusions, limitations and restrictions that can deny claims. Coverage doesn’t apply to specific disabilities and injury causes that are excluded. For example, mental health conditions have a 24 month limit, fatigue and musculoskeletal conditions can be excluded or limited.
Pre-existing conditions
To avoid being denied on pre-existing conditions, it’s essential to review your policy and provide a full medical record. The pre-existing condition exclusion in Prudential’s policies can be overcome if you time your claim right. A pre-claim consult with an experienced long-term disability lawyer can be worth its weight in gold.
What to Do After a Denial Letter
Getting a denial letter from Prudential is devastating. You must act fast after your claim is denied but you must also be smart about your appeal. (You only get one shot at an appeal.)
Review the denial letter carefully to understand why the claim was denied. Once you know the reasons, gather all the necessary documentation and proof to contest their decision. If you think Prudential denied your claim without merit, find an experienced long-term disability lawyer to help you appeal.
Review the Denial Letter
Read the denial letter carefully and follow the appeal process outlined. The letter will tell you why your claim was denied. Missing appeal deadlines (typically 180 days) will bar you from reapplying for benefits or taking legal action against Prudential.
Knowing why your claim was denied is key so you can start your appeal right away.
At BenGlassLaw, we will review your denial letter for FREE and give you personalized feedback on your next steps.
Get More Medical Evidence
You need to get Medical records to support your claim when appealing. Failure to follow treatment plans such as missing appointments or not taking prescribed medications can be a reason for denial. Vocational evaluations are key to showing your work limitations and building your appeal.
Get testimony from family, friends or professional colleagues to strengthen your appeal. Detailed records of doctor visits, following treatment plans and any changes to treatment will support your case.
Talk to Your Treating Doctor
After being denied, you need to talk to your treating doctor about your condition. This may result in more records that can help your appeal. The additional medical evidence and support from your doctor can significantly increase the chances of reversing the denial.
Prudential Long-Term Disability Appeal Process
If your Prudential long-term disability claim is denied, you can appeal this decision. This process allows you to add evidence and fix any gaps in your case. Prudential often denies or delays claims because of lack of documentation.
Having an attorney who specializes in long-term disability denials can help strengthen your appeal. With a lawyer, you have a much better chance of reversing a denial on your long-term disability claim.
Appeal
You have 180 days to appeal after a denial. Be sure to include medical evidence and legal arguments. Submitting your appeal in writing keeps a record of all communication with Prudential.
You must exhaust the internal appeal process before suing Prudential.
Additional Documentation
Comprehensive medical records including tests and progress notes will support your claim by giving more detail into symptoms that may not be reflected in standard reports. Medical assessments or opinions from specialists can be key to strengthen the appeal.
Include vocational evaluations and supporting documentation with your medical records and your appeal will be stronger. Additional diagnostic testing, doctor statements and letters from previous employers are extra ammunition for your case.
Doctor written letters explaining how your condition affects you will give context to support legitimate claims.
Legal Help in the Appeal Process
Having a disability attorney can increase your chances of winning an appeal with Prudential. If your case manager is being evasive about claim delays, you may want to get legal help. Having an ERISA attorney is key when fighting a denial.
Our team of ERISA lawyers has years of experience with Prudential claims and knows how to reverse denials. Working with a long-term disability insurance attorney can help navigate the complex aspects of your case.
Insurance Bad Faith
Bad faith by insurance companies means unlawful and unethical practices to avoid paying claims. Denying legitimate disability claims is bad faith. Insurance companies can act in bad faith by misrepresenting medical records to deny claims.
Bad faith practices can involve cherry picking information to deny legitimate claims and ignoring disability evidence. Insurers may favor opinions from doctors who have not examined the claimant, showing lack of thorough evaluation.
If you suspect bad faith, get legal advice and consider filing a bad faith denial against Prudential.
When to Sue Prudential
If your appeal is denied, you can sue Prudential for bad faith denial to get your benefits back. No valid reason to deny claims is a basis for a lawsuit.
If bad faith is evident in the denial of your claim, you may be able to sue before exhausting all levels of the appeal process. Get legal advice to know your options. An attorney can help you contest wrongful denials and inform you of the legal avenues available to you.
Exhaust the Appeal Process First
Make sure to exhaust all administrative appeal options, potentially multiple appeals, before suing Prudential. According to ERISA, you have 180 days to appeal after a denial letter.
New evidence is not usually allowed after the ERISA appeal process is complete.
Short-Term or Long-Term Disability Attorney
Working with a specialist can help navigate the long-term disability claims and lawsuits. A disability attorney can challenge the insurer’s decision and get you benefits.
How a Long-Term Disability Attorney Can Help
Having a long-term disability attorney is key to handling the claims process and fighting denials. If your claim is denied, this attorney will be your advocate, fighting for you and explaining the legal mumbo jumbo and paperwork.
With their experience, long-term disability attorneys know how to challenge Prudential’s denial tactics. They have established relationships with defense attorneys at Prudential to make the process easier.
ERISA Expertise
An ERISA attorney can guide clients through the appeal process, contesting disability denials.
Add to Your Case with More Evidence
An experienced attorney can get you the evidence you need to appeal. This strong evidence is key to appealing a Prudential long-term disability denial and our law firm has over 25 years of experience doing just that.
Settlements and Litigation
Skilled attorneys are key to negotiating with Prudential to get the best settlements for clients. These negotiators often get settlements without litigation.
If those negotiations don’t get you a good settlement, you may need to sue Prudential. In that case, an experienced attorney is critical to make your case strong, whether in settlement talks or in court.
Conclusion
Appealing a Prudential long-term disability denial can be tough, but knowing the reasons for denial and what to do next can make a big difference. From reading your denial letter to getting more medical evidence and talking to your doctor, every step counts in building your appeal.
You don’t have to do this alone. Get legal advice and know your ERISA rights. Whether you’re appealing or suing, having the right lawyer can get you the disability benefits you’re owed.
How BenGlassLaw Can Help With Your Prudential Financial Long-Term Disability Claim Denial
Facing a Prudential Financial disability denial is a daunting experience, but understanding the process and knowing your rights can empower you to fight back. From reviewing the denial letter and gathering strong medical evidence to filing an appeal and seeking legal counsel, each step is crucial in securing the benefits you deserve.
Remember, you don’t have to navigate this journey alone. Our team at BenGlassLaw is available to guide you through the complexities of the appeals process and ensure you have the best chance of success — no matter where you’re located in the United States. Stay proactive, informed, and persistent in your pursuit of justice.
Contact our team today for a free, zero obligation consultation to learn how we can help you.
