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How can the insurance company ignore the facts about your claim?If the insurance company has withheld information, whether it was part (or all!) of your medical record or the details of your job description then the contractors cannot possibly write an accurate report. How could they, without all the facts?

In a recent case when we asked our client’s insurance company, Prudential, to send us ALL documents related to his case. Tucked quietly in the back of his file was a review by an independent medical examiner, a neurologist, whom Prudential had hired to review our client’s case. Somehow this document had failed to make it to our client and had failed to be mentioned anywhere else in his file.

As we read, it became clear why: this neurologist wholeheartedly agreed that our claimant was disabled. He wrote a very helpful letter in support of our client’s case. Prudential conveniently forgot it existed, failed to provide it to any other IMEs or vocational reviewers, and proceeded to deny our client benefits.

It is wrong for an insurance company to be anything less than transparent about their process. It was wrong for Prudential to withhold that positive review from the other reviewers. It was wrong for Prudential to pretend the review did not exist; claims administrators are required to address all evidence favorable to the claimant thoughtfully and at length before denying a claim. It was also wrong for Prudential to hide the positive review from our client until we explicitly asked for every single claim document.

Ben Glass
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Ben Glass is a nationally recognized ERISA disability & life insurance attorney in Fairfax, VA.