Long-term disability (LTD) insurance offers protection against uncertainty. If you become disabled due to an illness or injury, this type of policy will provide monthly payments to help you cover your expenses while you are unable to work. LTD policies are offered by a number of insurers, including the Prudential Insurance Company of America (Prudential).
While LTD policies may seem straightforward, it can often be difficult to be approved for benefits. That is because insurance companies like Prudential are in the business of making money. They often deny or delay legitimate claims or cut off benefits — all to increase their profits at the expense of disabled policyholders.
A New Jersey disability benefits attorney can help you through the process of applying for LTD benefits. By carefully examining the terms and conditions of your policy and then compiling the proper information, your lawyer can increase the likelihood of a favorable outcome. Read on to learn more about the tactics used by Prudential — and how you can beat them.
Tactics Used by Prudential to Deny Long-Term Disability Claims
Prudential’s LTD policies offer income protection. Depending on the terms of your policy, this means that you could receive between 50 to 60% of your salary each month in the event that you are unable to work due to a disability. However, in order to be eligible for these benefits, you must be disabled under the terms of your policy.
As with other types of insurance, Prudential LTD policies have limitations and exclusions. There will be a waiting period before you can start receiving benefits, and your payments may be cut off after a certain period of time (anywhere from 24 months to retirement age — or when you are no longer disabled). In addition, certain types of causes of disabilities may be completely excluded from coverage, such as self-inflicted injuries.
Prudential has a well-documented history of wrongfully denying claims for LTD benefits. It has also been charged with unfairly terminating benefits when a policyholder is still unable to work due to a disability. A recent federal court case decided in Colorado, Paquin v. The Prudential Insurance Company of America found that Prudential’s termination of LTD benefits was wrongful.
In this case, Michael Paquin was diagnosed with encephalitis (inflammation of the brain) after being bitten by a mosquito that was infected with the West Nile virus. He suffered brain damage as a result and was unable to perform his job functions. He applied for and was awarded LTD benefits in April 2004.
In January 2015, Prudential terminated Mr. Paquin’s benefits, based on its conclusion that there was not sufficient evidence that he was still impaired. Mr. Paquin filed two unsuccessful appeals. He then filed a lawsuit in federal court against Prudential.
The court noted that 16 medical professionals had determined that Mr. Paquin is disabled, while just 3 doctors determined that he was not. The 3 doctors who determined that he was not disabled were all hired by Prudential, and 2 were hired after Prudential decided to terminate benefits. In addition, shortly before terminating his benefits, a Prudential claim manager had noted in Mr. Paquin’s file that his cognitive issues were not likely to improve and that there were no gainful employment options for him.
Because the weight of the medical evidence showed that Mr. Paquin was disabled, the court found that Prudential had abused its discretion in terminating his benefits. It ordered Prudential to reinstate his LTD benefits and allowed Mr. Paquin to request that Prudential pay his costs and attorneys’ fees associated with filing the lawsuit.
This case demonstrates the lengths that Prudential may go to in order to wrongfully deny or terminate LTD benefits. In a case where the claimant has a clear disability, supported by substantial medical evidence, Prudential still terminated benefits. It was only through a lawsuit that the policyholder was able to obtain justice.
If you have applied for LTD benefits through Prudential, they may deny or delay your claim in a number of ways. This may include arguing that you have submitted insufficient evidence of your disability, stating that their own doctors have determined that you are not disabled, or even using surveillance to gather evidence that you are not disabled. Any of these actions can result in an unfair denial of your LTD claim.
Fighting Back Against Unreasonable Prudential Disability Claim Denials
If you have an LTD insurance policy, you expect to be covered if you cannot work due to a disability. Insurance companies like Prudential often look for ways to deny coverage. If they act in bad faith in doing so, you may be able to file a claim against them.
If your LTD claim is denied, the first step in the process is to file an appeal directly with Prudential. Your lawyer can work with you to make sure that this appeal addresses the reasons for the denial and that the appeal is submitted in a timely manner. If the appeal is submitted beyond the deadline (set either by the policy or under the law), then you may not be able to file an appeal or a lawsuit.
Prudential will either deny or grant the appeal. If they grant the appeal, then you will receive benefits. If the appeal is denied, you may choose to move onto the next step: filing a lawsuit.
The law requires insurance companies to act in good faith. In New Jersey, if the denial of a claim was fairly debatable, then a bad faith claim will fail. However, if the insurance company did not have a reasonable basis to deny the claims they acted in bad faith.
The type of lawsuit that can be filed will depend on the type of policy that you have. Many group LTD policies are covered by federal law, the Employee Retirement Income Security Act of 1974 (ERISA); lawsuits regarding these policies must be filed in federal court. However, policies bought by individuals and some group policies are not covered by ERISA; these claims will be filed in state court.
Questions? We Can Help.
In LTD appeal cases, it may seem like the deck is stacked against you, with massive insurance companies using complex strategies to deny or delay your claim. An experienced New Jersey disability benefits attorney can help to level the playing field, advocating for you and working to get you the benefits that you deserve.
Bross & Frankel is committed to helping people like you get the best possible outcome for their disability benefits case. We strongly believe in fairness, and put our decades of experience to work for each of our clients. To schedule a free disability claim review, contact our office today at 856-795-8880 or reach out online.