Prudential Disability Insurance Claim Denied?

Newfield Law Group Fights Back When Prudential Wrongfully Denies Disability Claims

Prudential is one of the world’s largest insurance companies, so anyone receiving a disability denial letter from such a huge company can understandably be overwhelmed. But when a denial letter arrives, it’s not the end – – claimants have the right to appeal a denial. 

Prudential is no stranger to battles for disability claims; the company is well known for wrongfully denying claims, making disabled claimants go through the appeals process and needing to go to litigation. In the case of ERISA claims – group disability policies provided by your employer – which means going to Federal Court. 

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This massive insurance company is counting on a certain number of claimants accepting their wrongful denials and not fighting back. It’s purely a numbers game for this huge company but it’s a serious matter for someone who is no longer able to work. That’s where Jason Newfield shines.

Can I Handle a Denial Appeal on my Own?

Technically, you could try to appeal a disability denial on your own, but you would be wise to enlist the help of an experienced long-term disability insurance law firm like Newfield Law Group. Here’s why:

Appealing a denied disability claim is spring-loaded with pitfalls, none of which benefit the claimant. The appeal will not succeed unless it is as complete as possible, including medical records, diagnostic tests, an occupational evaluation, and other supporting documents.  Jason has represented insurance attorneys and insurance agents who thought they would easily be able to manage their own claim – – but they did not know how a disability claim works, and their appeals were denied. 

Providing materials for an appeal is also preparing for litigation if it becomes necessary. When dealing with Prudential or any disability insurance company denial for a group (ERISA) disability claim, the materials used in an appeal will be the only materials permitted to be provided into evidence if the case needs to go to Federal Court.  Preparing a claim and going to Federal Court require experience and knowledge of how these proceedings work, what documents are required and what is and what is not permitted. The stakes are simply too high to do this without the guidance of an experienced disability attorney.

How is a Group ERISA Appeal Different from a Private or Individual Disability Policy Appeal?

Group disability insurance policies are considered employee benefits and as such are governed by a federal law known as ERISA. Appeals and court actions must follow the restrictive rules of ERISA.

Individual or Private Disability insurance policies are governed by state law, which differs from state to state. In many cases, individual policies, which cost more than group policies, have more options to resolve a dispute, either through negotiations or in state court. 

Why Would Prudential Deny My Claim When My Doctor Says I Can’t Work?

Prudential will deny your claim if it only contains notes in your doctor’s records stating you cannot work. This is not enough medical evidence to demonstrate a disability, for Prudential or Unum or any disability insurance company. The person reviewing your claim is looking for objective documentation which can include diagnostic test results clearly indicating an illness or injury. In many cases, the medical records submitted to Prudential fail to include “gold-standard” tests used to prove an individual’s disability. 

If your treating physician is not a specialist, Prudential may deny your disability claim. The merits of having a specialist in the field of your disability, whether it’s an illness or an injury, cannot be underestimated. A person filing a claim with Prudential who has a cardiac condition, for instance, could be denied if their medical records have been submitted by an internist and not a cardiologist. There are tests a cardiologist may order – blood work for natriuretic peptides, considered the most commonly used biomarker for heart failure – that an internist may not deem necessary.

Vocational evaluations are important to a Prudential claim. Stating you are disabled and including medical records isn’t the full picture for a claims adjuster looking for a reason to deny a claim. An up-to-date evaluation of your job, including all the tasks and duties and cognitive skills and training necessary to perform the job, needs to be proactively included in your claim application. 

Prudential Disability Insurance claims are often denied and disability attorney Jason Newfield has represented people where Prudential used an out-of-date vocational description for just that purpose. Someone who is a Chief Executive Officer today requires a different skillset and physical abilities than a CEO from the 1960s.  Today’s CEO needs to have high level cognitive skills, the ability to travel globally, make complex decisions quickly and work at a much faster, harder pace than in the past.

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    How we have Helped Others 

    An unsolicited testimonial from a client with CFS/ME

    2 years ago

    If you have had the terrible misfortune of being disabled by CFS/ME (and any of the co-occurring conditions – fibromyalgia, Hashimoto’s, small cell fiber neuropathy, dysautonomia, etc.) you need to retain Jason Newfield. These conditions are sadly still viewed by many as “yuppie flu” type, subjective non-illnesses. I can attest that they are nothing but. I was diagnosed with (eventua…pert who successfully provided support for my case at a level I could afford. Jason and Christina successfully worked together in effectuating an internal reversal of my denial of benefits, in relatively short order, much to my immeasurable relief and gratitude. This means they convinced the insurance company to overturn its own prior decision! Jason and Christina were also responsive, available and consistently on top of my case. They were empathetic, and understood when I felt too ill to get something back to them in a timely fashion, or failed to return their call. However, what allowed me to stay grounded and hopeful during an incredibly stressful, difficult time in my life (in addition to the fact that I always was completely confident in their work and strategy), was that they believed me and in me. Anyone who suffers from the conditions that I do know this alone is priceless and necessary.

    Prudential Says I Need a FCE – Functional Capacity Evaluation – Is That True? 

    If you receive a letter instructing you to have an Functional Capacity Evaulation, start by examining your long term disability benefits policy to determine whether you are required to comply. Jason Newfield has represented many clients with disability policies with no mention of an FCE and whose conditions were too severe to undergo an FCE. For some claimants, an FCE can be harmful – and in most cases, is harmful to the continuation of a long term disability insurance claim. 

    Purportedly, the FCE is a test to measure one’s functional capacity to perform the tasks and duties of a job.  It often involves lifting, carrying, pushing/pulling, balance, fine motor skills and cardiovascular tolerance – all while monitoring purported effort by the claimant.  This test is a no-win for claimants, and disability attorney Jason Newfield often advises his clients not to attend or only to go with a witness present.  If one exerts themselves, and satisfies the testing, but suffers for days as a result (proof of impairment) that often is not considered by the insurance company.  Or if someone cannot complete performing a task, they are often accused of self limiting behavior.  If you have an orthopedic injury and physical activity is difficult and/or painful, performing some of the required tasks can actually cause harm. If you are careful and protect yourself, the person administering the test may characterize you as not trying and therefore not complying with the test. 

    Before attending an FCE or an IME, speak with Jason Newfield to find out what your options are and how to protect yourself and your claim.

    What Strategies Work Best When Prudential Denies a Disability Claim? 

    The first step you will need to take after receiving a denial or termination letter from Prudential is to prepare yourself for an appeal. You will need to start gathering all of the relevant documents, including any materials you didn’t submit when you initially filed a claim. If you have not already done so, consider contacting a long-term disability insurance attorney with the experience to file an appeal.  

    The appeals process is more challenging than filing a claim and needs to be done with an eye to possible future litigation. A Prudential disability denial claims attorney will know what kind of materials are needed. They will work with your treating physicians to make sure the right medical records and diagnostic test results are prepared. They will know the tactics used by Prudential’s claims adjusters, attorneys and medical reviewers and will prepare a robust appeal.

    Why Does Prudential Send Investigators to Conduct Field Visits to Disability Claimants?

    Field visits of a disability claimant by an investigator may be one of the most intrusive and, in our opinion, morally wrong actions taken by a disability insurance company like Prudential, although Prudential is far from the only insurance company using field visits.

    What is a Field Visit?

    For the disability insurance company, a field visit is when an investigator, hired by the insurance company, or a disability insurance company employee, travels to a claimant’s home to get a look at the claimant, their surroundings and in our mind, gathers information that can be used to deny, delay, or terminate a claim.

    Each disability insurance policy is different, so it takes a careful examination of the policy to see if this is required by the disability insurance policy. Newfield Law Group advises our clients to do the following if a field visit is required by their policy:

    Don’t answer the door if someone arrives without having made prior arrangements. There are far too many scams and violent criminals who attempt to gain entry to permit anyone to enter your home without an appointment. Call your disability insurance attorney if someone arrives at your door and says they are with your disability insurance company.

    Even if an appointment has been made with a Prudential insurance company representative, never admit them into your home without a witness being present. It may be a family member or a trusted friend, but you need someone to advocate for you and to take detailed notes about the appointment.

    No matter how friendly the investigator may be, they are not there for a social call. This is Prudential sending someone to your home to make sure you are legitimately unable to work. If there is evidence of activity, even if it is medically advised, like a treadmill in the house, be aware it may be used as a reason why you are able to work. 

    If possible, have your friend/family member video the meeting. If the investigator protests, tell them it’s for your protection and theirs. You want a record of what takes place during this meeting.

    Surveillance of Disability Claimants by Prudential 

    Surveillance by a Prudential investigator happens frequently, and you need to be prepared. Often, surveillance happens from a desk in another city, simply by making a connection on social media. Newfield Law Group advises all clients to be very careful on any new friend or connection requests if they have filed a disability claim with Prudential or if they are being paid (on claim) with Prudential. Don’t post yourself doing anything that could be deemed as evidence that you are able to work and ask your friends and family members to respect your need for privacy and economic protection.

    Someone from Prudential Called My Friends and Asked About Me – What Should I Do? 

    Prudential has been known to have its representatives contact friends, family members and co-workers to build a dossier of information about you before and after you filed a claim. This complicates claims, as people who mean well may not understand the repercussions of such a conversation. Prudential takes the position that it is entitled to gather information about you, while we take the position that our clients deserve to know beforehand who they are contacting.

    If you are on claim, use your judgment in telling people who know you to alert you if anyone contacts them to learn about your well-being or your activity level. An experienced disability insurance attorney will be able to advise you how to best handle this and other scenarios with Prudential employees.

    What’s My Next Step with Prudential Long Term Disability Insurance Claim?

    Your best strategy is to be proactive about your claim – as we often say, let us help you stop the spill before it happens and needs to be cleaned up. Jason Newfield has decades of experience representing Prudential disability policy owners who have wrongfully had their claims denied at all stages of the disability insurance process. If you need help with a Prudential group LTD claim, or private policy with Prudential and have questions, please feel free to call us for a free consultation. 

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