Prudential Disability Insurance Class Action and Claims

Disability benefits are sometimes improperly administered or outright denied. If you are entitled to benefits, a wrongful denial could put you in a difficult or even impossible financial position. Policyholders may seek to protect their rights through lawsuits.

Prudential Financial is one of the largest disability insurance companies in the world. It has faced many lawsuits, including class action suits and individual litigation, over denials of long-term disability insurance claims. Below, you’ll learn what to do if Prudential or another insurance provider denies your claim.

A disability insurance lawyer can explain your rights and whether you have a legal claim against the insurance company. This article examines and explains denied claims, lawsuits against Prudential Financial, and other disability cases.

Why Disability Benefits Are Sometimes Denied

Filing a claim for disability doesn’t guarantee that you will receive benefits. In fact, only about one-third of Social Security disability claims are initially approved. Having private insurance with an insurer like Prudential doesn’t guarantee that your claim will be approved either.

Claims can be denied for a variety of reasons, such as:

• Insufficient medical evidence of disability: Most common when there has been a lack of regular medical treatment to document the disability, missing medical records, or an inadequately detailed doctor’s statement
• Failure to meet the policy’s definition of disability: Some plans require that an individual must not be able to do any type of work
• Policy exclusions: Some plans may exclude coverage when medical disability is related to conditions such as drug or alcohol abuse

Even if you have a medical condition that has qualified for long-term disability insurance benefits in the past, you might find your benefits suddenly taken away. Insurance carriers have a financial interest in denying disability claims. They scrutinize new claims and conduct reviews of ongoing long-term disability claims to find opportunities to preserve their profits.  However, insurers must still follow industry laws and regulations.

Insurers have their own staff of doctors they can depend on. In addition, there’s no presumption that the opinion of a claimant’s treating physician deserves more weight. This means that the insurer can rely on its own doctors and vocational experts to deny a claim that might otherwise be medically justified.

What To Do if Your Disability Benefits Are Denied

If your disability insurance claim is denied, it’s important that you protect your rights. If your claim under an employer-provided disability plan is denied, you must submit a written appeal to the insurer, often within 180 days of the denial. Failure to appeal within this period typically eliminates your ability to later file a lawsuit under the Employee Retirement Income Security Act of 1974 (ERISA).

A long-term disability attorney can evaluate your options and guide you through the appeals process. If necessary, a lawyer can also represent you in a lawsuit.

Employee Benefit Plan Appeals

Companies like Prudential manage employers’ group disability plans, including short-term and long-term disability benefits. Employer-provided disability insurance policies are governed by ERISA.

ERISA requires that the insurer provide you with a detailed explanation of the denial. This legal requirement can give you a chance to resolve the specific reason you were denied. It also may help show whether the insurer quashed your claim in bad faith.

As the policyholder, you may then file an appeal for reconsideration. This means supplementing a claim with additional information and asking the insurer to take another look.

If your appeal is denied again, you may file an ERISA lawsuit against the insurer to enforce your disability rights in federal court for improperly denying benefits. The federal judge reviews the claim based on the administrative record created during the appeal process and does not hold a jury trial or accept new evidence.

Social Security Disability Appeals

As with employer-provided insurance, applicants for Social Security disability benefits have the right to appeal a denial. There are four levels of appeal, which must be exhausted in order.

Steps in the appeals process include:

1. Reconsideration by the state agency
2. An administrative hearing
3. Review by the Appeals Council
4. Review in federal court

At each stage, the claimant or their lawyer must file a request for appeal in writing within 60 days. Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) function differently from employer-sponsored plans. You can consult a lawyer who practices in these claims for more information.

Denied Disability Claims and Class Action Lawsuits

If you have been wrongly denied disability benefits by Prudential or other insurers, you can consider legal action. This action may be your own lawsuit with an attorney, or it might be a class action lawsuit with many other policyholders.

Suing for a Prudential Disability Claim Denial

An individual lawsuit against Prudential may be appropriate for an improper claim denial or underpayment of benefits. Knowing which laws apply to your case can help you understand what the legal process and your remedies will probably entail.

Most disability claims fall under ERISA regulations, but not all do. Claims under private insurance policies and workers’ compensation policies are common exceptions.

Disability insurance cases under ERISA are subject to federal preemption, which means that federal laws will apply over any conflicting state laws. These lawsuits are held in federal court. Instead of a jury trial, a federal judge decides the case. ERISA federal preemption often limits recovery to unpaid benefits and, occasionally, attorneys’ fees and interest. Punitive damages and compensation for emotional distress are not available under ERISA.

In contrast, benefits denial cases that don’t fall under ERISA are held in state court. State laws, court procedures, and remedies apply. For example, an employee who suffered an accident on the job may file a workers’ compensation claim while unable to work. Since ERISA applies to disability insurance but not workers’ compensation, the employee may dispute their claim denial under their state’s laws. Likewise, a claimant who carries their own private insurance policy would likely sue for disability claim denial in a state court.

If you are considering bringing your claim to court, it’s a good idea to learn more about suing an insurance company. Begin gathering your case details and get professional legal advice. These legal claims have a time limit, which varies and is usually stated in the plan documents.

Prudential Disability Insurance Class Actions

Claim denials often involve an insurance company’s policies and practices on a large scale. This often means you aren’t the only one with a wrongfully denied disability claim.

A class action lawsuit may be appropriate. Class action lawsuits are often available when many people have suffered the same or similar injuries. When a class action is brought, the class representative and his or her lawyers must make efforts to give notice to potential class members who may then choose to opt in to the lawsuit.

Prudential has faced several class action lawsuits over its disability insurance programs. These lawsuits claimed that Prudential violated the law, alleging:

• Paying less than what the policyholder was entitled to (Martin v. Prudential Insurance Company of America)
• Improperly reviewing secondary or voluntary disability claims appeals
• Arbitrarily paying benefits to some disabled military beneficiaries and not others to avoid negative publicity

Class actions are highly complex. A disability insurance attorney can help you evaluate whether you may want to pursue a class action or individual case.

Get Help With a Disability Benefits Denial

If you’re considering filing a disability claim or have questions about why you were denied, contact a lawyer specializing in disability law or class actions in order to protect your rights and discuss your options.