Prudential Financial, one of the largest insurers in the world, is currently facing a number of lawsuits, including class action suits and litigation over denials of disability insurance claims. When benefits are improperly administered or denied outright, policyholders may seek to protect their rights through lawsuits such as class actions.
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. One of the most common ways insurers avoid providing benefits is by contending that there's insufficient medical evidence to demonstrate disability. This is most common when there has been a lack of regular medical treatment, and thus no extensive medical file documenting the disability, missing medical records, or an inadequately detailed doctor's statement.
Failure to meet the policy's definition of disability may also result in a denial of benefits. For example, some plans require that an individual must not be able to do any type work. Additionally, plans may exclude coverage when medical disability is related to conditions such as drug or alcohol abuse.
Insurance providers have a financial interest in denying disability claims. Insurers generally 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, so 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 Benefits are Denied
If your disability insurance claim is denied, it's important that you protect your rights. Employer-provided disability policies are governed by the Employee Retirement Income Security Act, or ERISA. ERISA requires that the insurer provide a detailed explanation of the denial. The policy holder may then file an appeal for reconsideration. Essentially, this means supplementing a claim with additional information and asking the insurer to look at it once more. If your appeal is denied, you may then file a lawsuit against the insurer for improperly denying benefits.
As with employer-provided insurance, applicants for Social Security disability benefits have the right to appeal a denial. There are four levels of appeals, all of which must be exhausted in order: (1) reconsideration by the state agency; (2) an administrative hearing; (3) review by the Appeals Council; and (4) review in federal court. At each stage, claimants or their lawyer must file a request for appeal in writing within 60 days.
Denied Disability Claims and Class Action Lawsuits
If you have been wrongly denied disability benefits by Prudential or other insurers, you might not be the only one. 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 chose to opt in to the lawsuit.
Prudential Disability Insurance Class Actions
Prudential is currently facing several class action lawsuits over its disability insurance programs. These lawsuits claim that Prudential violated the law by:
One class action, Martin v. Prudential Insurance Co., claims that Prudential paid less in benefits than what policy holders deserved. The class action alleges that Saia Motor Freight Line improperly deflated the monthly earnings of its truck drivers when calculating disability pay, leading Prudential to pay less than the plan required. Another class action claims that Prudential improperly reviewed thousands of disability claims appeals. This lawsuit maintains that long-term disability claimants who filed secondary or voluntary appeals had them improperly reviewed by the same employee who denied the initial appeal.
Finally, the surviving families of disabled military servicemembers and veterans claim that Prudential insurance arbitrarily paid benefits to some beneficiaries and not others. The families in this case claim that Prudential made payments to certain beneficiaries to avoid negative publicity but arbitrarily denied benefits to other policy holders in the same or similar circumstances.
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.