If you’re facing a denied disability claim from a Prudential policy, you’re certainly not alone. As one of the largest providers of group disability insurance policies, Prudential generates a high percentage of the country’s disability claims – as well as the resulting appeals and ERISA lawsuits.
This video by disability lawyer Greg Dell and fellow attorney Alex Palamara highlights some “do’s and don’ts” for when your claim has been denied and it’s time for the all-important Prudential disability appeal. The Dell & Schaefer disability insurance law firm has handled thousands of Prudential appeals over the years, equipping these attorneys with all the insider tips for successfully getting those disability benefits you’ve earned.
Obtaining the Medical Records and Support
As any competent and skilled disability lawyer will tell you, the first and most important thing when filing a Prudential appeal is to obtain the medical records and related support documents. Sounds easy, right? But not so fast; you need to be aware that the insurance company will make it sound as simple as signing an authorization for them to get your medical records, so that they can make their decision and start your benefits.
That’s the last thing you should do, according to disability attorney Alex Palamara. “Asking the insurance company to prove to themselves that you’re disabled is crazy,” he says. “You’re asking them to prove to themselves that they should be paying you money… you cannot do that.”
Greg Dell agrees, stressing that people must understand that the insurance companies encourage claimants to submit an appeal on their own using only updated medical records and a letter from your doctor. But Alex Palamara explains that he, as a seasoned disability lawyer, would compile and submit a vastly different set of documents to make sure you have every chance of winning that appeal.
After gathering and reviewing the existing medical documents from your treating physician, the next step is to personally speak to all the supportive physicians and doctors whose medical records show that you are disabled under the terms of the Prudential policy. After the phone conversations, the attorneys assigned to your case will compose a customized “attending physician statement,” sometimes referred to as an APS.
This APS document is much more thorough than the typical two-page form the insurance company sends to your doctor, which usually designates as little as two lines to describe your disabling condition. A customized form from Dell & Schaefer will instead contain in-depth information about at least three things: the client’s disabling condition, occupation and ongoing long-term disability needs. The attending physician statement is unique for every single client and contains multiple pages.
Documenting the Disability
It’s crucial that the attending physician statement actually documents the specific disability, notes Greg Dell. When doctors are treating a patient, they document what they need to do in order to properly provide medical help. They ask about how the disabled patient is feeling, what the current complaints may be, whether there’s any improvement in the pain, and similar questions.
But they’re typically not taking notes to document it for scrutiny by a disability insurance company. Unfortunately, says Dell, the insurers “eat that up” and take advantage of how things are worded in the ongoing medical files – which becomes a huge problem. The appeal must, therefore, go to great lengths to pinpoint the disability and, specifically, how it affects the capacity to perform your pre-disability “own occupation” as well as “any occupation.”
It’s the job of the disability lawyer to address those things with the doctor and get his or her diagnosis into the appeal, along with any objective evidence of the condition. And that works both ways; the claimant must not have any kind of attainable contradictory evidence, including on social media.
“If you’re on social media, you should make it private to begin with. Let alone, for a disability insurance claim,” warns Alex Palamara. “Just realize that, if you’re on social media, they’re going to check all that. They’re going to check your LinkedIn, they’re going to check your Facebook, your Instagram, they can find you on Snapchat. They’re going to find you, and they’re going to see what you’re posting on there.”
Greg Dell further reveals that Prudential is widely known for running video surveillance on a disability claimant. They could take photographs of you at a ballpark with your kid and twist it to show that you’re not disabled because a particular photographic angle appears to show you having fun while participating in certain activities.
Dell even relays a story about an insurance company incorrectly claiming that a disabled policyholder ran two 5-K running races within the previous six months. As it turned out, they had culled that information from a Google search listing the names of 5-K run participants in the same town as the disabled claimant – but the runner was merely someone with the same name as the claimant. It’s just one of many examples of how insurers such as Prudential go out of their way to find a reason to deny a disability insurance benefit.
Defining the Occupation for the Appeal
In addition to correctly documenting the medical evidence, it’s critical for your disability lawyer to “define the occupation” in your appeal. Prudential may have done only a cursory review of what your occupation entails and what your actual job duties require. They may, for example, look at someone who has a desk job in his current occupation and assert that the person’s work is sedentary.
Based on that, Prudential could determine that your medical condition allows you to sit at a desk performing sedentary chores. However, this overly simplifies what you actually do during the course of a day. Do you sit, stand, carry things, do presentations that requiring prolonged standing? Is your mental capacity impaired by the pain from your injury or debilitating conditions, and does that affect your ability to stay engaged and focused for full job functionality?
Attorney Greg Dell notes that the dysfunction can lead to missed days of work and poor performance, which jeopardizes the job itself. “Employers don’t say, well just come in when you feel like it, it’s no problem because everything else will be fine if you just come in on a random schedule.”
Dell reveals that his firm works with vocational specialists to identify the specific requirements of your job, including both physical and mental responsibilities. They dive into the occupation itself as well as how the medical documentation supports the occupational limitations.
The other pivotal part of winning a disability claim denial is making sure the appeal includes language that sufficiently supports an eventual ERISA lawsuit. If you lose your appeal and end up in court to obtain your denied disability benefits, the appeal that you originally filed is your only chance to get all your details into the court record. The way that ERISA laws are written, explains Alex Palamara, you are unable to add any new information into the case file. The appeal is your only “bite at the apple” to get your story before the assigned judge.
“These lawsuits, they’re hard to win because the ERISA laws are against the employees, they’re against the claimants,” notes Alex Palamara. “It makes it really hard for you to win the lawsuit, so your appeal is the most important thing you can possibly do for your claim.”
Prudential also adds another layer to the complexity of disability denials and appeals: they allow an optional, voluntary second appeal. There are multiple pros and cons of doing that second appeal, which makes it even more important to have a seasoned professional going to bat for you.
“Insurance companies don’t reinvent their wheel with each denial,” says Alex Palamara. “This is my job. I’ve seen all the denial letters, we’ve made all the arguments.”
If you have a claim that’s been denied by Prudential, feel free to give Alex Palamara or Greg Dell a call. You can also make contact through the company website or speak to any other disability attorney at Dell & Schaefer. They represent clients throughout the nation and always offer a free initial phone consultation.