Prudential Disability Attorney

Prudential’s Playbook: Exposing Tactics Used to Deny ERISA Disability Claims

Insurance companies are businesses focused on profitability. While they provide essential coverage, their financial interests can create an inherent conflict: paying fewer claims increases profits. Sandstone Law Group‘s experience reveals that Prudential, like other large insurers, sometimes employs specific tactics within the ERISA framework to deny or terminate legitimate disability claims.

Recognizing these tactics helps you understand the challenges you face:

• The “Own Occupation” to “Any Occupation” Gauntlet: Many Prudential-administered ERISA plans usually change the definition of disability after 24 months, but some policies may vary. Initially, you might only need to prove you cannot perform your own specific job. After 24 months, Prudential often requires you to prove you cannot perform any occupation for which you are reasonably qualified based on education, training, and experience. Prudential frequently uses this “change in definition” as a prime opportunity to terminate benefits, often relying on minimal or flawed evidence to claim you could work some job, somewhere.
• Ignoring Your Treating Doctors, Favoring Their Hired Guns: Prudential routinely gives minimal weight to the opinions of your own doctors—the medical professionals who have treated you long-term and understand your condition most intimately. Instead, Prudential heavily relies on:
  • Biased “Independent” Medical Exams (IMEs): Prudential may compel you to attend an IME with a doctor Prudential selects and pays. These doctors often generate substantial income from insurance companies and frequently write reports that minimize your impairments, question your credibility, or directly contradict your treating physicians’ findings, providing Prudential with a convenient justification for denial. Furthermore, the doctor may lack the specialization to accurately diagnose your disability.
  • Selective Paper Reviews: Prudential employs or contracts physicians to review your medical file without ever examining you. These reviewers may cherry-pick information, ignore crucial test results or clinical findings, and issue opinions that align with Prudential’s financial interest in denying the claim.
• Demanding Unattainable “Objective Evidence”: For conditions primarily diagnosed through clinical evaluation or subjective reporting (like chronic fatigue syndrome, fibromyalgia, mental health disorders, some types of chronic pain), Prudential may deny the claim, asserting a lack of objective evidence (like a specific X-ray or lab test finding). This tactic improperly dismisses valid diagnoses and ignores the real-world limitations these conditions impose.
• Using Surveillance to Misrepresent Your Abilities: Prudential may legally hire private investigators to monitor and videotape your daily activities. They also scrutinize your social media presence. Prudential then isolates brief moments—carrying a light grocery bag, driving to a doctor’s appointment, attending a family gathering—and presents this footage out of context as “proof” that you are not as disabled as you claim, ignoring factors like pain levels, recovery time, or the inability to sustain activity reliably for a workday.
• Generating Flawed Vocational Analyses: To support denials, especially under the “any occupation” standard, Prudential uses vocational experts. These experts frequently produce flawed transferable skills analyses or employability assessments that:
  • Overstate your functional capacity by ignoring documented medical limitations.
  • Identify jobs that are not realistically available in your geographic area or that you cannot medically perform.
  • Fail to consider the impact of medication side effects or the need for frequent breaks.
  • Suggest “sedentary” jobs without acknowledging that even those require sustained concentration, attendance, and specific physical tolerances you may lack.
• Exploiting Complex ERISA Plan Language: Prudential leverages the dense, legalistic language within the official ERISA Plan Document. They may narrowly interpret key definitions (“disability,” “regular occupation,” “pre-existing condition”) or invoke obscure exclusions or limitations to deny an otherwise valid claim.
• Leveraging Procedural Missteps: Under ERISA’s strict rules, Prudential might deny your claim if you miss a deadline by even one day or fail to submit a specific form exactly as they require, regardless of the strength of your medical evidence.

When Prudential uses these tactics to deny your ERISA claim, it bases its decision on its interpretation and objectives. Federal law allows you to challenge that decision through an administrative appeal.

• Our process includes:
  1. Free Consultation & ERISA Case Assessment: We start with a thorough, no-cost review of your Prudential denial letter, your Summary Plan Description (SPD), and any other documents you provide. We assess the specifics of your situation under ERISA law and explain your rights and potential strategies.
  2. Immediate Demand for Your File & Plan Documents: We formally request your complete claim file and the official Plan Documents under ERISA regulations. Reviewing Prudential’s internal notes, consultant reports, and the precise plan language is essential.
  3. Proactive Development of the Administrative Record: We don’t wait for Prudential. We strategically identify and gather all potential evidence needed to support your claim before the 180-day deadline. This includes working closely with your doctors to obtain persuasive narrative reports tailored to ERISA standards and the plan definition, coordinating necessary expert evaluations (medical or vocational), and helping you prepare detailed personal and witness statements.
  4. Meticulous Analysis of Prudential’s Denial: We scrutinize every reason Prudential provided for denying your claim, identifying weaknesses, contradictions, procedural errors under ERISA, instances where Prudential ignored favorable evidence, and potential bias in their reviews.
  5. Submitting a Powerful ERISA Appeal: We synthesize the evidence and legal arguments into a comprehensive appeal brief submitted directly to Prudential’s appeals unit. This document systematically refutes Prudential’s denial, presents the compelling case for your disability under the plan terms, and demands reversal based on ERISA law and the evidence in the now-strengthened administrative record. We decide and advise whether you should participate in any second appeals, as well.
  6. Leveraging Direct Experience Against Prudential: The ERISA attorneys at Sandstone Law Group have a proven history of taking on Prudential and winning complex ERISA appeals. We know Prudential’s common arguments, the medical reviewers they frequently use, and the federal case law relevant to Prudential-administered plans. We know how to appeal a claim Prudential denied based on misrepresented surveillance footage by presenting detailed medical evidence and expert testimony that clearly demonstrated the client’s severe limitations despite the footage. Our ERISA experience gives our clients a critical edge against Prudential.
  7. Handling All Communications: We take over all communication with Prudential, shielding you from confusing requests or potentially problematic interactions while ensuring the appeal process moves forward correctly under ERISA rules.

FAQs: Your Questions About Prudential ERISA Disability Appeals Answered

Sandstone Law Group – Phoenix Office

Address: 6122 N 7th St suite b
Phoenix, AZ 85014, United States

Phone: (602) 615-0050

Sandstone Law Group Leadership Team