Beware of buried language in Prudential long term disability insurance policy

I recently came across some language in a Prudential Long Term Disability Policy which can be troublesome for disability claimants that are completely unable to work in their regular occupation. The Prudential Group Disability Policy I reviewed defines Disability as:

You are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury, and you have a 20% or more loss in your indexed monthly earnings due to that sickness or injury.

Upon reading this definition it would be reasonable to assume that if you can not perform the material and substantial duties of your occupation, then Prudential should find you disabled. Common sense does not always dictate with long-term disability carriers. Buried in the Prudential disability policy is a sentence that says, “We will stop sending you payments and your claim will end on the earliest of the following: 1. When you are able to work in your regular occupation on a part-time basis but you choose not to.” Part-time basis means the ability to work and earn 20% or more of your indexed monthly earnings.”

Technically speaking a claimant could possibly work 1/5 of a work week and earn 20% of their pre-disability earnings. Claimants need to be aware that this language may be in their disability policy and taken caution when making statements about an ability to work a few hours a week. It is not practical to think that any employer would hire someone in their prior job for 1/5 of the time they previously worked. Disability claimants can also incur problems with their disability claim if their treating physician states that a claimant can work part time.

Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell shares these court cases so you can understand how complex representing disability insurance claimants actually is. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company.

Comments (24)

  • Geordie, Prudential can be tenacious in their denials. All we handle are disability insurance claims and have litigated many against Prudential. We would certainly be more than happy to review the denial letters and appeal and discuss your options in filing a lawsuit. Please feel free to contact our office to discuss your wife’s claim.

    Stephen Jessup Dec 29, 2022  #24

  • Prudential denied my wife’s claim over own/any occupation test. She had a three tier fusion on her cervical spine which still causes her pain and three significant bulging discs at the lumbar level and dx’d with spondylosis c and l. We did retain an attorney however Prudential continued to deny and now we have to file a lawsuit. We have maintained that Sandra, upon activity still experiences pain that is debilitating as she reports nausea from sciatica. She has maintained that being off work allows her to lie in bed or recline when needed. She is not a candidate for additional surgery on her l spine as they fear it will make her spine unstable. She worked as a stock room counter/clerk and now Prudential says she can work as a telemarketer. Do you think its favorable to retain a different lawyer for the lawsuit? Are you familiar with these type claims?

    Geordie A. Dec 28, 2022  #23

  • V, some short term disability insurance policies do not cover injuries sustained at work or injuries covered by worker compensation laws/policies. However, if your short term disability policy does cover for such injuries, then in all likelihood, any benefits you receive from workers compensation would likely be an offset to your short term disability benefits. However, please keep in mind that there can be scenarios where you can receive both. In order to properly answer your question, we would need to learn more about your claim and have a chance to review your policy.

    Alex Palamara Oct 7, 2022  #22

  • Can you receive short term disability through your employer and worker’s comp benefits at the same time?

    V Oct 6, 2022  #21

  • CJ, you would have to find out if they would still pay you if you are working. Some policies allow it, some do not. Also you have to be careful that you are not doing something that you claimed you could not do due to your disability.

    Rachel Alters Aug 6, 2021  #20

  • I have been getting LTD thru Prudential for some time. It is due to end in July 22. I just found a place where i can sweep the floor like 2 days a week for 8 hours total a week. Am i allowed to do that with a Prudential LTD policy. Its not worth losing my benefit for a few hours that i may or may not be able to do!! I just thought if i can since i will be going to straight SSD next year i might try it?

    CJ Aug 6, 2021  #19

  • Mitchell, Prudential does negotiate lump sum settlements of disability claims. That being said there are criteria that have to be met before they will even consider. Please feel free to contact our office to discuss your situation in detail and to determine how we may be able to assist you in maximizing any potential settlement.

    Stephen Jessup Jul 19, 2020  #18

  • Can you get Prudential disability to settle? They pay me $400 a month I think till 2024. I just want to be done with them not to have to keep sending dr. paperwork.

    Mitchell S. Jul 19, 2020  #17

  • Kenneth, I am sorry to hear all that you have gone through. Often times, settlements of other claims such as workers compensation can be an offset to your LTD benefit. The policy governing your claim will list what the insurance company can offset. Please gather a copy of the LTD policy governing your claim and contact us for a free consultation. We will be able to review your policy and give you an answer as to what can reduce your claim.

    Alex Palamara Jun 5, 2020  #16

  • Back in 2012 I got injured on the job, hurt my eye and was worthless, a massive stroke. I am on long-term disability LTD and I got a settlement from workman’s comp about the eye back in 2016. Will that affect my long term disability?

    Kenneth H. Jun 4, 2020  #15

  • Yvonne,

    We would need to see a copy of the denial letter and your policy. Please feel free to contact our office to discuss your claim in greater detail.

    Stephen Jessup Nov 23, 2015  #14

  • I work for a major bank. Any injury prevents me from being able to work. My STD ended October 21, 2015.

    My LYS denied my claim staying: Pre-existing condition and their Vocational Specialist said to just shift positions.

    My injury was to my spine. Surgeries were being performed at the time of the denial. I was also accused of having a nonexistent criminal history.

    Please advise.

    Yvonne H. Nov 22, 2015  #13

  • Johnt,

    Without review of your policy we would not be able to ascertain one way or another. You can always inquire of Prudential if they will attempt to offset your benefit if you were to roll it over.

    Stephen Jessup Oct 17, 2015  #12

  • Stephen
    It took me almost a year to convince prudential that my severe sleep Apnea. Heart disease and diabetes caused me to suddenly quit my job of 32 years. I loved my work as a regional Manager over a large area of the eastern states. I finally did receive a disability approval after catching a private investigator basically stalking me and of course once my Atty contacted them by certified mail, benefits were immediately granted. I guess this scenario of catching a fox in in the chicken pin. I even had to take it upon myself to file for as.! So I am 6 yrs receiving benefits and now received a letter from my companies pension fund, stating they are allowing employees a 100% payout which I think would be great to roll all 150k into an Ira or long term annuity. Would prudential be able to penalize me on my regular payouts?

    Johnt Oct 16, 2015  #11

  • Nicole,

    If your policy does not allow for part time work, then yes it can prevent you from receiving benefits. Please feel free to contact our office to discuss your situation in greater detail, especially the policy provisions as they relate to total disability and (if available) partial disability.

    Stephen Jessup Jun 29, 2015  #10

  • I was on LTD from Prudential terminated my claim because they said they didn’t receive information from my doctor.I’m currently appealing I have no choice but to start working part time .Could the fact that Im working part time affect my appeal?

    Nicole Jun 28, 2015  #9

  • Pam,

    It is very much arguable that they do. Please contact our office with a copy of your disability policy. Additionally, as you have a lengthy claims history, Prudential may consider a lump sum buyout of your claim.

    Stephen Jessup Mar 2, 2015  #8

  • I received a letter from Prudential regarding my LTD payment. They say I owe $3,888.00 and demanded payment by 2/23/2015. My letter was dated 2/9/2015. I did not receive it till Fri. 2/20/2015 my benefit was due Tue. 2/24/2015. I was under the impression that it had to do with COLA. Could not reach them but left messages. They kept my check.

    Finally spoke with them on the 25th. My original award was based on the previous years salary. When Social Security increased my benefit Prudential never corrected their payment. They say I owe them $18.00 for 10/1996 through 12/2014. I had signed and returned all their Social Security information release forms, and reported income on their form, but they never checked with S.S. Is this right? Don’t they have a responsibility to have checked this out? It’s been 19 years.

    Pam Adams Mar 1, 2015  #7

  • Charles,

    That does not sound right at all as most policies do not allow for the offset of a COLA increase. Please contact our office

    Stephen Jessup Jan 27, 2015  #6

  • I received a letter from Prudential regarding my long-term disability payment. They say I owe them $73,365.00 because they didn’t adjust my LTD benefits for the Social Security Disability Benefit COLA increases from April 1, 1998 through December 31, 2014. The letter is dated January 21, 2015. I received it January 26, 2015 and the money is due February 4, 2015. Can they go back that far to adjust my monthly benefit?

    Charles Redden Jan 26, 2015  #5

  • Paula,

    You must have support from your treating doctor in order to have any chance of collecting disability benefits. You need to get a new doctor ASAP.

    Gregory Dell Sep 27, 2012  #4

  • My doctor wrote to my place of work, that I could return to work. But my employer told me they do have positions for a person with limited restrictions. I can not bend, pick up load of 50 pounds no more. They told me it would be best not to return. My doctor however has been secretly seeing the staff of Human Resource office and lawyers.

    They keep calling the house saying they do have enough information, they now have asked for workers comp agent and number.

    Paula Banks Sep 26, 2012  #3

  • John, I would agree with your opinion that a job must be available, but the language you are referring to is contained in most Prudential Group Disability Policies. The language is ambiguous and could be dangerous for a claimant. Fortunately, we do not see Prudential use this provision often in order to deny Prudential Disability Claims.

    Gregory Dell Apr 12, 2011  #2

  • I have a long-term disability claim against Prudential and this exact language is contained in the policy. The question I have is can Prudential deny your claim even if no such part-time jobs are available? The phrase “you choose not to” to me implies that there has to be a part-time job available that you choose not to work at. Your thoughts and input will be greatly appreciated.

    John Wear Apr 9, 2011  #1

Leave a comment or ask us a question

Questions About Hiring Us

Do you help Prudential claimants nationwide?

We represent Prudential clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Prudential disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Prudential. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Prudential.

How do you help Prudential claimants?

Our lawyers help individuals that have either purchased a Prudential long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Prudential:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Carolyn O.

They were very professional in helping me with my legal situation. I was very fortunate to find such a competent company and attorney to represent me. Everyone that I had the pleasure of talking to, was very pleasant and helpful.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us