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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.



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