Disability Insurance Law Research

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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There are 18 comments

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 JessupJul 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 PalamaraJun 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 JessupNov 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 JessupOct 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?
JohntOct 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 JessupJun 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?
NicoleJun 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 JessupMar 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 AdamsMar 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 JessupJan 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 ReddenJan 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 DellSep 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 BanksSep 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 DellApr 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 WearApr 9, 2011 #1

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