Question

Prudential's doctor said I wasn't disabled when several others said I was. Can they reuse this doctor to terminate me months later?

Asked on August 21st 2016 by Shhh
I have a policy with Prudential, and this is the second time I’ve gotten a denial since first filing and getting approved. They first denied me during STD, got a lawyer, appealed, and won (after they took the maximum amount of time to decide, of course.) It’s been about a year since then, and they’ve terminated LTD leave (right after I got my initial denial for SSDI). I have a question about their medical experts that I can’t find info on anywhere. Prudential used a doctor when they terminated during STD who said I wasn’t disabled. Months later, and an IME where one of the two paid-for docs said I was disabled, I’m approved. They used that same doctor to terminate me this time. Are they legally allowed to do that? It would seem to me that if a doc said I wasn’t disabled but others later found I was/Prudential reinstated benefits, he’d be a poor choice for future reviews. If this ends up dragging out to the lawsuit stage, I’m sure that’d be a mark against them, but I’m wondering if there’s any ERISA protection from that or something in case law where that was held against a disability insurer.

Answer

Answered on August 23rd 2016 by Attorney Alex Palamara

Shhhh, it does create the appearance of impropriety that their review was arbitrary and capricious, but more investigation into the file would be needed to determine to what extent. What is the status of your claim/appeal?