Prudential Long Term Care Claims


Gregory Dell: Prudential Disability
Insurance Company also does long term care. And I’ve been representing
a claimant who has a disability
claim, but also has a long term care policy with
them for more than 10 years. About nine years ago,
we litigated a case on behalf of my client who has
bipolar schizophrenic disorder. He was a physician who was
no longer able to practice. But also, he was a
danger to himself, which required him
to have supervision from family members. After litigating
that case, we were able to get him back on claim. And I’d say for about
five or six years, he was pretty good
without Prudential bothering him too much,
although they would often continue every six months to
request claimant forms to show that he’s still under the care
and treatment of a physician and that he still has to
have constant supervision so that he’s not a danger to
himself or a danger to others. Now, people usually
think long term care means you can’t do
two out of the five activities of daily living. But also, these
policies have what’s called, if you have severe
cognitive impairment and require the supervision
of another employee to protect yourself
or harm to others, then you can also be
entitled to coverage. And that’s what
happened for our client. Shockingly, I receive
a letter the other day. And it’s basically a one
page letter from Prudential that says, we reviewed
the medical records and we don’t think your
client’s eligible for long term care anymore. What’s so unbelievable
about this particular case is that my client,
about two years ago, slipped and fell and ended
up having a traumatic brain injury requiring brain surgery
due to a hematoma on his brain and swelling of the brain. Secondary to the
bipolar schizophrenic he was already
experiencing, he now has cognitive impairment as
a result of the brain injury. Further, the brain
injury exacerbated his schizophrenic
condition, because now was he not only
paranoid and depressed and anxious about everything
that was going on around him due to his inability
to work, now he has all of the issues dealing
with his physical health condition due to the brain
condition that he had. We had just sent medical records
within the last month or so to Prudential. They reviewed them without any
basis whatsoever for denial. They go ahead and send
you this one page letter. So we’re obviously going
to work on an appeal and get this
overturned immediately. And if we have to sue
them again, we’ll do so. But you can never let your
guard down with Prudential. I mean, these
medical records even said that the client
was in a downward spiral with his condition. They were contemplating having
an inpatient in a facility. And what’s really going on
here is that they basically came to the conclusion to say,
the family can take care of him and we don’t need to do
inpatient care right now. And what I’m willing
to beet happened is Prudential had a nurse
look at the file who said, well, he doesn’t
need inpatient care, so I guess he’s OK. Well that’s not what
the policy says. And what happens is you have
these unqualified nurses, or unqualified claims person,
review a claim for Prudential, make a determination to say,
yeah, the client’s fine. And they don’t understand
the terms and conditions of the policy. So this is going to
be quickly overturned on behalf of our client. And everything was done
to try to avoid this. But the point is, people
think you go years and years and years and they’re
not going to bother you, but they never stop. Prudential, specifically,
will always monitor the claim. They will always continue to
look for any possible bases they can to deny that claim. So in this case, we got this
letter just the other day. Within 24 hours, we turned
around an appeal letter, and we’re currently waiting
for the reversal of this claim denial. But it was so frustrating and
so unbelievably disgusting, the conduct of
Prudential, that I wanted to get out there
and let you know about this type of situation
that occurs with Prudential all the time. And it was so
important in this case that the medical
the medical records continue to be documented
every two to three months. And we were able to
have, at our disposal immediately, very strong medical
records from the psychologist, the psychiatrist, also
from the claimants treating neurologists. So we jumped on it right away. We’re confident that’s
going to be overturned. If you’re someone who has
a Prudential long term care policy, or any long term
care policy with any company, feel free to give us a call. We will give you a
free consultation, walk you through your claim, and
let you know immediately how we can assist you with your claim. Thank you for considering us.

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