Usually, there is so much focus on Unum Group and its unfair claims practices, that the second worst insurance company, Prudential, is often left out of the discussion. Make no mistake, however, Prudential and its close ties to Unum, remains steadfast in unfair claims practices.
Prudential’s leadership has never been more than implementing Unum Group’s “bad faith” claims practices by hiring the old hat terminated Unum managers and VPs to run the company. As a result, Prudential really represents a clone of Unum Group’s collection of denial strategies, and then some.
More mental and nervous claimants have been “duped” by Prudential than any other insurance company except for Unum. To begin, Prudential’s reputation for misinterpretation and misrepresentation of actual psychotherapy notes is well known by the public. In the past, Prudential denied claims because therapists refused to release therapy notes. But, the company’s past extreme abuse is in its misrepresentation of patient therapy notes in its own favor.
Another egregious Prudential practice is the fact that claims with relatively high financial reserve value are reviewed by RN’s who have no specific specialty in the claimed disability reviewed, and are permitted to deny claims without internal MD input. A claim I reviewed was denied because a claimant’s therapy notes indicated her boyfriend was living with the claimant and wasn’t working. How crazy is that?
On the other side of the coin, however, Prudential is also well-known for hiring Unum’s old hack “claims killer” physicians to write medical reports supporting denials. Either way, Prudential’s treatment of Mental and Nervous claims rivals that of Unum, and in fact, are worse in some areas of review.
Prudential is also not above deliberately “stacking the deck” to show payable claims as not payable. For example, Prudential is known to deny STD benefits within several weeks of the 26 week maximum duration so that claimants fail to meet the LTD elimination period. A contract structural move to be sure, it is still an unfair claims practice.
Something to keep in mind for all insurers, particularly Prudential, is that claims handlers have no autonomy to make claims decisions on their own. Claims managers always remain behind the scenes, and along with off-site, claims experienced medical reviewers, decisions are made much farther up the chain of command. I recently spoke with a Prudential claims handlers whose only answer was, “…we have to abide by the medical review.” Therefore, we know the claims handlers’ jobs, (every where) are that of a glorified Administrative Assistant with no decision-making authority at all.
To what end? Prudential is NOT a good insurance company when it comes to paying claims. It was nearly the only company that scheduled IMEs during the worst of COVID despite the risk of infection. Keeping in mind that disabled persons have pre-existing conditions, Prudential didn’t seem to care that it was placing its own claimants at risk. And therein lies the story of Prudential.
Prudential is by far the second most egregious group insurer in the country. Like Unum, it “targets” claims for denial so that no amount of submitted paperwork from treating physicians will change its mind to pay and not deny. “Targeting” claims is an unfair claims practice that both Unum and Prudential, a prodigy, engage in for profitability.
My advice to anyone with a group Prudential claim, particularly a mental health claim, is to stay on top of what’s going on and challenge any position taken by the company on mental health issues.
Prudential reviews claims to deny rather than to pay, s sure sign of an unfair egregious disability insurer.
