Prudential Relies on Paper Medical Reviews to Deny Long Term Disability Benefits

Hi, Greg Dell with Dell Disability Lawyers and Cesar Gavidia. And Cesar, I hate that Prudential relies on these medical reviews to deny claims. And we've been doing a series of videos where we talk about the reasons or tools that Prudential relies upon to deny long-term disability claims. So let's talk about these medical reviews, give some tips as to how people can be prepared for them, but more so talking about what are they and why is Prudential allowed to use them to deny a claim. So medical reviews are generally conducted by either someone internally who's a nurse or a physician, or sometimes they reach out to third parties and they conduct them externally. But you know, oftentimes they are conducted internally by someone who is an employee of Prudential. And what essentially they do is once the claims examiner has requested and obtained all your medical records, they go through those medical records, review them, you know, in whatever format they come or whatever, you know, form they're in, and determine whether the substance within those records would show or, you know, establish some level of impairment that would prevent them from performing their occupation or any occupation. So, you know, essentially they're making the decision on whether the claimant is disabled or not because they're generating this opinion that's going to be heavily relied upon by the claims examiner. So that was my first question to you. This internal person, whether it's a nurse or a doctor, whatever type of person they use, but it could be a nurse, if they find that there's no restrictions or limitations, what percentage of time do you find that the claims person working for Prudential does anything other than follow the recommendation of their in-house doctor? I don't think that you'd see it any percentage of the time. Maybe, you know, 99% of the time they're probably going to follow the opinion of that doctor. If there's some level of confusion or something that is unclear, they might go to a second doctor or a third doctor or send the person for some sort of external examination, a physical exam. But what's important for the person to understand if they're dealing with Prudential is that oftentimes your entire claim comes down to the decision of this one physician or nurse that has reviewed your medical records, that hasn't reviewed you, hasn't examined you physically, hasn't, you know, even spoken to you personally, or sometimes not even spoken to your doctors, although they do try to reach out to a claimant's doctors, and it's not for the reasons that you might think that, oh, well, they want to just understand more what the person's limitations may be or have some legitimate questions about the person's medical treatment. They're usually reaching out to try to convince the doctor that there are no limitations that would support a claim of disability here. So, they're trying to turn your doctor on you. So now, essentially, their decision is going to be foolproof. What percentage of the time do you see Prudential deny a claim based only upon a medical review as opposed to actually examining the claimant? I'd have to say probably at least 75 to 80 percent of the time. You're not going to, you know, you have to understand that IMEs can be expensive. So, they can run, you know, several thousand dollars depending on, you know, what kind of independent medical exam is you're undergoing and what the doctor's expected to opine and what kind of report they're expected to generate. So, they're expensive, and they're not going to be conducted in every case, and unfortunately, most of the times when they are conducted, they're not very favorable anyhow. But, most of the time, the decisions come down to just this paper review of your file. So, what always bothers me is that if the claimant never went to a doctor and basically just called the doctor and said, these are my complaints, this is what's going on with me, put it in the records, Prudential would likely say, no, that's not enough. You have to be physically examined by this doctor. We see what the paper's saying, but the doctor didn't see you. But, on the flip side, how does a Prudential hired doctor, an in-house employee, look at records that clearly state this person has these limitations, but yet without ever examining or speaking to the claimant, Prudential, 75 to 80 percent of the time, like you just stated, makes a conclusion to say, no, just based upon the records, we think that you have no restrictions and limitations. How is that even ethical? Because there is no consequence to that course of action. They essentially, when they're, and it really comes down to the federal law, and without getting into this whole hour-long conversation about this, they basically have the discretion to examine and review a claim any way they see fit. So, if they believe, subjectively, that all that's required here is some meager paper review of your medical records by this physician, then that's all that's going to be done. And they know that a very large percentage of the time, that may be all that they need to win a case. And that's why they do it. So, you know, we've done tons of other videos where we talk about the next step progression here is to say, so what do I do to overcome this, these notorious paper reviews where they're going to try to deny my claim? And just in the five-second answer is, is you got to have incredibly strong medical records. And regardless of what your medical condition is, we've created a lot of videos where we talk about the different medical issues and how you can document for that specific medical condition, who you should see, the appropriate medical specialist. There's so many different factors. Like you said, it would be an hour video. The point of this video is be aware of these paper medical reviews. Be aware that Prudential will do as little as just review your records and make a determination based upon that that you're disabled. So one of the solutions is here, call you, call me, call any of our disability lawyers. We're always going to review your claim, let you know immediately what we think you can do to protect your benefits or if you've been denied, talk about a strategy as to how we can get you back on claim. So no matter where you live in the country, we look forward to helping you and we always enjoy providing you with a free consultation. Hi, I'm Gregory Dell, the managing attorney of Dell Disability Lawyers, and I hope you find the video you just watched helpful. We put these videos out all of the time and we'd love if you would subscribe to our YouTube channel. Beyond our videos on our YouTube channel, we also have lots of information available on our website and we encourage you to come to our website. The goal is that we want you to be educated about the disability insurance process and when you get to our website, you'll see that we have information all about your specific disability insurance company, your occupation, and your medical condition. And we've designed our website such that you can easily search our website to find things that you may specifically be looking for. 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