If you have recently been denied disability insurance benefits from Prudential, learn what you need to do to file an appeal. Attorneys Dell & Schaefer has helped thousands of Prudential disability insurance policy holders receive benefits.

GREG DELL: Hi, I’m Greg Dell, here with attorney Alex Palamara. And Alex, we want to talk about the dos and don’ts of a prudential disability appeal. So this video is geared towards the claimant who’s recently had their claim denied, and they are contemplating what to do about filing an appeal. Now we’ve handled thousands of appeals against prudential over the years.

So we’re in a special position because we know the ins and outs and how the prudential claims people are trained, and everything that they’re looking for. But I want to get right into it, I want to talk about what is the most important thing in an appeal for a prudential disability denial?

ALEX PALAMARA: Clearly what you need to do first and foremost, is get your medical records together. You can not rely upon the insurance companies. They’ll say, oh, sign this authorization, and we’ll get the medical records for you. But asking the insurance company to prove to themselves that you’re disabled is crazy. You’re asking them to prove it to themselves, they should be paying you money. So you cannot do that, the first most important thing is getting the medical records together.

GREG DELL: So obviously, once you get all the medical records, and we get a copy of their claim file. I want people to understand, the insurance companies encourage claimants to submit their appeal on their own. Like just go ahead and get us some updated medical records, get us a letter from your doctor. What is different about what we do in our claims versus what a claimant, who’s never done this before, is able to do?

ALEX PALAMARA: Well not only do we get all the medical records together, and we obviously review them, there’s a few other things that we do. After we review all the medical records, we obviously speak to all the supportive physicians, or any doctors that the medical records show that our client is disabled under the terms of the policy. We reach out to those doctors, not only do we call them up, we also send them attending physician statements that we specifically draft for each of our clients. We don’t just send them a form, Prudential will send you a form, say, have your doctors fill out this APS, and it could be–

GREG DELL: A two page forms that they have.

ALEX PALAMARA: It’s a two page form that they use for no matter what you’re disabling condition is. It’s the same form, but we write our own APS, attending physician statement, that’s specific to our client’s disabling conditions, our client’s occupation, our client’s needs. And we’ll draft one up for every single client, it’s always unique.

GREG DELL: Right, so the attending physicians statement we have is multiple pages. Since we’ve dealt with every medical condition, almost every occupation, and again, it does go back to the definition of disability. Because we’re dealing with an own occupation, and we have someone who has a desk job, then we’re going to talk about things, to sitting at a desk using a computer, typing. Do they have to sit? Do they have to stand? Do they have to carry things?

Address all those things, and get the doctors to specifically address those things. Not just can a person sit-in a chair for four hours a day, with two breaks of 15 minutes. And then, get into is there any objective evidence of this condition? If there’s not, then we get into are the complaints reasonable, and talk about those things.

ALEX PALAMARA: Correct.

GREG DELL: So all of those things can be great, as long as the claimant doesn’t have any kind of contradictory evidence out there. Which would be things in social media, video surveillance, things like that. And Prudential is huge in running video surveillance of a claim, and checking your social media profile, checking Instagram, Facebook, if your YouTube channel all of those things.

ALEX PALAMARA: I mean, if you’re on social media, you should make it private to begin with. Let alone, for a disability insurance claim, but just realize that if you’re on social media, they’re going to check all that. They’re going to check your LinkedIn, they’re going to check your Facebook, your Instagram, they can find you on Snapchat. Anyway, they’re going to find you, and they’re going to see what you’re posting on there.

And a picture is worth a thousand – whatever they say, a picture is worth a thousand words, whatever it is. That they’re going to take a picture of you sitting at a ballpark with your kid, and run away with it, say, listen you’re claiming disability, but look at you having fun all these different days doing social stuff.

GREG DELL: I just had an example, a claim yesterday, a doctor called me on one of our clients, and said, the insurance company sent me a letter, and they were saying, well, the fact that your client ran two 5K’s in the last six months – 5K running races – change your opinion. The doctor called me, and said, Greg, what do you know about him running 5K’s? And I said, I have no idea.

So I called the claimant, and he says it’s not me. So it was someone else, who had the same name, but the insurance company did a Google search, it came up with this person, in the same town, with the results of running. And he’s like, I swear I’ll sign any affidavit, I never did it. And then we go back to the doctor – this doctor, because of our relationship, had the respect to call and say, you know, what’s going on here?

So the insurance company was doing their research looking for any reason not to pay him, and found a 5K, which wasn’t him. Obviously it was a bad claim, it would have made a difference in the claim, but it wasn’t him, so that’s a perfect example to say they’re looking into everything and anything. So going back to the medical support, it’s important to have that relationship. These doctors, they’re documenting to treat the patient.

How are your complaints today? How are you feeling? And then it’s a refresher for the doctor for the next visit. But they’re not documenting it for an insurance company because they think that their records are going to be scrutinized by an insurance company. And unfortunately, insurance companies eat that up, and take advantage of that fact. So that that’s a big problem.

So let’s shift a little bit in second, we get the medical support, we work with the treating physicians, we work with outside medical consultants often, depending upon what the issue is. How important is it to present vocational or occupational information in an appeal?

ALEX PALAMARA: Very important, I mean, if you have a denial letter in front of you right now, why you’re watching this video, they might have done a very cursory review of what your occupation is. If you’re in the own occupation standard of your definition of disability, they might say, you work as a, whatever it may be, it’s a sedentary job. We believe you can do sedentary work, so you’re not disabled anymore. I mean, of course, they’re not taking into account every other requirement of your occupation.

Whether it be high level of concentration, or a high level of using your brain all day, and the fact you’re dealing with pain, maybe you can’t sit for four hours straight. But there’s no way you can concentrate and do your high level of functioning job using your brain all day, because of the pain that you’re suffering from. So the fact that they just take a cursory look at maybe the physical requirements of your occupation, it’s not enough. That’s why when we do reviews, we will work with the vocational specialists to figure out what your actual, I guess, all of your requirements of your job might be. Not just the physical ones, but also anything beyond the physical requirements of a job.

GREG DELL: All right the mental capacity required, how long you have to focus. Can you take a break? Can you just sit for 15 minutes, or do you have to be engaged because you have to do presentations three times at day 45 minutes straight? And you can’t just say, hold on, I need a 15 minute break. Hold on, I need to go lay down, or I don’t feel well today I can’t make it. How does that work for day two of the week when you’re just like – employers don’t say, well just come in when you feel like it, it’s no problem because everything else will be fine if you just come in on a random schedule.

It doesn’t work like that, but, unfortunately, when someone doesn’t feel right, or doesn’t have the ability to commit to the employer, there’s no way they can keep that job. Anyone would get fired, so, we get all that information, also do our own research diving into whatever the occupation is to make the claim rep who’s reviewing the file understand what’s going on. So vocational, super important, medical, super important.

But what’s very unique about what I think that we do, is that we’re not just thinking about the appeal, we’re thinking about what if we lose the appeal, how is a judge going to look at this? And why is that important?

ALEX PALAMARA: I mean, your appeal is your last bite at the apple to make your claim as strong as possible, especially under the ERISA laws. I mean, the ERISA laws, if you get a final denial, you could get hit by a bus the next day, and that information’s not getting into your claim file, the judge is never going to see it. So the last chance you can ever possibly make your claim as strong as possible for a lawsuit is by doing the appeal.

So with your appeal, you have to submit everything under the sun that’s supportive of your claim. It’s your last chance to do so. That’s why the appeal is actually the most important part of your claim for that reason, because it gives you a chance to get back on claim to you get your full benefits again. But it also gives you the last chance of making your claim as strong as possible for a lawsuit. And these lawsuits, they’re hard to win because the ERISA laws are against the employees, they’re against the claimants. It makes it really hard for you to win the lawsuit, so your appeal is the most important thing you can possibly do for your claim.

GREG DELL: Right, I mean the best case scenarios for a claimant, is when they have an attorney or someone skilled helping them with their appeal. We handle lawsuits all the time where we didn’t do the appeal, but every claimants says, I wish I had you do my appeal because it’s just, you’re not in it, you haven’t done thousands of claims. You don’t know what to expect, you did what your job was, and now you’re somebody who’s disabled, and can’t work, worrying about getting yourself better, not worrying about how to I present an appeal to the insurance company so that I could win?

ALEX PALAMARA: I mean, this is my job. I’ve seen all the denial letters, we’ve made all the arguments. I mean, I can’t even give you the number I’ve filed against Prudential. But in my career, I filed, I’m getting up to 1,000 appeals on my own. So I’ve seen every single denial, I know the arguments to make on different denials and whatnot. And the insurance companies, they don’t reinvent their wheel with each denial.

They’re all very similar, so it’s, I mean, we know what to do in these type of cases. But getting the medical records, getting the occupational review done, speaking out all the treating physicians, and even getting to speak with an outside doctor, maybe having an outside, independent doctor perform a review of our client medical records. They’re always helpful for our claims. But it’s the most important thing you can do for your claim, is doing these appeals, it has to be done right.

GREG DELL: Then the last thing to touch on, which one, if you have a claim on Prudential to call us, is the secondary appeal, voluntary appeal, which Prudential always offers. And that is exactly what it is, a voluntary appeal. Whether or not you should do it or not, is not a given, it’s a strategy that has to be discussed depending upon, in my opinion, how poorly Prudential did when they reviewed the first appeal that was submitted.

ALEX PALAMARA: Or how poorly the first appeal that was submitted actually was.

GREG DELL: If a claimant did it on her own. So, definitely, something that has to be discussed. Not every company offers that second level appeal, Prudential’s unique, it’s not required, it’s clearly voluntary. And there’s a lot of pros and cons of doing it, but it’s a case by case analysis that we would love to discuss with you.

So, if you have claim that’s been denied by Prudential, feel free to give Alex a call, or any of the stability attorneys at our firm. We represent clients throughout the nation, and we always offer a free initial phone consultation to let you know right away whether or not we can help you. We look forward to the opportunity to speak with you.