Will A Prudential Critical Illness Claim be Denied or Approved
We get maximum payouts for our client’s critical illness claims so policies like a Prudential critical illness claim are paid and not denied.
A Critical Illness Benefit is a Rider to a life insurance policy that allows the policyowner to receive part of their death benefit while they are still alive if they’re diagnosed with an illness that is covered by the Rider. A Critical Illness Rider is a supplemental benefit — or an add-on — usually to a life insurance policy. They’re also known as Living Benefits. Many of the largest life insurers in the US offer Critical Illness riders to their life insurance policies.
When a policyholder has been diagnosed with a critical illness they can make a claim against some portion of the death benefit of their life insurance. If the claim is approved they’ll receive the money while they’re still alive. This is a Critical Illness Benefit.
Life insurance companies don’t want to pay Critical Illness claims. They investigate every claim and look for reasons to not have to pay. Having a Critical Illness claim specialist represent you — who doesn’t work for the insurance company — will help get your claim paid.
We specialize in getting maximum payouts for critical illness claims paid to our clients. If you need representation contact us at 1-888-428-4868.
*No retainer $$ required.
How Much Does a Critical Illness Claim Pay?
Insurers use a formula to determine how much they will pay for a Critical Illness. The formula is very detailed and they only share part of their calculation with the policy owner. In order to get the maximum payout you need to understand the insurers’ method of calculating benefits and double-check to be sure they’re doing it in your best interest.
If your claim is approved you’ll be offered a 100% claim payment and a 50% claim payment. If you chose the 100% claim payment you’ll receive a lump sum payment and your life insurance will terminate. If you chose the 50% claim payment you’ll receive a lump sum payment and you’ll keep one-half of the death benefit.
To receive a Critical Illness benefit you first file a claim and then await the insurance company’s decision to approve and pay the claim or deny the claim. This process can take a few weeks if presented properly, or it can take several months if left to the insurer’s claims department.
Critical Illness Claims Are Handled by a Special Claim Unit
When you file a Critical Illness claim with Prudential they ask for a very brief Claim form to be completed and submitted. They simply ask for a box to be checked next to a certain critical condition and the contact information of the treating doctor. This should be your first clue that you need professional help when you file a Critical Illness claim with Prudential.
Completing this form in a way that fully describes your condition, how the condition came to be diagnosed and how you’re being treated is extremely important. None of this is explained by Prudential.
Your claim will be handled by a special unit at Prudential that only examines Critical Illness and Chronic Illness claims. That may sound positive but in fact its another red flag that should have you very concerned. These specialists are not instructed to pay claims. They’re instructed to find reasons claims should be denied. If an insurer simply wanted to pay your Critical Illness claim they would. Instead, a full investigation will begin.
The investigation will involve the Critical Illness team gathering as much medical information from your treating doctors as possible. They’ll scan these records looking for evidence that may trigger an exclusion to benefits, give them an argument that your diagnosis doesn’t follow their Policy or in a worst case allow them to rescind the Policy as if it was never issued.
How Do Insurers Deny Critical Illness Claims?
Critical Illness riders have both Conditions and Exclusions. The Conditions apply to each type of illness and the Exclusions are general for the entire rider.
Conditions to coverage are requirements that the insurer puts on the way a medical event is measured or how extreme it must be or how long it is expected to last for it to be eligible for a claim payment. While having Cancer or being in a Coma, as examples, may seem like very straight-forward medical conditions, under a Critical Illness benefit they aren’t.
Look at the way one major life insurer determines if someone in a Coma can qualify for benefits under their definition:
Coma – Lasting for 30 consecutive days with no reaction to external stimuli, no reaction to internal needs and the use of life support systems. Diagnosis must indicate that permanent neurological deficit is present.
Not only do they set a minimum time of 30 consecutive days, they also demand that the person have permanent neurological deficit. Doesn’t common sense indicate that being in a 30-day coma would be enough of a critical condition for an insurer to pay a claim?
In another example for Paralysis an insurer sets the following conditions for benefits:
Paralysis – Quadriplegia, paraplegia, or hemiplegia that is expected to last for a continuous 12-month period or longer from the date of diagnosis to determine if paralysis is permanent. A benefit will not be paid for paralysis that results from a stroke or psychiatric related causes.
Here again is an example of how an insurer can deny a critical illness claim for a condition that seems like an obvious approval. Someone suffering paralysis must have had their condition triggered in a specific way or there is no Critical benefit payable.
And Exclusions in critical illness policies set forth a blanket statement such as, “We will not pay a benefit if:
- The covered person participating or attempting to participate in an illegal activity.
- The covered person intentionally causing self-inflicted injury.
- The covered person committing or attempting to commit suicide, whether sane or insane.
- The covered person’s involvement in any period of armed conflict.
- Surgeries performed outside the United States or its Territories.
Making a Critical Illness claim against your life insurance policy is not as easy as many people would like to believe. These claims are some of the more complex and challenging. Getting a Critical Illness claim approved is best done by having your own claim experts working just for you.
How To Get Critical Illness Claims Approved
The value of having a firm like the Center for Life Insurance Disputes represent you and your claim during the critical illness claim process is significant.
For starters we understand the language of the Policy better than most and we know how the smallest of details effect whether a benefit is paid or denied. We assure that exclusions are held in the narrowest context rather than liberally applied by an insurer to deny the claim.
Our clients also benefit because we have our own experienced medical professionals who can speak directly to the insurer’s medical professionals about a person’s diagnosis, treatment, and life expectancy. This high-level interaction with the insurer’s doctor forces them to consider a diagnosis in favor of getting a claim paid.
In matters where a claim is filed within 2 years of the policy being issued we can go back and investigate the original application so as to protect our clients from having their life insurance benefits rescinded altogether.
And, we expedite the transfer of information after it’s been evaluated by our medical team so our client’s claim is paid expeditiously.
Will your Prudential Critical Illness claim be denied or approved depends on how well the claim is prepared and presented. If you have a Critical Illness claim and would like our representation please contact us by phone or email now.
The Center for Life Insurance Disputes
1-888-428-4868
How is a Terminal Illness Claim Denied?
According to some Critical Illness insurance policies a Terminal Illness is a medical condition that creates a life expectancy of 6 months or less. In California it’s 12 months. Here again is room for a claim dispute. Your doctor will probably want to give you a best-case idea of life expectancy. In reality, he or she may know its quite shorter. The claim examiner can use this single item to deny a claim.
More about Critical Illnesses
All of the below are considered to be Critical Illnesses:
Critical illnesses include: Stroke, Cancer, Heart Attack, Coronary Artery Disease, Angioplasty Or Other Invasive Treatments For Coronary Artery Disease, Heart Valve Replacement, Fulminant Viral Hepatitis, Chronic Liver Disease, Primary Pulmonary Arterial Hypertension, Chronic Lung Disease, Kidney Failure, Surgery To Aorta, Aplastic Anemia, Major Organ Transplant, Blindness, Loss Of Hearing / Deafness, Loss Of Speech, Coma, Major Burns, Multiple Sclerosis, Paralysis / Paraplegia, Muscular Dystrophy, Alzheimer’s Disease / Irreversible Organic Degenerative Brain Disorders, Motor Neuron Disease, Parkinson’s Disease, Terminal Illness, Encephalitis, Benign Brain Tumor, Major Head Trauma, Bacterial Meningitis, Poliomyelitis, Apallic Syndrome, Loss Of Independent Existence, Aids, and Cardiomyopathy.
Critical Care Patients
According to the society of critical care medicine more than 5 million patients are admitted annually to U.S. ICUs for intensive or invasive monitoring; support of airway, breathing, or circulation; stabilization of acute or life-threatening medical problems; comprehensive management of injury and/or illness; and maximization of comfort for dying patients.
Adult: Cardiac, respiratory, and neurologic conditions are common in adult ICU patients. The five primary ICU admission diagnoses for adults are respiratory insufficiency/failure with ventilator support, acute myocardial infarction, intracranial hemorrhage or cerebral infarction, percutaneous cardiovascular procedures, and septicemia or severe sepsis without mechanical ventilation. Other conditions and procedures involving high ICU use are poisoning and toxic effects of drugs, pulmonary edema and respiratory failure, heart failure and shock, cardiac arrhythmia and conduction disorders, renal failure with major complication or comorbidity, gastrointestinal hemorrhage with complication or comorbidity, and diabetes with complication or comorbidity.
Also see:
Chronic Illness & Critical Illness Claims
Prudential Critical Illness Claim form
Prudential Critical Illness Claim be Denied or Approved @Copywrite 09.08.2020
