Prudential Critical Illness Claim Form

If you have a Critical Illness claim to make with Prudential you’ll need the Prudential Critical Illness Claim form. But before you submit your claim you need to read:

WHY IT’S SO DIFFICULT TO GET A FAIR OFFER FOR A CRITICAL ILLNESS CLAIM FROM AN INSURANCE COMPANY

Very few types of insurance have as many conditions and exceptions as critical illness policies. They are only rivaled by accidental death policies. Medical events such as cancer and kidney failure, which seem like obvious conditions that would qualify for benefits under a critical illness policy, take on new definitions within Critical Illness insurance. It’s often not enough to have cancer or renal disease because Critical Illness policies are chalk full of conditions that must be met before they are eligible for a claim.

What makes the policy’s conditions so difficult to adhere to is not whether someone was diagnosed with cancer. That, in fact, is the easiest part of the claim. The hard part is that many of these policies require specific testing to be done, and specific doctors who can make diagnosis, and what the prognosis is, all before a claim is even eligible for benefits. In other words, the insurers put burdens on treating doctors who have no time or interest in satisfying their needs.

IF YOU’VE BEEN DIAGNOSED WITH A CRITICAL ILLNESS CONTACT US BEFORE YOU FILE YOUR CLAIM. WE REPRESENT POLICYHOLDERS IN GETTING THE NECESSARY CONDITIONS MET FOR CRITICAL ILLNESS CLAIMS APPROVAL. NO ONE ELSE OFFERS THIS VALUABLE SERVICE OR KNOWS THE INNER WORKINGS OF THE CLAIMS DEPARTMENT BETTER THAN WE DO.

Filling out a Critical Illness Claim Form:

The Claim form asks for basic information about the insured. It’s the usual items such as name, address, policy number and so on. It also asks when the person was diagnosed with their condition and who the treating doctor is. There are several medical conditions already listed and the claimant can check one of the boxes next to their condition. But it’s much better to write-out a description of the insured’s diagnosis with as much detail as possible and attach it to the claim form. This helps to assure the claim examiner doesn’t make any wrong conclusions about the medical condition.

The most important part of the Critical Illness claim form is the Attending Physician’s Statement.

The claim examiner wants this section completed by the doctor who is treating the insured. That’s fine, but the doctor doesn’t know what the Policy says and this is where the breakdown begins. The doctor doesn’t know what Conditions are in the policy for any critical illness. For example, the doctor doesn’t know that for a Stroke claim to be approved specific imaging tests have to have been completed and evaluated in writing. Therefore, simply acknowledging the insured had a “stroke” won’t be enough to get the claim paid.

Doctors are busy professionals and they aren’t likely to spend time making sure they meet the reporting requirements of a life insurer when the complete the Attending Physician’s Statement. Likewise, the claim examiner isn’t going to “educate” the doctor on what information they need to approve a critical illness claim. They simply instruct the insured to get the form completed. The claim process doesn’t favor the insured. It’s in place to protect the insurer. That’s why is so important to have your own claim representative who knows what the policy says, what the insurer wants and works with the treating doctor directly.

Critical Illness Claim Approved

If your claim is approved you’ll be given a few payout options. Usually you’ll be able to chose from a 100% payout and a 50% payout. The insurer won’t tell you how they determined the amount of the two options. They’ll simply send you a letter and tell you that if you accept the 100% payout your policy will be terminated and if you accept the 50% option your policy will continue with 50% of the death benefit. There are other options that may be offered as well, but these are the most common.

Critical Illness Claim Denied

If your critical illness claim is denied the insurer may also cancel your life insurance coverage. This would be because they think you didn’t disclose all of your medical history or you didn’t qualify for the policy for some other reason when you applied.

If they do deny your claim they’ll put it in a letter and tell you in general terms why they aren’t approving your claim. If this happens you need to file an Appeal. Just like our advice on filing the claim, an Appeal for a Critical Illness benefit should be done by experienced specialists. Many of the steps discussed above have to be taken and included in order for an Appeal to be successful.

If your critical illness claim was denied contact us to start your claim Appeal.

You Need Your Own Critical Illness Claim Specialist

Insurance companies don’t give people instructions on how to get their critical illness claims approved. The process is secretive and it doesn’t favor the policyholder. These claims are not simple. Having a specialist working just for you who has the background and knowledge of how to get a critical illness claim approved will greatly increase the chances of the claim being paid.