Our long term disability lawyers answer common questions about appealing a disability claim denial from Prudential. We explain that the success of an appeal largely depends on the strength of the evidence supporting the disability. Claimants must provide strong proof such as medical records, physician statements, diagnostic tests, and evaluations that demonstrate their inability to perform the duties of their occupation. While success rates vary depending on each case, experienced attorneys may win a significant portion of appeals when the evidence is well developed and presented effectively.
The appeal process itself takes time because it requires gathering and reviewing extensive documentation. Attorneys must obtain the claimant’s entire file from the insurance company, collect updated medical records, and sometimes arrange additional testing or expert opinions. This preparation is critical because the appeal is often the final opportunity to add evidence to the claim file. If the appeal is denied and the case proceeds to court under ERISA law, the judge will only review the existing claim file, meaning any missing evidence cannot be added later.
Once the appeal is submitted, the insurance company typically has up to 90 days to issue a decision. During this time, Prudential assigns an appeal specialist who may send the records to medical reviewers or independent physicians for evaluation. The attorneys emphasize that claimants must complete the appeal process before filing a lawsuit because ERISA requires exhaustion of administrative remedies. They also explain that their firm often handles appeals on a contingency basis, meaning clients do not pay upfront and attorney fees are only collected if the case is successful.