DOL: Prudential forced to pay $7M to families after unfairly denying claims
Hundreds of families were illegally denied life-insurance death benefits despite paying into the plan for years, in what the Department of Labor called a “game of gotcha.”
The Labor Department has announced a settlement with Prudential Insurance Co. over allegations that the company did not pay more than 200 beneficiaries because the insured people failed to provide “evidence of insurability” when they applied for life insurance. Each claim varies, up to a maximum limit of $500,000, but Prudential will pay a total of $7 million to these grieving families.
In announcing the settlement, the department said that parallel investigations have found that other insurers engaged in similar practices. And department officials warned that group policyholders, such as employers, may be held liable if they failed to give notice to the participants that Prudential had not approved their evidence of insurability.
“This egregious practice left grieving families without the life insurance for which their loved ones had paid, in some cases, for many years,” Solicitor of Labor Seema Nanda said. She added, “We would urge all insurers to examine their practices to ensure that they aren’t engaged in similar conduct.”
The settlement prohibits the company from denying benefits if premiums were collected for more than three months. The settlement also ensures that coverage is not denied more than a year after they started paying premiums based on insurability, or based on evidence that they were not insurable after they first began making premium payments.
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Prudential is required to notify all group policyholders of these new processes. The Employee Benefits Security Administration said that from 2017 to 2020, the company denied more than 200 similar claims related to supplemental coverage, which is paid for in payroll deductions, on the grounds that the participant failed to provide evidence of insurability. The Labor Department said investigators also found that going back to at least 2004, Prudential collected premiums for this supplemental coverage from participants despite lacking this necessary paperwork.
Prudential is required to notify all group policyholders of these new processes.
“The Employee Benefits Security Administration will take appropriate action against any insurance company that collects regular premium payments from plan participants, and later plays a game of ‘gotcha’ to wrongfully deny benefits based on technicalities like ‘insurability’ after the participant passes away,” Assistant Secretary for Employee Benefits Security Lisa Gomez said,
The settlement should serve as a reminder that employers should review contracts to determine eligibility requirements and to ensure that employees receive benefits, according to Mariko Paul, assistant general counsel and HR consultant at Engage PEO.
She added that employers should establish standard procedures for new benefits enrollment. Those procedures should include a task tracker or checklist of documents that are required.
“Employers should audit their benefits documents on at least an annual basis to ensure that the documents are accurate and all necessary paperwork is in place, especially those related to evidence of insurability,” Paul said. “Employers may want to also consider hiring an outside third-party company to conduct such an audit.
Paul said that in addition to problems similar to the ones that Prudential faced, beneficiaries also may assert claims for fraud and misrepresentation based on denial of benefits or an over-deduction of premiums.