Labor officers started speaking to Prudential about adjustments in group life declare procedures after a the division’s Worker Advantages Safety Administration discovered that Prudential had denied about 200 supplemental life claims, from 2017 by way of 2020, based mostly on allegations that group life plan individuals had failed to offer proof of insurability.
In some circumstances, officers stated, Prudential denied claims based mostly on lack of proof of insurability after insureds had been paying premiums since way back to 2004.
Labor officers say difficult a declare for lack of proof of insurability, after the insurer has had ample time to ask for the that proof, is mistaken.
“The Worker Advantages Safety Administration will take acceptable motion in opposition to any insurance coverage firm that collects common premium funds from plan individuals, and later performs a recreation of ‘gotcha’ to wrongfully deny advantages based mostly on technicalities like ‘insurability’ after the participant passes away,” Lisa Gomez, the assistant secretary in command of the Worker Advantages Safety Administration, stated, in a remark included within the settlement announcement.
Eric Schwimmer, a Prudential Insurance coverage Co. of America vice chairman, signed the settlement for Prudential.
“Constructive engagement with our regulators is a vital part of doing enterprise the fitting means, which is foundational to our method to delivering for our prospects, whereas fulfilling our regulatory obligations,” Prudential stated in assertion. “We’ve labored with the Division of Labor to resolve this matter. The impacted claims characterize a really small subset of supplemental group life insurance coverage claims the place employers had collected premiums with out acquiring the required documentation. We’re addressing this with the small variety of supplemental group life insurance coverage prospects which are impacted and proceed to offer clear steerage to our prospects concerning the obligations for sustaining proof of insurability going ahead.”
The U.S. Labor Division constructing in Washington. (Picture: Mike Scarcella/ALM)