Prudential Insurance Co. systematically has denied promised medical help to its customers and has failed to let them know about its restrictive policies and procedures, a lawsuit charges. In addition, the lawsuit accuses the health insurer of employing officials who denied treatment coverage, even though they were not trained to make medically necessary decisions.

The lawsuit is similar to one filed in April 2000 against Prudential HealthCare. "It isn't the same, but the general issues are similar," says Stephen D. Annand, one of the lawyers for the plaintiffs in the latest lawsuit. "Our clients are very concerned about the way they've been treated."

Other managed care organizations have been hit with lawsuits that have similar themes. "It seems to be the intent of the managed care organizations to deny benefits based on cost considerations rather than on issues of good medical practice and necessary care," Annand says.

Prudential spokesperson Kevin Heine declines to comment, saying the company has not seen the lawsuit.

The lawsuit also names as defendants Prudential's health care subsidiaries, which were sold in August 1999 to Aetna U.S. Healthcare.

The lawsuit, which is seeking federal class action status, was filed May 22 in U.S. District Court in the Eastern District of Pennsylvania by the following law firms: Cohen, Milstein, Hausfeld & Toll of Washington, D.C., Levin, Fishbein, Sedran & Berman of Philadelphia, and Lieff, Cabraser, Heimann & Bernstein of New York. The lawsuit seeks a court to order Prudential to pay an unspecified amount of money to its affected customers, among other things.

"The managed care industry needs to take seriously the commitments it makes to those it serves. The days of cutting corners must end," says Annand, a lawyer with Cohen, Milstein, Hausfeld & Toll.

Potential class members include all customers of Prudential HealthCare (PruCare) who were or are beneficiaries in employee welfare benefit plans administered by the insurer during the six-year period prior to the filing of the lawsuit. PruCare insures about 6.6 million people nationwide.

The lawsuit alleges breach of fiduciary duty and breach of contract by Prudential.

For example, Prudential's insurance contracts and HMO agreements promised its customers that care would be provided or reimbursed unless found to be neither necessary nor appropriate under prevailing medical opinion.

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Instead, the lawsuit charges, Prudential applied guidelines that restrict care. Prudential based the guidelines on its own financial needs, rather than on the best medical practice, the lawsuit alleges.