Prudential's Policyholder Remediation Plan letters: Guide to the Appeals Committee Review Process
Policyholder Remediation Plan
For Prudential Policyholders
The Appeals Committee
A Brochure for Claimants
1. OVERVIEW OF THE APCOM REVIEW PROCESS
If you are not satisfied with your award decision, you have the right to have an independent decision maker review your claim through the Appeals Committee Review Process described in this brochure. This Independent reviewer will not give any consideration to the original decision made by Prudential and will independently consider and review your claim. This brochure provides you with an explanation of this appeals process, the steps you must take to have your claim reviewed, and the assistance you may receive at no cost to you in preparing and presenting your claim. Please take the time to read through these pages carefully so that you understand this process.
B. The Appeals Committee
An Appeals Committee ("APCOM") has been selected and approved by state insurance regulators, lawyers for the class, and Prudential. The role of the APCOM is to conduct an independent review of claims for policyholders who are not satisfied with the relief they have been offered in the ADR Process.
The individuals serving as APCOM Reviewers have been approved by the insurance regulators, lawyers for the class, and Prudential. These individuals have experience either (i) with the life insurance industry or life insurance products, (ii) with the resolution of insurance-related complaints, or (iii) as arbitrators or other adjudicators who have the appropriate expertise to serve as members of the APCOM.
C. The APCOM Review Process
The APCOM Review Process is described in the following pages. Briefly, the process begins when a Selection Form marked to request an Appeals Committee Review is received from a policyholder. The policyholder may request on the Selection From that an attorney Representative be provided for assistance in the APCOM Review. The request must be submitted to Prudential by the date indicated on the Selection Form, which is generally 45 days from the date of the award letter.
Soon after the request for an APCOM Review is received, the claim is assigned to the APCOM Reviewer who is designated to review claims for the particular region in which that policyholder lives. The APCOM Reviewer will contact the policyholder, any attorney Representative or legal counsel of the policyholder and Prudential and attempt to mediate a resolution. If an agreement cannot be reached, then the APCOM Reviewer will schedule a hearing, which can be conducted either by telephone or in person.
Policyholders may receive the assistance of an attorney Representative who will be available at no cost to them, and who will help policyholders prepare for the APCOM Review and represent them at the hearing if so requested. In lieu of the Representative, policyholders may at their own expense retain legal counsel of their own choosing to assist them. Policyholders will not be responsible for any fee or expense of the APCOM Reviewer or the Representative.
The APCOM Reviewer will evaluate the claim under the Policyholder Remediation Plan. This determination may result in an award of relief that is greater or less than the relief originally offered. Written notice of the APCOM Reviewer's decision will then be sent to the policyholder. In virtually all circumstances, the APCOM Reviewer's determination will be final and will not be subject to further review, including review by any court.
II. APCOM REVIEW PROCEDURES
We understand that the APCOM Review Process will be a new experience for you, as it will for most policyholders who are requesting a review of their claims. This section is meant to give you a more detailed description of the APCOM Review procedures, including mediation, the hearing itself, the APCOM Reviewer's decision and notice of the decision. Finally, this section also addresses the limited circumstances under which claims may be reheard and explains the binding nature of the final decision that you obtain in the APCOM Review Process.
A. After your request for APCOM Review
After your Selection From marked to request an APCOM Review is received, you will be sent information concerning the following:
As soon as we receive your request for APCOM Review, it is sent along with a copy of your claim file to the APCOM member who is assigned to review claims in your geographical region. You will receive a letter with the name, address and telephone number of the APCOM Reviewer assigned to review your claim.
2. Your Claim File
In order to assist you in preparing for your APCOM Review, you will be provided with copies of the materials in your file.
If you wish, an attorney who has been selected by lawyers for the class and approved by the state insurance regulators will be appointed to help you prepare for the APCOM hearing. The Representative may also appear at the hearing if you so choose either by telephone or in person. The Representative is a qualified professional familiar with the life insurance industry and alternative dispute resolution procedures like the APCOM Process. The Representative is provided at no cost to you. The name of the Representative will be provided to you along with instructions about how to contact the Representative. Instead of the Representative, you may choose to hire an attorney at your own expense to assist you in the APCOM Process.
- Your APCOM Reviewer
B. Mediation Prior to Hearing
Before scheduling a hearing, the APCOM Reviewer will get in touch with you, the attorney Representative or other legal counsel, and Prudential to mediate your claim. This means that the APCOM Reviewer will communicate with you and someone from Prudential, either by telephone or in person to see if the claim can be resolved. The only materials allowed before the APCOM Reviewer at the mediation stage are those contained in your claim file. Additional materials from any party will not be accepted or considered at the mediation stage.
C. The APCOM Review Hearing
If a resolution of the claim is not possible through mediation, a hearing will be held in accordance with the following:
- Scheduling and Format of the Hearing
It is anticipated that, in most cases, the hearing will be conducted by telephone. If you, or your representative (or private attorney) wish to appear in person at the hearing, you must notify the APCOM Reviewer no later than 15 days before the scheduled hearing date. If you appear in person you will be responsible for your own travel expenses.
You will be allowed to submit a five (5) page written statement in support of your claim to the APCOM Reviewer fifteen (15) days before the hearing. Prudential may also submit a five (5) page written statement at least five days before the hearing. You and Prudential will each have ten minutes to make oral presentations to the APCOM Reviewer concerning your claim.
- Conducting the Hearing
The APCOM Reviewer will be responsible for conducting the hearing. The APCOM Reviewer may maintain the privacy of the hearing by excluding any person not having a direct interest in the outcome of the APCOM review.
- Postponements of Hearing
Sometimes it happens that one or more of the persons required to attend the hearing cannot be at the hearing as originally planned. If good cause is shown by the person requesting the postponement, the APCOM Reviewer may postpone the hearing for up to ten (10) days.
- Weighing the Evidence and Evaluating Your Claim
The APCOM Reviewer will independently review and evaluate your claim. The APCOM Reviewer may only award or grant relief that is specifically provided for and permitted by the Policyholder Remediation Plan.
D. The APCOM Reviewer's Decision
The APCOM Reviewer will review and decide the claim de novo. This means that the APCOM Reviewer is not bound by the original determination of your claim. The APCOM Reviewer will consider all of the evidence in your file, the written statements submitted by you and Prudential, and the oral presentations made during the hearing. He or she will then decide your claim under the Policyholder Remediation Plan as if the original determination had not been made. However, the APCOM Reviewer can award only the relief provided for under the Policyholder Remediation Plan. Please remember that the APCOM Reviewer's determination may result in an award of relief that is greater or less than the relief originally offered to you.
The APCOM Reviewer has thirty (30) days from the end of the mediation and/or the hearing to issue a decision, unless a longer time period is required. Once the APCOM Reviewer has made a decision, you will receive written notice of the decision.
F. Rehearing Procedures
If you believe that the APCOM Reviewer's decision is in error, you may, in certain limited circumstances, be entitled to a rehearing. The standards and procedures for seeking a rehearing will be included in the materials sent to you with the APCOM Reviewer's determination.