MassMutual Long-Term Disability Denial
MassMutual ranks within the top 100 of the Fortune 500. However, their history of dealing with claims raises questions as to whether MassMutual puts its profits ahead of its policyholders. If you feel as though they’ve denied your insurance claim unjustly, you have the right to litigate your claim. Robinson & Warncke can help. We have successfully recovered millions in denied claims.
How Do MassMutual Policies Work?
MassMutual markets individual long-term disability policies to professionals such as doctors, attorneys, and small business owners who would otherwise not be covered under group plans. They also sell group plans to employers who provide these plans as part of an employment package at their companies.
The group policies are subject to ERISA rules that are governed at the federal level. Some executives are covered under ERISA group packages and supplement their disability coverage with an individual plan.
While MassMutual is one of the largest and most profitable insurance providers in the U.S., it is uniquely structured. Instead of being owned by shareholders and publicly traded, MassMutual is owned by policyholders (i.e., a mutual company). Superficially, that may seem like an excellent reason to purchase a policy from MassMutual. But MassMutual long-term disability denials are common and not always made in good faith.
Additionally, there was a recent class-action filed against MassMutual alleging that they failed to pay dividends owed to their policyholders. Despite reaching the decision that MassMutual acted in bad faith, the jury concluded that it was unclear whether or not the policies generated a profit and thus were not subject to dividends.
“Robinson Warncke Recovers $1.7M in Benefits, Overcoming MassMutual Attempt to Dilute “Own Occupation” Disability Coverage for Owner of Commercial Roofing Company”
Submitting a Claim to MassMutual
Claims forms have three sections that you need to fill out:
- Your own statement,
- A statement from your employer, and
- A statement by an attending physician.
These can either be mailed or emailed to MassMutual. MassMutual will then contact you within ten business days of filing the claim. If you are not contacted within ten days, you can call the claims manager and ask why the claim is being delayed. They may indicate that they require more paperwork. At this point, it may be a good idea to hire an attorney.
When Should I Contact a Long-Term Disability Attorney?
A MassMutual long-term disability denial is not the end of the road. It may be the first step in a frustrating process. But if your claim is valid, that process will end with you getting the disability benefits that you paid into for years.
How do you know when it’s time to contact an attorney? Any of the following events are generally very good indicators that it’s time to talk to a lawyer. MassMutual:
- Has requested that you meet with their claims adjusters or agents;
- Appears to be challenging your credibility;
- Is unwilling to accept a resolution or is claiming that you do not meet the threshold for a disability claim;
- Requested paperwork and, after you’ve followed up with them, claims that they never received the paperwork;
- Failed to respond to your claim leading to significant delays;
- Required that you attend a Function Capacity or Independent Medical Exam; or
- Has canceled your benefits after you sent them a disability progress report.
Insurance companies are always testing the limits of what they can get away with. Sometimes it’s worth it to pay out one bad faith claim if they can deny ten valid policy claims. In the past, MassMutual has been accused of:
- Willfully misinterpreting medical data to draw erroneous conclusions;
- Accusing their own policyholders of lying or misrepresenting their situation;
- Denying claims arbitrarily and without providing sufficient reason within the terms of the policy;
- Leveraging ambiguous language within the policy to deny claims (and thus moving the goalposts);
- Leveraging willing doctors to provide contrary medical findings to your treating physician’s;
- Misclassifying a physical disorder as a nervous condition to reduce potential benefits; or
- Simply denying claims without giving them a proper review.
Denials Based on “Somatic Symptoms”
MassMutual hires doctors who scour medical evidence and policies to develop terms such as “somatic symptoms” that can be used to deny claims. In medical terms, “somatic symptom disorder” refers to an extreme focus on physical pain or other symptoms that causes emotional distress.
In cases where a MassMutual long-term disability comes back denied for “somatic symptoms”, they’re claiming that you’re so overly focused on your physical ailments that it’s making you feel anxious, depressed, or some other emotional issue. They can thus claim that physical problems are actually nervous conditions and misclassify them as psychological disorders that are partly induced by physical problems. Clever, right?
Appealing a MassMutual Long-Term Disability Denial
A disability insurance attorney can help you appeal a denial of benefits. To learn more about appeals, read our article Should I Handle My Own Appeal?
When you hire a long-term disability attorney to manage your claim, we go out of our way to collect the required medical evidence to satisfy the claim. In many cases, long-term disability insurance providers will deny claims based on the ambiguity of certain facts. They will attempt to exploit ambiguity in the wording of the policy and, if certain medical data can indicate that your disability falls outside of the realm of the policy coverage, they will most certainly make that argument. In many cases, this ambiguity can be cleared up by simply ordering more tests.
The benefit of having an attorney manage your claim is that we are well aware of the tricks that disability insurance providers pull to try to get out of paying coverage to their policyholders. We build ironclad case files based on your medical reports and the duties of your current job.
There is no reason why anyone, having paid coverage into a policy for years, should ever be denied coverage when they need it the most. We can help ensure that you’re not among those who have been unfairly denied benefits.
Robinson & Warncke Can Help With Your MassMutual Long-Term Disability Denial
If you’ve received a MassMutual long-term disability denial, the attorneys at Robinson & Warncke can help. Contact us today.