Northwestern Mutual Long-Term Disability Denial
If you’ve attempted to file a claim on either your long- or short-term Northwestern Mutual disability policy and received a denial letter, you don’t have to simply throw up your hands in surrender. With the help of a skilled disability attorney at Robinson & Warncke, you can appeal a denial and fight for your benefits.
How the Northwestern Mutual Claims Process Works
Northwestern provides both individual and group policies. Group policies are generally purchased by your employer. If you need to file a claim under either policy, the Northwestern claims managers will review your claim alongside the terms of your policy.
Northwestern will take your own doctor’s notes into consideration; however, they can leverage ambiguous terminology or a lack of medical certainty as an excuse to deny your claim. Robinson & Warncke understand how long-term disability companies operate and can help you prepare an initial claim by ensuring that your records accurately reflect your situation.
As a mutual company, Northwestern is owned by policyholders, not shareholders. The company is considered one of the top three providers of long- and short-term disability benefits, and has a pretty good reputation for selling policies. But when it comes to denying claims, their tactics are aggressive.
At some point, Northwestern Mutual may require that you do an interview with one of their representatives. You should not do this interview without your attorney present. Bear in mind that the insurance company represents its own interests, not yours. Their job is to reduce the number of payments to the extent possible.
Tactics Northwestern Uses to Deny Your Claim
Northwestern will often require you to undergo a physical, or independent medical evaluation (IME), with a doctor who is on their payroll. Their primary focus is not to determine whether or not you have a disability. It’s to provide the insurance company with a valid legal reason to deny your claim.
Exploiting Ambiguities in Your Records
A doctor or nurse will go over your medical records with a fine-tooth comb and then exploit ambiguities in your records to show that you do not have enough evidence to support your claim. This can include saying that your condition is either psychiatric or “somatic” — a term used to describe a functional disorder or any other disorder for which is difficult to discover under laboratory examination.
Trying to Discredit You
Additionally, even when your claim is valid, Northwestern will attempt to discredit you personally. They will conduct a thorough investigation complete with social media surveys and hire private investigators to tail you around. They will also conduct background checks on you and if they can find any reason to deny your claim based on that information, they will. This may include criminal convictions, injury settlements, divorce agreements, and just about anything else they can get their hands on.
When dealing with a protracted or particularly combative disability claim, we advise our clients to disable all their social media or (at the very least) be very careful about what they post. If you post anything that could be interpreted as indicating your disability isn’t as serious as you say it is, Northwestern will certainly use that against you to try to discredit your claim. Long-term disability insurance providers will go so far as to conduct surveillance and send private investigators to snap photos of you in positions that compromise your claim.
This information can be used to both deny your benefits or terminate benefits you are already receiving. Yes, that means that Northwestern Mutual will continue to keep tabs on you while you are receiving disability benefits. And if they catch you doing something that you claim you cannot do, then they will attempt to cease paying your disability benefits.
Requiring Detailed Information on Pre-Disability Job Duties
In a long- or short-term disability claim, you need to be able to establish two elements. The first is that you are medically disabled. The second is that your disability prevents you from doing the work you used to do.
Northwestern Mutual will require you to provide a detailed list of your duties at your previous job. This may include appointment books, client lists, and a full work description. For those who work in white collar jobs, the standard can be quite high. For instance, doctors, lawyers, and other office workers may have a more difficult time collecting on their policies. You may be required to provide two years worth of profit and loss statements, tax returns, and other financial documents. If you are seeking partial disability, the requests for information will be even more extensive.
How a Skilled Disability Attorney Can Help
Your Northwestern Mutual long-term disability denial letter will generally give some reason why your claim was denied. This may be as simple as claiming a lack of conclusive evidence that your claim meets the criteria for “disability” laid out in the contract. However, since that excuse is so generic, it becomes easy for claims managers to use it when they want to deny a claim without valid cause.
Robinson & Warncke can help if Northwestern Mutual has done the following:
- Determined you are not disabled using a false description of your current occupation or duties;
- Misclassified your policy as requiring that you cannot perform “any” occupation as opposed to your own occupation;
- Generalized the requirements of your job based on false assumptions of what duties someone in your occupation is required to perform;
- Failed to evaluate all medical evidence related to your claim;
- Denied your claim based on specious reasoning;
- Continually required more information as a delay tactic;
- Underpaid your claim based on invalid or extra-contractual reasoning; or,
- Otherwise violated your rights under ERISA.
A long-term disability can also help you appeal a denial. To learn more about appeals, read our article Should I Handle My Own Appeal?
What to Do After a Northwestern Mutual Long-Term Disability Denial
If your claim has been denied or you’re getting the sense that Northwestern Mutual is stalling, Robinson & Warncke can help. We have successfully protected our clients against aggressive surveillance tactics and biased medical exams. Contact us today to learn more.