In The Northwestern Mutual Appeals Process, “DIY” Is Not Advisable
Once the appeals process is exhausted (and that really means you are exhausted by the endless requests for information and battling with Northwestern Mutual), the only recourse is to file a lawsuit. If you purchased your insurance through your employer, the policy is most likely governed by the Employee Retirement Security Act or ERISA.
Despite its name, the ERISA statute and regulations are NOT policyholder friendly. You CANNOT add anything to the claims file after the last denial so all the Federal judge gets to see is what is in Northwestern Mutual’s file which is stuffed with medical and vocational opinions that are favorable to Northwestern Mutual. If you didn’t know enough to get the claims file when you appealed, didn’t know enough to add medical, vocational, or lay evidence to the file, or didn’t make the right arguments, you have all but destroyed your case.
An appeal of a denied Northwestern Mutual claim is the trial of your case. Taking on a tough insurance company like Northwestern Mutual is an endeavor for a specialist. A federal judge will give Northwestern Mutual the benefit of the doubt because your Northwestern Mutual policy requires you to prove they are wrong and not the other way around. You owe it to yourself and your family to have an experienced disability attorney, like me, take on Northwestern Mutual. After all, this is about getting the disability benefits you deserve and you paid for.
Some policyholders have bought their own disability policy through an agent and that is known as an individual disability insurance policy. The game is the same but the playing field is more level because any claims denial can be challenged in state court which is a friendlier place to be if you have to sue Northwestern Mutual. Don’t think that Northwestern Mutual isn’t playing the claims delay, denial, or termination game with individual disability policies. They are, and the policy benefits at stake are high. There is much more to lose if you aren’t represented by a Northwestern Mutual individual disability attorney like me.
Three Types of Disability Policies that Northwestern Mutual Offers:
Group ERISA Disability Insurance
Northwestern Mutual offers disability policies through employers which are governed by ERISA. A Northwestern Mutual ERISA policy generally has the following:
- strict definitions of disability and occupation,
- limitations on how long payment will be made for mental conditions or subjective conditions like headaches, pain, fibromyalgia or chronic fatigue,
- “other income” provisions that allow for a dollar for dollar reduction for the receipt of Social Security disability benefits, workers’ compensation benefits, and personal injury settlements, and
- A “golden handcuff” on a judge that only allows for a claims denial or termination reversal if Northwestern Mutual’s decision is “arbitrary and capricious.”
Group Non-ERISA Disability Insurance
However, a group plan offered by a church plan, such as the Catholic Church, or by a municipal employer like the City of Baltimore, Baltimore County, or the State of Maryland is NOT generally covered by ERISA. The policy terms are much like those of an ERISA plan but there is one CRUCIAL difference. A claim denial or termination can be challenged in state court and new evidence can be submitted at trial.
State law courts are a much friendlier place for a policyholder than Federal court. You are entitled to a jury trial in a state law claim and not some Federal judge just making a decision based on Northwestern Mutual’s file stuffed full of things that are unfavorable for you!
Individual Disability (ID) Insurance
Without a doubt, the best and most expensive policy is a private individual disability policy known as an ID policy. The policy terms and coverage are broader and more generous. But that means a high monthly premium and a lot of financial exposure that Northwestern Mutual has if you become disabled. It isn’t uncommon for Northwestern Mutual to invoke a pre-existing exclusion or a medical condition policy rider right out of the box as a way to justify a denial of the claim from the beginning of the claim. That is just one reason why it is so important for a policyholder to contact me BEFORE they stop working and apply for benefits.
For example, let’s say you are a dentist who has a policy that excludes any claims for disability as a result of carpal tunnel syndrome but you now are unable to work because of a herniated cervical disc. The symptoms of carpal tunnel syndrome can mimic those of a herniated cervical disc that causes tingling, numbness, and weakness of the hand.
You can bet that Northwestern Mutual will be looking for a way to say that you are disabled as a result of carpal tunnel syndrome and not a herniated cervical disc. Do you know what your medical records say about your medical history, your carpal tunnel complaints, how your complaints are different because of the herniated cervical disc, or how they impact on your practice is different than your carpal tunnel symptoms? Northwestern Mutual fights an individual disability claim as hard, if not harder than an ERISA claim and costly mistakes can be made at the initial application and appeal stages of a case.
Northwestern Mutual Disability Claim FAQs
Below are some of the most frequently asked questions about Northwestern Mutual disability insurance benefits.
What is Covered in Short-Term Disability with Northwestern Mutual?
Are you preparing to submit a short-term disability insurance claim with Northwestern Mutual? If so, it is important that you understand how coverage works. Through a short-term disability insurance claim, an employee who is suffering from an injury or illness can recover temporary income replacement benefits. These disability payments provide a much needed financial bridge to workers and their families.
Depending on the plan, short-term disability coverage from Northwestern Mutual can cover anywhere between 50 percent and 100 percent of an employee’s pre-disability earnings. You may be covered by short-term disability insurance if you suffered an accidental injury, developed a significant illness, or are dealing with another type of disabling medical condition. If you have any specific concerns about the scope of Northwestern Mutual’s short-term disability coverage, please do not hesitate to contact our attorney for help.
What Happens If I Didn’t Get My Disability Payment from Northwestern Mutual?
Disability insurance should provide financial security to people in one of their times of greatest need. Unfortunately, in far too many cases, people struggle to get the full and fair disability payments that they are rightfully owed under the terms of their plan. State and federal regulations require insurance companies to process disability claims in a fair and efficient manner.
If you did not get your full and fair disability payment from Northwestern Mutual, you need to take action to protect your rights and interests. Do not lose out on your appeal to fix the problem or file an appeal. Contact an experienced Florida disability lawyer for immediate assistance.
With extensive experience going up against large insurance companies such as Northwestern Mutual, our law firm can protect your rights. We are more than prepared to help your figure out exactly what is going on. Additionally, we will fight to rectify the situation. If it turns out that your disability claim was denied by Northwestern Mutual, our attorney is more than ready to file an appeal on your behalf.
How Long Does Northwestern Short-Term Disability Last?
The duration of short-term disability insurance coverage depends on several different factors; most notably, the specific terms of your coverage. Northwestern Mutual explains that the company offers several different plan options. Generally, short-term disability coverage lasts between three months and one year. You should review the specific language of your plan to determine the maximum duration of short-term disability benefits. In some cases, you may want to get more comprehensive coverage.
While it can be frustrating and stressful to exhaust your short-term disability insurance coverage, there may be other options available. After your benefits have run out, you are not necessarily out of luck. In many cases, employees receiving short-term disability benefits can transition to a long-term disability plan assuming that their injury, illness, or medical condition persists. To get professional help with your short-term disability application, contact our Northwestern Mutual claims attorney today.
Hire A Lawyer Experienced in Northwestern Mutual Disability Claims
The disability claims process can be difficult to navigate on your own without legal assistance. Attorney Nancy Cavey has the experience and knowledge of how insurance companies like Northwestern Mutual operate, and how you can successfully appeal your denied claim. If you have further questions, or to get the help you deserve, contact The Law Office of Nancy L. Cavey today.