Northwestern Mutual Long-Term Disability Denial: How to Appeal
Northwestern Mutual is an insurance company based in Milwaukee, Wisconsin that offers disability insurance, life insurance, annuities, and other insurance and financial services. In 1859, just two years after its founding, the company experienced its first two death claims when a passenger train and an ox collided. The company did not have enough funds to cover the losses, and so the company president and fellow trustees personally borrowed the funds needed to settle the claims.
Despite this heartening story, it is not always easy to get a long-term disability claim approved by Northwestern Mutual. In 2010, Robert Mustain-Wood, a Colorado lawyer, suffered congenital heart failure. He attempted to return to work part-time but was unable to handle the high-stress environment of his job. He applied for long-term disability with Northwestern Mutual. Due to attempting to return to work, even though unsuccessful, he was not found disabled and his claim was denied. Mustain-Wood appealed, and his case was taken to court. It was ruled that Northwestern Mutual owed him benefits for not being able to fully resume his duties after his heart failure.
Northwestern Mutual, despite boasting a selfless reputation, will dig into your case to find any reason to deny your claim. Building an appeal can be difficult and stressful, but the lawyers at Chisholm Chisholm & Kilpatrick can aid you in the process. Our attorneys have extensive experience handling complicated long-term disability appeals and are able to assist with your claim. You can contact us at 800-544-9144 for a complimentary consultation with a member of our team.
Why Did Northwestern Mutual Deny My Claim?
You will receive a letter from Northwestern Mutual informing you that your claim has been denied, or, if you were previously receiving monthly benefits, that your benefits have ceased. In this letter, you should find the reasons that your claim was denied or your benefits terminated. You will want to carefully review this letter to prepare your appeal. The reasons your claim was denied will help you identify the areas of your claim that need to be strengthened.
There are several reasons that Northwestern Mutual may deny long-term disability claims, such as:
- Failure to meet your policy’s definition of disability: The definition of disability in your claim will define the terms you must meet for your condition to qualify for benefits. Often, this definition will follow either the own occupation or the any occupation definition of disability. Under the own occupation definition, you must be disabled from performing your individual occupation, while under the any occupation definition, you must be unable to perform any occupation in the workforce. Failure to prove that your disability meets your specific definition of disability may be grounds for a claim denial.
- Insufficient evidence: Your medical records will be required by your policy to document your condition, but often you will need more supporting evidence. If you do not submit enough additional evidence, or evidence that is not strong enough, Northwestern Mutual may find that as a reason to deny your claim.
- Active surveillance: Northwestern Mutual may keep surveillance on you. By doing this, they are trying to find something in your daily activities that will invalidate your claim. Hired investigators may record you on camera, track you using a GPS, or stake out near your home or places you frequent. A representative may even visit your house for a face-to-face visit. While under surveillance, your actions will be scrutinized. If Northwestern Mutual believes you are doing anything that does not align with your claim, they may deny you benefits.
- Social media surveillance: Investigators may also keep an eye on your social media. Your claim may state that you cannot be on your feet for long periods of time, but a video of you dancing at a wedding is posted online. While you know that was the only time that night you were on your feet, an investigator may report it as a claim violation. You will want to be careful about what you post, as well as what friends or family may post, because it can be easy for Northwestern Mutual to take a video or picture out of context and use it to deny your claim.
- Missed deadlines: A missed deadline can easily result in a claim denial, or a loss of rights to your benefits altogether. This is especially relevant if your long-term disability claim is governed by ERISA, which imposes strict regulations on group plans.
How to Build Your Appeal after a Denial from Northwestern Mutual
When you understand the reasons your long-term disability claim was denied, you can move forward in building a stronger case for your appeal. You may want to strengthen weak evidence or seek additional forms of proof. If your claim is ERISA-governed, you will not be able to submit evidence after your appeal, which means getting the best evidence on the record is particularly important during this stage.
Steps you can take to strengthen your appeal include:
- Make sure your evidence is up to date: You do not want to submit old evidence in your appeal. As you gather materials, you should ensure that you are submitting the latest forms of evidence. This means going to additional doctor appointments or being reevaluated.
- Correct errors you made in your initial claim: If you were denied benefits because your claim did not satisfy all requirements correctly, or did not follow guidelines, your appeal is your chance to fix these errors. You may want to adjust the language you use in your claim to suit Northwestern Mutual’s policy requirements or ensure that the correct types of evidence are submitted. Reevaluate your definition of disability to confirm that you are meeting your policy’s terms if you did not satisfy it the first time.
- Acquire additional medical evidence: As mentioned, your medical records are often not enough to satisfy your claim on their own. Obtaining a written report from your personal physician can highlight symptoms discussed during your appointments that may not be emphasized on your record. It can also be helpful to seek the assistance of additional medical professionals who may be able to perform further evaluations that can document other aspects of your condition.
- Seek the assistance of a vocational expert: A vocational expert will review and judge your ability to perform the functions of your job with your medical condition. They can provide evidence as to the ways your condition disables you from the physical or cognitive duties of your job. A vocational expert can be especially helpful if you are fighting an appeal based on a change in your definition of disability.
- Obtain statements from personal acquaintances: The people you interact with in your personal life have typically witnessed the ways that your condition has affected you. It can be useful to get statements from coworkers, who can speak on how your condition affects your work, as well as friends and family, who may be able to provide evidence as to how your condition disables you in your personal life.
Chisholm Chisholm & Kilpatrick is Here to Assist You with Your Long-Term Disability Appeal
It is beneficial to seek the help of an attorney for your appeal. While it is possible to handle your claim on your own, a long-term disability lawyer may be able to aid you in ensuring that all steps in your appeal are completed correctly. The lawyers at CCK have experience with Northwestern Mutual’s long-term disability policies and will evaluate your personal plan to determine the best evidence to prove your case.
We understand how Northwestern Mutual may make the long-term disability process difficult for you. We know that insurance companies often include confusing requirements in their policies or prioritize their business needs over your need for benefits. A CCK representative can ensure that your claim is being treated fairly. We will do all that we can to prevent you from being subject to any further wrongful denials.
Chisholm Chisholm & Kilpatrick attorneys work with a variety of medical and vocational professionals who can provide additional evaluations for you. Utilizing our trusted contacts can be convenient as opposed to seeking out experts on your own. We understand that appealing a case with Northwestern Mutual can be stressful and tiring. We want to provide you with the resources you need to build your appeal. From documentation and statements to medical evidence necessary for your claim, we can collect it all while you focus on your health.
Contact CCK Today for a Free Consultation
Our long-term disability lawyers are prepared to assist you with your appeal against Northwestern Mutual. Our legal team has over three decades of experience fighting for the benefits of those who have been wrongly denied. With our knowledge of long-term disability practices and ERISA law, we are ready to get you the benefits you deserve.
If you have a disabling condition and need to appeal a denial from Northwestern Mutual, you can call us for a free consultation today at 800-544-9144. You can also contact us online to speak with a member of our team.
