Mass Mutual Insurance Company isn’t one of the big names in disability coverage, even though it does offer individual and group long-term disability policies. If you’ve been injured and are unable to work, Mass Mutual will pay you disability benefits according to the terms of your disability policy—but this coverage often doesn’t come without some hiccups, and benefit denials are common. What should claimants know about appealing the denial of a Mass Mutual disability benefit claim, including an ERISA lawsuit?
GREGORY DELL: Hi, I’m attorney Gregory Dell here with attorney Cesar Gavidia. And we are going to talk to you about private disability insurance lawsuits against Mass Mutual Insurance Company. And Cesar, the reason I said that they’re private disability suits is, at least from 99% of the cases we’ve seen is that the people who are buying these, Mass Mutual, long-term disability insurance policies have bought them from an agent. And basically, what that is that makes it a private contract. And that contract says that if you’re unable to work or whatever the definition of disability is, then Mass Mutual will pay you disability benefits.
Now, we have litigated a lot of cases against Mass Mutual for denied long-term disability claims. Let’s just start generally speaking, what is your view of Mass Mutual as a long-term disability insurance company compared to the other companies that offer long-term disability coverage?
CESAR GAVIDIA: Well, you know, Mass Mutual is not– being that they’re mainly in the individual disability insurance business, not in the group disability insurance business, you don’t see as many of their policies out there as you would. Or you don’t have as many claimants or insureds calling you regarding Mass Mutual as you would against you know, Unum or Hartford for instance. But when I’ve you know, come across or have been called by someone with a Mass Mutual disability insurance policy, and they have an issue or a question, I’ve always discovered and found in most cases that they’ve been paid for some period of time by Mass Mutual.
Now, there may be some issue that’s come up that now they’re either doing some intensive review of their claim, or they want to do some sort of independent medical examination of them or something like that. Or there might be an issue over– because sometimes these are loss-of-income policies, not so much true total disability policies. And we’ll get into that. But they may be working, and there may be some questions about the income they’re earning or something like that. But in most cases, I would say that we’re coming across people who are being paid by Mass Mutual, or who were paid by Mass Mutual at some point in time. And now, some issues come up.
GREGORY DELL: OK, so in terms of Mass Mutual, they’re not one of the companies where I talk about cultures in my opinion, where they’re like looking for every reason not to pay the claim. I think that they’re more– in the private companies, they don’t have the volume that these other companies have. They have better resources. They have less employee turnover, and I think they dial in a little bit more than the other companies on the review of the claim.
Sometimes they are over dialing in. And that’s leading to a denial that probably isn’t necessary and could probably be overturned, because they’re so thick in the weeds of what’s going on. We’ve seen that a lot. They think the claimant’s hiding something or whatever it may be. And we shake it all out and deal with that through the discovery process of litigation.
But this video is about the litigation and that whole experience. So you know, right off the bat, what’s a typical time frame for litigating one of these cases against Mass Mutual?
It is important to take immediate action to preserve your rights to a lawsuit
CESAR GAVIDIA: Well, you know, we don’t want to waste much time with any disability insurer in terms of filing a lawsuit if it’s ready for that. But with Mass Mutual, one thing that you have to be aware of is that their policies contain statute of limitation provisions. So what that basically means is that– and you’ll see it under the subject heading in the table of contents, legal action– and what that provision does is it limits the time frame that you may have statutorily under state law to file suit against Mass Mutual for a breach of contract, for denying your disability benefits.
And that period of time can start running from the time– around the time, I should say, that you submit your claim. OK, so you need to be very prompt and quick–
GREGORY DELL: Especially if they never approved the claim?
CESAR GAVIDIA: Correct.
GREGORY DELL: OK, so in terms of from the start of a claim to the end, what’s the average time period that you see?
CESAR GAVIDIA: Well, every claim is different. Some claims for example, I may have someone who contacts me with a Mass Mutual claim. And I’m looking at and I think, well, you know, I think you need to have a neuropsychological examination conducted, or I think that you need a functional capacity examination conducted. We have to gather your medical records. We have to ensure that you’re going to the right person to administer that type of examination.
And then we have to wait to get the report from that examination. OK, and that’s something that can be very helpful to Mass Mutual in terms of continuing to either pay your claim or overturning your claim. So you know, but regardless of what it is, you want to get moving very quickly. I don’t think in terms of– if it’s a case that requires a lawsuit, meaning that nothing extra needs to be done, you know, it could take anywhere from a year to two years to see a case through litigation.
Right now, the federal courts– and I just received in one of the district courts in California an order from the court stating that there are in emergency procedures, and they’re basically– they said, don’t depend on your trial date that we’ve set, because right now, we’re so bogged down with criminal federal cases that we don’t have time for a lot of the civil cases to tend to those within the time frame that we gave you in your original scheduling order. So they’re pushing those cases out another six months, another year in some cases before they’re heard or before you get to trial.
GREGORY DELL: Well, that brings up an interesting point, because you were talking about California. And we litigate these all over the country. That may be a reason that we want to take the case to another jurisdiction where they’re not as busy.
Because case I just filed in Philadelphia where they’ve added a few federal judges recently, the judge was like, OK, we’re going to trial in three months. So they’re on top of it there. So every jurisdiction is different. And we have some jurisdictional options based upon where the policy was delivered, based upon where the insurance company is–
CESAR GAVIDIA: With Mass Mutual for instance, you could always sue them in Massachusetts. That’s where they’re based out of. That’s their primary place of business. You could sue him right there.
If your claim is denied there may be options other than filing an immediate lawsuit
GREGORY DELL: But I want to go– you brought up a really interesting point before. Because when I asked you the timeframe, you didn’t jump right in and say it’s a year to two years. Because what you said that a lot of people don’t think about is you basically had your trial lawyer hat on where you’re like, wait a second. I got to look at the claim first and see if I have all the evidence where I like this claim.
This isn’t an ERISA claim where the record’s closed and we’re limited on evidence. So what you were saying was I may want to build more evidence, possibly resubmit it to Mass Mutual or maybe not. But even if you do, you may be looking at it– what you’re saying is, I think if we got this or that we may be able to win that claimant’s claim and avoid the whole litigation. And even if we don’t, then we’re giving them more information to review to make it harder for them to say no.
CESAR GAVIDIA: Correct.
GREGORY DELL: So that was a interesting thing. I wasn’t looking for you to say that in that answer. But obviously, very important, because we’re analyzing every claim to see if there’s a way that we can make it better.
CESAR GAVIDIA: And I think that that’s important. Just keeping in mind that just because you file a lawsuit, doesn’t mean you’re going to be in trial next month.
GREGORY DELL: No, for sure you’re not.
CESAR GAVIDIA: In some limited cases, for instance, you were talking about your ERISA case in Philadelphia. Well, the judges in that case are reviewing legal briefs, they may give you oral argument. And those types of things can usually get dispensed very promptly by a federal judge.
Whereas you know, a case where you have to conduct extensive discovery, where you may spend four days, five days in a jury trial where you’re bringing in witnesses and conducting direct and cross examinations and doing opening statements and doing closing statements– that could take a lot longer. And so the case the court has to give you more time to try that case. So I think sometimes doing some proactive work you know, upfront before you go and file that lawsuit could lead to a turnaround and that victory you’re looking for without having to expend all the time.
GREGORY DELL: So for more than 20 years, we’ve been litigating these long-term disability cases against Mass Mutual. And what I believe we’ve gained the respect of them as a law firm that this is what we do, and they know these are the cases we do versus the other lawyers out there who try to jump on these cases and aren’t really long-term disability insurance lawyers. Based upon our experience, some companies say, look, we know that if we litigate against you, you know exactly what to do. It’s going to be hundreds of hours of litigation. Is there any kind of like a pre-suit mediation or pre-suit resolution that is able to be worked out with Mass Mutual?
CESAR GAVIDIA: And the one thing I have to credit Mass Mutual with is that they’re usually open to engaging us in pre-suit settlement discussions or negotiations, at least just to openly speak with their in-house counsel about the claim. And the reason that’s important is because as soon as out lawsuit is filed against Mass Mutual, they’re going to be expending money on their defense.
And that means they’re hiring high-end lawyers, lawyers that are billing at $500, $550, $600 an hour. And that adds up very, very quickly for Mass Mutual. So there’s also that cost-benefit situation for them in terms of engaging us, talking to us early, trying to see if we could work out our differences. There’s a lot of companies that don’t offer that, but Mass Mutual is one that we’ve had some success with in the past with that.
The most common reason for claim denial is Mass Mutual’s reliance on their medical experts
GREGORY DELL: OK, in terms, I just want to touch a few things, and we had some things out there. The most common reasons for a claim denials and things like that. With Mass Mutual in particular, what would you say is the most common type of claim denial that you see?
CESAR GAVIDIA: Well, you know, I think that they’re a company that focuses pretty intensely on the medical records. So one of the common reasons for denial that I’ve seen is that they’ve sent your claim through a physician review process. Their physician, whether it’s internal or external, because sometimes they use external doctors– so as to say well, look, we hired someone outside who’s not hired by us, who’s not on our payroll to look at this. And it’s their independent opinion that the medical evidence here doesn’t support your claim or that you can’t perform your occupational duties. And that’s one of the reasons I’ve seen.
The other– you know, there’s other reasons that they bring up. If you don’t file your notice of claim timely. That’s really important.
GREGORY DELL: Well, that’s a technical–
CESAR GAVIDIA: Yeah, that’s a technical issue. And that’s one of those things I don’t think that they will necessarily completely preclude you from submitting their medical records, they’ll still go through a review, but it’s something that they certainly take into account.
GREGORY DELL: All right, so I don’t know if this is one or two. You know, you mentioned obviously, they’re going to dive into your medical records and eat them up and look for a reason. But I tell everyone when it comes to a jury trial, which is where this case is going to end up that the case is only as good as your plaintiff. Which means the case is only as good as you as the claimant.
And the way in which Mass Mutual defends these cases is based upon the credibility of the claimant. And so if they think that they can show that you are not being truthful, even if it’s only one thing– about one thing– then they’re going to try to relate that to your complaints about pain, your complaints about your limitations, your complaints about whatever it is you’re saying is causing you to be unable to do your job. And so, what are the tools that you find Mass Mutual uses to try to prove that a person is not credible?
CESAR GAVIDIA: Well, what they’re going to do is dive into a lot of things that you may not expect them to be diving into, aside from surveillance, because it’s a very common thing that you see a lot of insurance companies do. But they’ll dive into your social media. So if you hold Facebook accounts, Instagram accounts, LinkedIn accounts, I’ve seen them ask for Pinterest, which I was wasn’t even all that familiar with before.
But they basically ask for any and all social media information that you have. They may not ask for it at this level, but I know their defense lawyers that they hire, you know. And those defense lawyers– we recently got into a discovery dispute over how much information we have to give them in terms of the social media accounts of our client. They wanted usernames, passwords, they wanted conversations that they had on there, they wanted all the pictures.
We filed objections. You know, so we got into this. And there is case law out there that does say that if you post pictures on Facebook or Instagram, that’s something that defense can discover even if your settings are set to private. So you have to keep that in mind.
Anything that you put out there on the internet, whether it’s through Facebook, through Instagram, any of those social media accounts you hold, they’re going to most likely obtain them. And whatever activities they show on there, that’s what they’re going to use to try to say that you are capable of performing your occupational duties.
GREGORY DELL: Right, so even though they may not have found something during the claim process, they have an even more powerful tool during litigation, which is the subpoena power. And of course, we can objective things. But the standard is whether it would lead to any type of relevant evidence.
And it doesn’t mean it’s admissible because they can get it now, but they can still go out and get it. And one of the things that annoys me the most that they often try to get is credit card statements and bank statements and credit reports, because they’re trying to look, based upon your credit cards what you’re doing, where you’re going to dinner, are you going on vacations, where are you spending money, why are you at a sporting goods store, whatever it may be. Which can lead them to ask questions and inquire about your activity.
Mass Mutual will attack the credibility of the claimant to support their benefit denial
So it can be very, very intrusive. Doesn’t mean it’s admissible evidence. But they are going to look for every little thing that they can to determine that your credibility isn’t what you say it is. So if you have good credibility, very good chance of winning the case, even if your medical support isn’t the best. But if your credibility isn’t good, it’s a problem.
And it’s a bigger problem too, because jurors are skeptical, not only of insurance companies, but they’re skeptical of claimants who they think might be looking for a free ride or free money, or they just don’t feel like working, or this is a retirement plan, or something like that. So that’s a problem. So with regard to your Mass Mutual claim, no matter where you live in the country, we’re able to help you.
If you’ve been denied with your claim, which is what would lead to litigation, please email or send us a copy of your denial letter. Give us a call. We’re going to provide you with a free consultation.
It’s important for you to know that we never charge any fees or costs unless we win. And so basically what that means is there no fee to retain us. There’s no fee to initially speak with us. We’re only going to charge a fee based upon a percentage of your past and your future benefits if we win your claim.
Our rates are negotiable based upon the amount of your benefit. So that’s something that we’ll freely discuss with you. Our rate is also determined based upon the risk level that we see with your case. So we really want to provide you with the opportunity of a free consultation to let you know if we think we can help you. And we appreciate you considering our law firm.
The long term disability attorneys at Dell & Schaefer often work closely with Mass Mutual and can quickly contact the company’s in-house counsel to discuss your disability insurance denial. Not only can our experienced long term disability attorneys evaluate your legal rights and help you decide how best to proceed, but they can also subpoena information on your behalf, take depositions and prepare documents to build a case, file motions seeking relief, and try to protect a claimant’s sensitive or private documents from being turned over to Mass Mutual during the discovery process. If you need some help navigating your disability insurance denial, look no further than Dell & Schaefer.