Northwestern Mutual is often at the top of lists of quality long term disability insurance carriers and was recently given an AA+ rating by S&P—the highest possible financial strength rating in the U.S. market. But this financial strength can be a double-edged sword for disability insurance claimants. At Dell & Schaefer, we’ve learned that when it comes time to file a disability lawsuit against Northwestern Mutual, claimants can expect a fight. Northwestern tends to dig in and mount a vigorous defense to a disability claim, and claimants who aren’t prepared for this process can quickly find themselves overwhelmed. From requests for records and financial documentation to secret video surveillance, learn more about the expectations long term disability claimants should have when preparing to sue Northwestern Mutual.
GREG DELL: Hi, I’m attorney Greg Dell here with attorney Cesar Gavidia. And we’re going to discuss disability insurance lawsuits against Northwestern Mutual insurance company. And Cesar, this is an interesting one, because overall, I think we’ve always said that Northwestern Mutual is probably one of the top five rated disability insurance companies in terms of a quality company.
But when it comes time to file a lawsuit, my opinion is that they’re really going to dig in and fight hard. And I want to go through in this video some of the expectations that people should have for filing a lawsuit against them and why we get to the opinion that they’re going to fight hard, besides the fact that we know because we’ve litigated against them so many times. But let’s start with first– the person who’s watching this video is concerned that they’re either about to be cut off or they’ve been cut off by Northwestern Mutual. And what first comes to your mind when you think about why it’s going to be a battle against Northwestern Mutual?
CESAR GAVIDIA: Well, the thing with Northwestern Mutual– there’s a lot of insurance companies that will do the big heavy lifting. Let’s call it like, the real hands-in-the-dirt investigation after they’ve denied the claim. In other words, they’ll let their defense lawyers do it, you know? Their defense lawyers will stick their surveillance teams on them, or private investigators, or they’ll go through the file and they’ll raise all these different legal arguments and things that you may have never seen or even heard from the insurance company themselves. Suddenly, these lawyers that you know, just get hired are the ones doing it.
Northwestern Mutual basically does all of this before they even deny your claim. OK, if there is surveillance that they need to do, they’ve done it. If there’s interviews that they need to have done, they’ve done it. They don’t wait for their defense team to do depositions, although they will. But you know, they will have had phone interviews or in-person interviews with you already. They would have kind of built up this basis for denial already before litigation actually occurs.
GREG DELL: Right, and then the other thing that I want you to talk about is talk about the quality of the people we usually deal with who are handling the claims of Northwestern and their experience, versus say, you know, like a big player like a Prudential or Cigna or something like that.
Northwestern Mutual’s employees are experienced and you must be prepared to get approved
CESAR GAVIDIA: Yeah, well there’s one thing about Northwestern Mutual. And I can tell you that you could tell that the executives, or you know, we call them the business decision people– they must really trust a lot of the claims handling people and claims managers. Because oftentimes, those are the people that are directly negotiating against us and dealing with us.
Sure, they’ll have an in-house lawyer overseeing things. Even when we’ve had mediations here, you know, they’ll bring you know their defense team. They’ll bring their in-house lawyer. But then, they also have this business person there.
And in many cases during mediations and things, business people or claims handling people, they don’t talk. They sit back. But Northwestern Mutual, they don’t have a problem discussing the issues in your case, explaining how they viewed things, explaining the issues that they had, particularly why you didn’t qualify or why you weren’t eligible for benefits. So that’s something unique about Northwestern Mutual that I don’t see a lot with other disability insurers is that level of trust that they have with their claims handling people, their claims personnel to deal with high-level lawyers dealing with disability insurance claims. It’s not something you see often.
GREG DELL: So I also think that the claims people who are assigned to the claim are very experienced. And they’ve been with the company for a long time. And the company has good values. So you know, I think that they’re looking to pay claims more so than they’re looking to deny claims.
But if they have a question or get a bad taste in their mouth about a claimant or don’t find that the medical records are super weak or not supportive at all, then they’re going to heavily lean towards a denial of that claim. Now, that being said, from our experience in handling numerous claims against Northwestern Mutual for claimants all over the country, even when the claim has been denied, talk about the ability to still work to get it reversed without having to file a lawsuit.
CESAR GAVIDIA: You know, I feel like– we’ve been doing this a long time. And sometimes insurance companies– they change. They change their philosophy. The changed the way that they do things. They change their principles and maybe strategies that they employ.
With Northwestern Mutual I feel that you know, at least availing yourself of this appeals process or going ahead with the recommendation of submitting more information to perfect your claim, or them expressing that certain things were missing– I just find that that hasn’t necessarily worked to the advantage of the insured or the claimant as much today as it used to before. I don’t know why.
I don’t know if it’s just been a change in kind of business philosophy of theirs, where they just kind of make their decision, and they feel confident enough with that. And you know, it’s just now you could sue us if you don’t agree with it. But you know obviously, if there are real things that are lacking in your claim, support that you could submit that will make your claim significantly better than it otherwise is, then you should go ahead and do that. Otherwise, it probably won’t help too much.
You know, if they say well, we need records from this period to this period. Well, what’s that going to do if you’ve already had the records up to that period and you haven’t found that they they’re disabled? So this new period of records you’re going to find that you’re disabled? Your medical reviewer is suddenly going to have a difference of opinion?
Well, I mean, it depends. If you suddenly had to go through a major surgery or something, then I think it would be important to submit something like that. But if you’re just going through the usual routine of going to see your doctors. They’re documenting the same thing they’ve always documented. Your prescriptions haven’t necessarily changed. And there’s really not much of a documentation of worsening or some distinctive difference, Then it’s probably not going to matter.
Factors that must be considered prior to filing a lawsuit against Northwestern Mutual
GREG DELL: All right, let’s talk about timing. And you touched on it briefly. When a claimant calls you and you review the whole file, do you immediately just say, OK, we’re going to file a lawsuit now? Or what are the factors you consider when determining when the right time is to file a lawsuit?
CESAR GAVIDIA: Well, particularly with Northwestern Mutual, you have to be aware of the legal action limitation provision. So it depends, of course, how long you’ve been involved in the disability claim process. But sometimes you’ll find a provision there that’s limiting you to, let’s say, three years to file your lawsuit.
And so, sometimes people come to us, and you’re at the edge of that time frame, and I don’t really have much of a choice. I don’t have time to request the whole claim file. I don’t have time to wait on the medical records to review everything to get a necessarily better understanding of the case before I file it. You just have to file it, because you have to preserve that person’s right to their lawsuit.
GREG DELL: All right, what about in a situation where you do have time? Are there scenarios where there’s other things you want to do before filing a lawsuit?
CESAR GAVIDIA: Sure, I mean, there are some cases where you may be considering doing some physical functional testing, so functional capacity testing. There may be scenarios where– because Northwestern Mutual in particular, their own occupation definition of disability is different than many other companies. So what they usually provide in their policies is an initial period of own occupation.
Now sometimes, you may have purchased that own occupation period through the life of the disability policy.
GREG DELL: Right, you can buy the option to have an initial period go to age 65 or lifetime, whatever it may be.
CESAR GAVIDIA: Right, but sometimes it’s limited to just a couple of years. So if Northwestern Mutual has paid you for your own occupation, let’s say, and then suddenly they’re saying well, we don’t think your own occupation disabled anymore, or we think that what you’re doing now is a gainful occupation. We’re not going to continue paying your benefits on total disability.
Well, then you know, we may have to do some vocational testing to determine if you’d be qualified to work a gainful occupation or not. We may have to do some transferable skills evaluation to determine if you even have the skills necessary. Like, if you’re a dentist let’s say, well, your education, training, experience– what can you really transfer skills to? What really could you do other than dentistry you know, or something in that field? You know, so those are the things we may need to consider doing before necessarily just jumping into a lawsuit.
GREG DELL: All right, let’s talk about some timeframes. We’re ready to file the lawsuit. Let’s just talk in averages, whether we’re filing in state or federal court and we always choose the venue that’s best for our claimant. And we’ve filed these cases all over the country against numerous companies, including Northwestern Mutual but what is a reasonable timeframe that a claimant should expect?
CESAR GAVIDIA: Well, from the time that the lawsuit’ filed, you could expect that the insurance company is going to answer that lawsuit or respond to that lawsuit sometime within you know, anywhere from 30 to 60 days. OK? These cases often land in the hands of their defense counsel you know, right at the edge of that time frame in which they have to respond.
Then we get a call from defense counsel asking if we’d kindly agreed to an extension of time to respond to answer so they can get the file, review it, and do a competent response. And we often agree to it, because 99.9% of the time if we dispute it, they’re going to file a motion. The court’s going to grant it anyways, and we’re going to just look like we’re unreasonable. So it’s a matter of just being professional and courteous and giving them that time to respond.
GREG DELL: So 60 to 90 days you get an answer. I mean, at the end of the day, our goal is try to get to a trial. How long usually until you could end up getting to trial?
CESAR GAVIDIA: The court’s going to set the timeframe. Right now, federal courts are backed up. These federal judges who are appointed by the President of the United States, they’re adjudicating or presiding over many different types of cases, not just civil disability cases or ERISA cases or whatever. They’re doing criminal federal cases, which is often the big backlog that they have.
So in some cases, you may have anywhere from a year to be in trial to two to even three years. I mean, that’s really a long time.
GREG DELL: Well, three would be extreme, but yeah.
CESAR GAVIDIA: But in some circuits like in California or in busy– in New York, or really busy places, that could be the case.
Over 90% of disability insurance lawsuits result in a lump-sum settlement
GREG DELL: What’s the reality as to how most of these cases end up being resolved?
CESAR GAVIDIA: Over 90% of civil cases that are filed today are resolved in some sort of settlement. Now, that could be achieved through mediation, which most federal courts require, in which we participate in all the time even before lawsuit’s filed. And sometimes it’s through just informal discussions with the defense counsel and their client. So most of these cases resolve in some manner.
GREG DELL: And then when someone does resolve in some kind of settlement, what are the typical types of settlements you see with Northwestern Mutual?
CESAR GAVIDIA: Most of the time when you reach a settlement with an insurance company– we’ve reached different types of settlements, creative types of settlements, whatever works in the best interests of our clients usually what we’re seeking– and always what we’re seeking. But most cases, disability insurance cases, resolve through a lump-sum settlement. In other words, it’s a complete divorce.
Imagine a divorce, a family law case where both parties have now irreconcilable differences. There’s no way to salvage this relationship. Both parties want to split up. They’re splitting the assets. They’re splitting the kids up.
And basically, they’re not really dealing with each other again, certainly not over any property or anything like that. And that’s how these cases usually resolve, through a lump sum settlement and a surrender of the insurance policy if it’s going to settle.
GREG DELL: So it’s a total buy out. They get a lump sum of money. And then are they free to do whatever they want or think they can do after that period of time?
CESAR GAVIDIA: Yeah, at that point in time, there are no ties left with the insurance company. If they were to return to work at some point in the future, it wouldn’t matter. It wouldn’t impact that settlement or anything at all. That’s the risk that the insurance company is taking on when they agree to a settlement.
GREG DELL: OK, the last thing I want to talk about is people always ask us how do we charge for these cases. And the way that our firm charges, because these cases take an extensive amount of time to litigate is we only charge on a contingency fee basis. That means that we’re not going to charge you any fees or costs unless we recover benefits for you.
If we do recover benefits for you, then it’s a percentage of the past and the future benefits. Or if it’s a lump sum settlement, then it’s a percentage of the lump sum settlement. And the fee varies in every single case based upon the benefit amount, because the benefits vary for all of our clients from anywhere from $2,500 a month to $50,000 a month. So there’s a big spread.
And obviously, the fees are going to vary based upon the facts and circumstances of the case, the amount that’s at stake, how long you’re supposed to continue to get benefits. There’s lots of factors. But the bottom line is unless we make a recovery, we’re not charging you any fees or any costs until such time that we win the claim or get a settlement.
So what we encourage you to do is contact us with a copy of your denial letter, whether you call Cesar or myself or any of the lawyers in our firm, we’re going to provide you with a free initial phone consultation. We’re going to review your denial letter and your policy. We’re going to let you know right away whether or not we think we can assist you.
If we need additional information, we’re going to ask for that. Now, Cesar, our clients are all over the country. But the beauty is that we can handle– they almost never have to leave their home to do anything, which is a great thing. And everything will be done telephonically or Facetime or any of those other modes of technology. So we welcome the opportunity to speak with you, and we hope that we will be able to assist you.
As you’ve learned, most Northwestern Mutual disability insurance lawsuits tend to follow certain patterns, even though the facts are different from case to case. Fortunately, at Dell & Schaefer, our team of disability insurance attorneys has extensive experience in litigating against Northwestern Mutual and can help negotiate a fair settlement of your disability insurance claim. And you don’t need to worry about paying legal fees until or unless you receive disability benefits, whether it’s a monthly payment or a lump sum settlement. To learn more about your legal options, get in touch with Dell & Schaefer to set up your FREE consultation today.