Northwestern Mutual sells many different types of disability insurance policies and you must review your own specific policy carefully to determine the definition of disability and what documentation is required. As a general overview of tips for having your claim approved, you must:
- Present strong medical evidence of your disabling condition.
- Explain how the disabling condition makes it impossible for you to do your own job for the first 24 months, and after that time, show how it prevents you from doing any job for which you are otherwise qualified.
- Submit your claim for disability benefits within the time limits established by Northwestern Mutual.
- Be prepared for Northwestern’s disability insurance interview.
GREGORY DELL: Hi. I’m attorney Gregory Dell, here with attorney Cesar Gavidia. And Cesar, today we’re going to talk about Northwestern Mutual long-term disability claims and providing some tips and guidance as to how to get a claim approved for long-term disability. And we offer a service where we help– we’ve helped hundreds of people apply for long-term disability benefits, and there’s so many things that go on go into the claim based upon the person’s medical condition, the definition of disability, they have in their policy– because Northwestern Mutual sells a policy that’s almost like buying a car.
There’s so many different options, definitions of disability, limitations. And we’re going to touch on all those things today in this video, but I want to dive right in with you and get into, when you think about someone’s calling you for a claim, what’s the single most important thing to help a claimant get approved?
CESAR GAVIDIA: Well, the foundation of every disability claim– the most important thing of any disability claim is the medical support, without a question. Without the appropriate medical support, without your doctor’s cooperation, without ensuring that there aren’t any gaps in treatment, or an improper medical care, or anything like that– if any of those things are there, then you’re going to have a very challenging time getting approved with Northwestern Mutual. So absolutely, the single most important thing– at least from the onset– is ensuring that your medical support is there, that you’ve got a very well-documented medical history for your disability claim.
GREGORY DELL: OK. A lot of claimants call, and of course, we say to them, does your doctor support your claim? And they’ll be like, yeah, my doctor’s on board. But explain why it’s so much more than just the doctor saying, I believe this claimant is disabled or I believe this claimant shouldn’t work.
CESAR GAVIDIA: It’s funny that you say that. Usually, what I find with most people that call us– at least when they haven’t applied yet– and I ask them that question, they say, absolutely, my doctor supports me. For the people that call us that have been denied, or terminated, or they say that they’re in the middle of a medical review, it’s usually because their doctor has now done something. The cooperation has fallen off. The medical support is no longer there, or there is some issue going on with the doctor– either insurance company’s doctor or their own doctor.
But yes, if you’re going back in terms of ensuring that your doctors are on board with you, it’s not just a question of sitting down and that visit with them before you call us or before you contact Northwestern Mutual, and saying, doctor, do you do you support me? Do you think I should continue working? Northwestern Mutual’s going to go back, look through all of your medical records, look through your entire medical history, and if things aren’t lining up and if the proof or the evidence isn’t there for the opinion of your doctor to say that you should not be working, then you’re not going to get approved, or your claim’s going to be challenged.
GREGORY DELL: So I know what we do when we’re– what I called guiding a claimant is making sure that all of the complaints are in the medical records, making sure that all of the appropriate medical testing– even beyond what the doctor may want– and often, we’re telling our clients, you should go get this test or that test, because we know what Northwestern Mutual is going to look for. We know what they can’t dispute.
There are certain objective tests that are out there that the doctors say may not need it, but if you don’t have it, then the carrier’s going to say, why don’t you have it? If you do have it, there’s not much they can say because then it comes down to a subjective complain of pain based upon your– or limitation based upon your diagnosis.
So the other thing is a lot of clients are very uncomfortable going to speak to their doctor about supporting a claim and what that means. So how do you guide a client in terms of, number one, getting the doctor to appropriately document the file, and number two, filling out the attending physician statements in the appropriate manner?
CESAR GAVIDIA: As much as you may try to control some of these things, sometimes they’re just not within your control. Of course, in the extreme case, if you don’t like the way that your doctor’s documenting your medical history or if your doctor tells you, I don’t get involved with insurance claims or disability insurance companies, then you’re not– you’re most likely not with the right doctor– certainly not for your disability claim.
GREGORY DELL: Right. So don’t be afraid to change doctors, because we’ve had to suggest that’s going to happen or you’re not going to get approved.
CESAR GAVIDIA: Absolutely. Absolutely. I always suggest that you have to have a very serious conversation with your doctor, because most of them don’t really understand, as much as you may say– you would be surprised how many people, even with chronic illnesses or chronic pain conditions, when they go into their doctor’s visit and the doctor says, how are you feeling, they say, I’m feeling fine. I’m feeling OK.
Well, if you’ve got a history of doing that with your doctor– I’m feeling fine, I’m feeling OK– then, when Northwestern Mutual opens up that medical file and looks through it, they’re going to say, well, you felt fine, you felt OK through– for five or six months. What’s happened? What’s changed?
So you can’t be afraid to go into your doctor to express your complaints, to express your symptoms, perhaps even keeping a log so that you remember and you recall all those instances where you might have had a pain flare, or a fatigue flare, or something that you were– where you were symptomatic on account of your medical issues– or where you had to stop– had to call in sick or not go into work. The more that you could log that and you could show that to your doctor, the more credible you that you become in the eyes of your doctor, and the stronger your claim becomes as well.
GREGORY DELL: Yeah. The other thing I find that our clients have found helpful is that, when you go to the doctor, these doctors are aware of these disability insurance companies– not just Northwestern Mutual, but all of them, in terms of them having a very sharp eye towards what’s going on and leaning towards looking for a reason not to approve a claim. Doctors want to help their patients generally.
When you go in and say, look, I know it can potentially be difficult for me to get approved these benefits, but I can’t work and I need this– I hired myself an advocate, an attorney, who’s helping me, who’s dealt with these companies hundreds, if not thousands of times, and this is what they’re suggesting– the doctors love that for the most part, because they’re like, wait a second. Your lawyer’s helping me to advocate the right way. I’m on board with what is being said here.
And that’s great. The doctor’s basically like, you made my life easier. and I understand now because we’ve educated the claimant in terms of how they need to talk to the doctor, and the doctor loves that, instead of just getting a random claim form and not necessarily knowing what to do. And sometimes the doctors don’t even understand that this isn’t about activities of daily living. This is about unable to do either the duties of your occupation– which is the definition of disability that you bought in your policy– or unable to work in a particular occupation based upon experience, education, and training.
This isn’t unable to bathe yourself, feed yourself, toilet yourself, dress yourself– those kinds of things– big difference. This isn’t about being better, and this isn’t about asking for a handicapped pass for a car.
CESAR GAVIDIA: Yeah. And the advantage that Northwestern Mutual has, and disability insurance in general– disability insurance companies in general have– is that lack of understanding and knowledge that most doctors have in terms of the requirements that need to be met to qualify for disability. Like you said, this isn’t about activities of daily living. This is about the ability to perform the substantial material duties of your occupation, or any gainful occupation.
Well, those are specifically defined terms in the disability insurance policy. So if the doctor doesn’t understand that– and this is, well, I think– sure, I think you could go work as a greeter in a store. I think that you could do something. Some of these doctors sometimes even say, I don’t qualify any one for disability. Well, why is it? Obviously there’s disabled people in the world.
GREGORY DELL: Right.
CESAR GAVIDIA: There’s people in the world that are unable to work in their occupation or gainful occupation. So the more that they– just that education of your doctor in terms of what they need to say or what they need to certify, that’s going to help your claim tremendously.
GREGORY DELL: And then also the doctor being prepared to know that Northwestern Mutual’s likely going to call them and start asking him questions. And the claimants need to tell their doctors, do not speak to them unless you speak to either the claimant first or the attorney so that they can be prepared for that phone call.
CESAR GAVIDIA: Right.
GREGORY DELL: The next thing that’s going to be required beyond the medical support is then submitting the application. And determining the date of disability is a huge factor, which we could discuss with any potential when they call us because of so many different risk factors, and coordinating the medical records, coordinating possibly a preexisting condition, coordinating when you stopped working versus .
There’s a lot of factors just go into choosing that date, which are super important. But you also have to make sure the Northwestern Mutual understands the occupational duties that the claimant was performing. And how do you go about presenting that beyond the limited space that Northwestern Mutual asks for usually in their application?
CESAR GAVIDIA: I usually tell my clients, well, forget that form, or forget those six lines that they give you, where above it, it’s bold– occupational duties list. They give you six, seven lines to basically describe in detail your entire occupation. You have to basically communicate the importance of every specific duty you have and the demands of those duties within this limited space.
If you were filling out a resume for a job, you wouldn’t be able to do that in the limited space, so how could you really describe your occupational duties in the space they give you? So I often will leave that form– not leave it, but at least reference an addendum.
GREGORY DELL: Right– see attached.
CESAR GAVIDIA: See attached– provide a detailed description, often typed out, expressing and explaining the specific occupational duties you have in your occupation, the physical demands of that specific duty. If, say, you’re a surgeon and you’re performing a colostomy or an appendectomy. Well, is it required to be done standing up?
How long does it take, what are the instruments you use, what kind of movements do you make– that type of thing. Are you in a static position? Are you moving? So those are the types of things you need to get into in terms of your occupational duties with Northwestern Mutual.
GREGORY DELL: And also, you brought up physicians, and we’ve represented tons of physicians with Northwestern Mutual policies, but with doctors in particular, they’re always going to ask for the CPT codes– if you’re a dentist, the ADA codes. They’re going to look at your procedure reports because they want to understand what percentage of time you were spending– which duties, what percentage of your revenue was coming from which duties.
They’re going to ask for tax returns for many years. They’re going to ask for financial statements. They’re going to ask for bank statements. They’re going to ask for credit cards. And you need to know what you should provide them and not provide them. We also need to dive in and analyze what’s in there so that we can present it in the initial application in a manner that’s consistent with the codes, because we know they’re going to analyze the codes and ask for them.
The last issue to talk about with Northwestern Mutual is, once you get everything together or– and you have everything ready to go, in terms of timing, in terms of when you notify them, number one, and also about being prepared for the interviews at Northwestern Mutual almost always wants to do on a claim, and how important it is to be prepared for that interview.
CESAR GAVIDIA: Yeah. So the policy likely requires that they have to be notified within 90 days from the time that your claim begins or that your claim arises. So that doesn’t give you too much time– doesn’t necessarily mean that, if you file outside of the 90 days, that they’ll invalidate it, but you might have to give them an explanation as to why you’re filing outside of the 90 days.
There’s not always a perfect answer to that question. A lot of people say, well, I didn’t expect to be out this long, or I wanted to see if I’d improve and be able to go back to work, or– so there could be a number of reasons why. But usually, there is a specific time period where you have to notify them. These interviews that you were describing, they’re usually done within a very short period of time after you file your claim. Not everything necessarily has been entirely developed by that point.
GREGORY DELL: Right.
CESAR GAVIDIA: Have you had all the necessary conversations with your doctors? Are you sure that they’re on board and cooperating, and that they’re going to support your claim? When you have to go through your occupational duties with the claim representative on the phone, have you really sat down and thought about those duties, and what they entail, and what the substantial material aspects of your occupation are?
So the Northwestern Mutual claims representatives, they do these interviews all of the time. So they’re very accustomed to these interviews. They know what questions to ask. They know what are the questions that are really going to potentially cause your claim to be invalidated. So those are important things you need to be aware of.
GREGORY DELL: Yeah. The Northwestern Mutual claim people are very experienced. There’s not a lot of turnover over there. They know what they’re doing, as opposed to other companies, and so they’re a good company. They’re going to look at the claim in a reasonable manner, but if you’re missing something or you’re not prepared, they’re not going to pay the claim.
So bottom line is you’ve got to be prepared. You’ve got to have a strategy. In my opinion, the best way to go about doing that is to take us up on our offer for a free consultation. Let us review a copy of your long-term disability policy. Whether you’ve applied or you’re considering applying, whether you call Cesar, myself, or any of our lawyers, it’s an easy process.
You can go on our website, click a free consultation, submit your information. We’ll call you back right away. We’ll ask you to send us a copy of your policy. We’ll set a meeting. We’ll go over everything with you. We’ll let you know how we can help you– what are the strengths, what are the weaknesses of your claim? All of our clients, Cesar, as you know are located all over the country, and we appreciate you considering our law firm, and we hope that we’re able to guide you towards getting your Northwestern Mutual claim approved.
We suggest you take us up on our offer of a free consultation with one of our disability insurance attorneys at Dell & Schaefer. The first step is for you to mail or email us a copy of your Northwestern Mutual disability insurance policy. After we review it, we will call you and discuss how we can help. If we can, we will also explain to you our free structure. If we do not collect benefits for you, you pay us nothing. Start the process by calling us at 800-411-9085.