Though you may think that being approved for long term disability benefits is the end of the race, disability insurers like Northwestern Mutual handle their benefit claims on a month-to-month basis – which means that disability claimants must prove that they are entitled to continue receiving benefits each month. Below, we’ll explain more about what we’ve learned after handling thousands of Northwestern Mutual disability insurance claims and what claimants can do to keep their monthly disability income benefits on track.
GREGORY DELL: Hi. I’m attorney Gregory Dell joined today by attorney Cesar Gavidia, and we’re going to discuss tips for preventing your long-term disability claim with Northwestern Mutual from being denied. And Cesar, Northwestern Mutual is not one of the larger disability insurance companies. They offer group coverage, they offer individual disability coverage and we’ve probably helped hundreds if not thousands of Northwestern Mutual claimants.
But in this video, it’s kind of geared around the monthly claim-handling service that we offer in which we manage every aspect of a claimant’s long-term disability claim with Northwestern Mutual, and we’ll talk about what we do in that. But I want to provide some helpful information for people of actions and steps that they can take to keep themselves from being denied.
So when a person first calls you and says, look, I have Northwestern Mutual, what is your thoughts about Northwestern Mutual versus if they called you and said, hey, I’m with Cigna, and Prudential, one of those – it’s the big run of the mill group disability companies?
CESAR GAVIDIA: Right. Well, one of the first things that I probably already know without even asking is that they probably are insured under an individual disability insurance policy, meaning that it’s a policy that they went out and purchased on their own as opposed to having through some larger employer benefit type of plan.
There are some employer benefit plans at Northwestern Mutual, but it’s not typical.
GREGORY DELL: It’s not their bread and butter. They’re trying to make it bigger, but it’s not their–
Northwestern’s Attention to Detail Can Make Claim Approval Challenging
CESAR GAVIDIA: I’d say out of every 10 Northwestern Mutual cases, nine of them are likely going to be individual disability insurance policies. I’m also going to know that in dealing with Northwestern Mutual, they’re one of the more reasonable disability insurers out there. They’re not one of these companies that will kind of just, as soon as your claim is in, they’re already putting in into medical review to basically say with a predetermined decision that you’re not going to be eligible for benefits.
Northwestern Mutual you can expect is going to do their homework, they’re going to be very thorough in terms of all the documentation they’re going to ask for and they’re going to review, and they’re going to have the claim reviewed probably by specialists who are qualified for the conditions that you’re claiming disability for.
So if it’s an autoimmune disorder or if it’s some sort of orthopedic issue, you’re going to see a specialist geared specifically to those conditions that Northwestern Mutual’s going to be conferring with to determine whether there are limitations here that qualify you for benefits and eligibility under the terms of their policy.
GREGORY DELL: So with Northwestern Mutual being one of the smaller companies and usually being more reasonable than not being reasonable, I find, though, that there comes a higher attention to detail.
So yes, there are companies who are looking– they pick up a claim and they basically go, well how– what can I find to deny this claim? And I think Northwestern Mutual has been one of the few companies that actually says, where is the evidence that’s supporting disability? And if it’s there, then we’ll go with that and make sure it’s sufficient or not. And that’s truly a different philosophy than many of the other companies.
But with that comes a higher level of intelligence from a claims person who knows what they’re looking for as opposed to many of the other disability insurance companies who have what I call puppets or paper-pushers who are just getting the files, giving it to medical review, and whatever that medical reviewer or nurse or doctor says, that’s what they do.
And I feel like the Northwestern Mutual claims people maybe have a little bit more guidance, independence, knowledge to properly be able to evaluate records and take people more at their word rather than looking for excuses to– any excuse they can to deny a claim.
CESAR GAVIDIA: Yeah. I mean, usually in the days that you still had these massive like insurance conferences, and we’d be going to these lectures and different educational courses there, who’s sitting in the class, basically? It’s a lot of Northwestern agents or claims adjusters. These people have pretty– they’re pretty well-qualified and they’re pretty well-certified to be looking into– it’s like a profession to them versus just a job.
GREGORY DELL: So due to the amount of detail, though, that is going to be come from– or scrutiny, I should say, from a Northwestern person, let’s get into what steps the claimant should be taking to really protect their long-term disability benefits. And I want to start with, as you know, the go-to is the medical records.
Make Sure Your Medical Records Meet Northwestern Mutual’s Requirements
How do you make sure your medical records are up to the standards– or how does a claimant make sure their records are up to the standards that Northwestern Mutual is going to need to see?
CESAR GAVIDIA: Yeah. And I’m glad you said records, because look, medical support is important. But if your doctor’s saying, oh yes, you’re disabled. Let me write this letter for you saying that you couldn’t work in your occupation, that letter’s really meaningless if it’s not supported by the medical records, by the medical documentation. That’s the foundation of the disability claim.
And in order to establish a really good foundation in terms of the medical support and medical records, you have to be very consistently treating. This is where you kind of get into this gray area, because your doctor may only want to be seeing you at certain intervals. In other words, maybe only every three to six months or something like that, especially with conditions that don’t expect to– you don’t expect to see a lot of progression or change between month to month.
Certainly you want to see your doctor as often as they want to have you come in and report to them. But also what you report to them is important. You are the– basically, all of the information that you’re giving to them, they should be noting in your medical chart, in your records. All those complaints about any symptoms you’re having in terms of discomfort or pain or fatigue, weakness, or limitations with doing certain activities, if you’re not reporting that to your doctor, then that’s not making it into your medical chart and medical records.
And when the insurance company is reviewing everything and they’re going through your records to see if the records basically are consistent with the support that your doctor is giving you, they’re going to say, well, we don’t see that the records really support the limitations the doctor’s placing on you. We don’t see that there’s really much complaints in terms of pain or fatigue that you’re reporting to us now. So where is that? So that’s really important. Really consistent reporting to your doctor and accurate reporting of your symptoms.
GREGORY DELL: Right. Because a lot of claimants go to the doctor and the doctor says, how are you doing? And they basically say, I’m doing OK. But you’re doing OK compared to where you’ve been, or if you look at a pain scale of 0 to 10 and 10 is the worst, your normal is to basically have pain every day.
CESAR GAVIDIA: Right.
GREGORY DELL: But your 4 or 5 is someone else’s 10. So it’s not– you can’t go in and just be like, look, as long as I stay in probably the bad manner that I’m already in living with a 4 or 5 pain level, then you think you’re OK, and then the doctor writes, patient’s OK, no additional complaints. Well, Northwestern Mutual is going to eat up that medical record.
CESAR GAVIDIA: Right.
A Symptom Log or Pain Journal Can Strengthen Your Medical Records
GREGORY DELL: So you have to treat every single office visit like it’s the first visit. And I often say to claimants, I think you should be keeping a pain log or a symptom log, and you need to document any difficulties you’re having– it’s not just the pain, it’s, did you have difficulty picking something? Did you turn your neck and something hurt? Did you bend over and something hurt? Were you laid up in bed for 30 minutes? Did you have to go stand every 15 minutes when you went out to eat?
Whatever it may be with whatever medical condition you have that’s changing your life and making it where you can’t be a reliable employee that can work for eight hours a day, five days a week continuously like a normal non-disabled person would be needs to be documented. Bring that to the doctor. Ask the doctor to either attach that to the records or read in some of the things. Patient comes and has documented the following complaints.
Because if it’s not there, Northwestern Mutual eats it up and says, look, I see, you went to the doctor, there isn’t really a lot here. They documented a few things, but a lot of times at the end of the day, the disability company’s not going to challenge the diagnosis. It’s whether or not your complaints are raising to the level which make them disabling.
Your Attending Physician Statement Must Be Detailed but Balanced
Talk about, though, along the lines of the doctors. These are the importance of filling out the attending physician statement and how you assist claimants in making sure that raises to the level of acceptability by Northwestern Mutual.
CESAR GAVIDIA: Yeah. The attending physician statement’s critical. I can’t tell you how many times I’ve seen someone contact us and say, I’ve been getting paid for four years and they asked for this form to be completed by my doctor, and the doctor filled it out or had someone in his office fill it out, and the next thing I know, they stop my benefit payments.
Northwestern Mutual is going to review that form very, very closely. And if the right– well, look, there are certainly areas that are going to be just simple check-offs or provide an explanation to this. But if they’re not indicating that you continue to remain disabled with these limitations, that translate in your inability to work in your occupation or in any occupation depending on what the language of your policy requires, then they’re going to terminate your benefits as soon as they have any indication from your doctors that you no longer qualify under the terms of their policy.
GREGORY DELL: And so claimants who have been on claim at Northwestern Mutual for a year or two years or years should not let their guard down with these attending physician statements and write, same as previously reported or anything like that.
Because you don’t know, first of all, if you’re going to have a changed claim rep at Northwestern Mutual, and the claim rep at Northwestern Mutual is likely going to take that attending physician statement, give it to their in-house medical team, and you don’t know who the new individual is there that’s going to review that claim and be like, oh, I think the claimant should have been doing this or the claimant’s been complacent in their treatment for the past couple years. Maybe now it’s time to run some video surveillance or there’s a new medication. They’re not doing appropriate care. Lots of different things can come up.
So the point is is you always have to have your guard up and always do a thorough job with that attending physician statement, because you’re right, that’s the impetus for something that can lead to a claim denial. And then also, Cesar, touch on the claimants statement and how important it is to be honest and communicate everything that’s going on without exaggerating your symptoms because you’re a claimant who thinks, if I don’t tell them this, they’re going to think that I can go back to work.
CESAR GAVIDIA: So remember, these forms are basically how they’re receiving their updates on you. Sometimes, though, they’ll make a phone call and say, hey, how are you doing? Do have any new treatment? But typically it’s in these forms. That precedes usually that type of phone call. And it’s really important that what you say in these forms and what you represent to them in these forms is accurate.
They may ask you about your current activities. What do you do on a day-to-day basis. It’s a very common question with Northwestern Mutual. And a lot of people say, well, I watch TV, I read, I do some cooking, I’ll run some errands. But if there’s anything in these forms or not in these forms that might be inconsistent with something that is in your daily life, then you can expect that there’s going to be some questions on behalf of Northwestern Mutual that they’re going to be making.
They may say, hey, do you mind if we come out and sit down with you for a lengthy interview? Because now they may be suspecting that you’re not telling them everything about your daily activities. And that’s kind of the snowball. It starts there. And then before you know it, you’ve dug yourself in real deep and it can be very hard to get out.
GREGORY DELL: On Northwestern mutual’s claim forms, I know we often put addendums. And why do you do that? And talk about the usefulness of why you highly recommend–
CESAR GAVIDIA: Well, I mean, with Northwestern Mutual’s forms, it’s a lot– they’re a lot like many of the forms that we see. I mean, there’s very limited space to basically provide the response– a full response, an accurate response to their question. Sometimes there’s a certain art to explaining and answering these questions. Because like I said, you want to inform enough, but do you have to over-inform where you’re basically just giving them more information than they really need? And I’ve seen both. And you really kind of have to strike a perfect balance.
And so with an addendum, if you need one, then we use that. I mean, it’s an area that maybe you can go into more detail about the limitations you have and how they really are affecting your ability to do and to perform certain activities, not just your work.
If you’re like partially disabled or something, discussing and explaining how things are progressing and how you’re maybe cutting back some or how it’s affecting your ongoing work activities. Or if you’re totally disabled, maybe on some things in terms of daily living activities that you have. They always ask you about hobbies and different things that you do. And is it OK to have hobbies and still live a life? Of course it is. Of course it’s OK to do those things.
If it’s something that you have done– are doing now once, you did the past week, it’s not something you really regularly engage in. You went out and you trimmed a hedge that’s in your front yard that’s been bothering you, and now– yeah. I mean, is that something that you really have to report? No, I don’t think you need to add an addendum for that type of thing.
But I think that when it’s necessary, when you really need to provide a level of detail that gives Northwestern Mutual a better understanding of what’s going on with your condition and the way it’s impacting your ability to work in your occupation or conduct your daily activities, then I think an addendum is a good idea.
GREGORY DELL: Right. And a lot of the guidance we’ve done, too, is we’ve had many claimants who go from either residual to total or total to residual, and Northwestern Mutual has a very claimant-friendly residual definition of disability where basically, I think, if you can’t do something for less than 15% of the time that you used to be able to or as much time as you used to, then you could be considered residually disabled as long as you have at least a 20% loss of income from what you previously earned.
So residual opens up a lot of opportunities for a claimant to be able to maximize the benefits on their policy as well, and of course, we’ve represented a lot of doctors by Northwestern Mutual policies and dealing with the transition from residual to total and talking about other occupations as they may want to do.
And we just recently did another video– I believe you and I did on the medical occupation definition of disability, which is different than any other company that offers a– what they call an own-occupation definition of disability. So if you’re a doctor, I encourage you to specifically look out for our video on that.
So we always offer a free initial consultation, Cesar, for claimants no matter what stage they’re at in their claim, and especially someone who’s on claim. The only thing we need is a copy of their policy to review, so we encourage claimants to reach out to us for that. We also encourage you to take a look around our website.
For Northwestern Mutual in particular, we have provided a lot of information, whether it’s cases we’ve resolved, summaries of lawsuits, occupational information, medical information. And we try to give you the whole flavor of how Northwestern Mutual is going to evaluate a long-term disability claim and provide you with that education so that what to expect in the future.
Because Cesar, you know that claimants, it’s hard enough to deal with their medical documentation. Their life is turned upside-down, they’re not working anymore. But they don’t– they’ve not trained in how a disability insurance company thinks. So we put all this information out there on our website and we asked for reviews from other people about the company so that a claimant should always be aware– like looking over their shoulder as to what’s coming next. How does this company think?
And that’s the big thing. We want you to know how they think. We’ll guide you and protect you through this process. But the more you know, the better you’re going to be able to help yourself and work with us in the future.
So no matter where you live in the country, contact Cesar and myself. We welcome the opportunity to speak with you, and we’ll be here should you need us in the future. Thank you.
As you’ve learned, receiving long term disability benefits from Northwestern Mutual can require some ongoing effort – attending regular medical appointments, keeping a journal of your symptoms and limitations, and maintaining a conscious eye toward what’s posted on your social media profiles. It can be tough to juggle these obligations on your own, and fortunately, you don’t have to. The experienced legal team at Dell & Schaefer offers free consultations for disability insurance claimants, no matter what stage of the disability process you’re currently in, and our attorneys have helped thousands of Northwestern Mutual claimants continue their disability income benefits. Give us a call today to schedule a consultation with one of our long term disability insurance attorneys.