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Northwestern Mutual denies partial disability benefits to trial attorney resulting in lawsuit for violations of Washington Insurance Fair Conduct Act

The Northwestern Mutual Life Insurance Company (Northwestern Life) was recently sued by a disability lawyer for the violations of the Washington Insurance Fair Conduct Act and Washington Consumer Protection laws. In Kurt D. Bennett v The Northwestern Mutual Life Insurance Company, the plaintiff alleged that Northwestern Life in denying the plaintiff’s claims for disability benefits was in violation of the above mentioned laws and breached the terms of the disability insurance policy.

Northwestern Mutual Claim Denial History

The plaintiff was a self employed criminal defense trail attorney. While in full time practice, the plaintiff obtained two disability coverage policies from Northwestern Life. He maintained all the premiums obligations and kept his coverage in force. Both policies provided that in the event the plaintiff became partially disabled, the plaintiff will receive disability insurance benefits which are proportionate to any loss of his income resulting from the disability as long as the losses exceeded 20% of his pre-disability income. Benefits were payable whether the plaintiff was unable to perform all the duties of his regular occupation or unable to spend as much time at his regular occupation before his disability. The policies also provided for a waiver of premiums during the disability period.

On February 2007, the plaintiff developed Bell’s Palsy which paralyzed half his face causing him to suffer pain, exhaustion and made it difficult for him to speak. As a result, the plaintiff’s practice began to suffer. In order to reduce stress, the plaintiff scaled back his practice to the stage that he had to let go of his employees and moved his practice to his home. This subsequently caused the plaintiff to suffer a reduction in income exceeding 20% of his pre-disability income.

Refusal to provide copy of Records

The plaintiff then filed a claim with Northwestern Life for benefits under both policies and was denied the claims. The plaintiff made an appeal to Northwestern Life regarding its decision to deny him his claims for benefits and was informed on November 19th 2009 that his appeal was unsuccessful. On December 18th 2009, the plaintiff through his Washington disability attorney made a second appeal to Northwestern Life. In the appeal letter, the plaintiff’s disability attorney also requested Northwestern Life to provide “a complete copy of Mr. Bennett’s file.”

Northwestern Life replied on December 28th 2009 refusing to provide the plaintiff’s disability attorney any of its record regarding the plaintiff’s claim on the ground that such records were “confidential” and could not be released without a release from the plaintiff and his healthcare providers. Later, even though the plaintiff’s disability insurance lawyer obtained a signed medical authorization for the release of all records, Northwestern Life still refused to provide a copy on the ground that it was “required by law to protect the privacy of our Insureds and those third parties who supply information to us.” On the third request for the records, Northwestern Life claimed that “while those records do reference Mr. Bennett, they are the property of the providers from which we received the information.”

On April 26th 2010 and August 30th 2010, the plaintiff sent Northwestern Life the Insurance’s “Cover Sheet” which activated the 20 days notice period under the Washington Insurance Fair Claims Act. Northwestern Life however still did not alter its position regarding the denial of the plaintiff’s claim for benefits.

Violations of Insurance Fair Conduct Act & Consumers Protection Act

The plaintiff alleged in the lawsuit that Northwestern Life had:

Because of the above mentioned actions of Northwestern Life, it had violated the provisions of both the Insurance Fair Conduct Act & Consumers Protection Act.

Relief Sought by the Plaintiff

Due to the alleged actions by Northwestern Life, the plaintiff is seeking from the court the following relief:

Northwestern Life, in response, petitioned for the case to be removed and be heard in the Federal District Court for the Western District of Washington.

Comments (2)

  • Kathy,

    IME doctors will typically never provide a copy of the report. Compounding this issue further is the fact that insurance carriers will not provide a copy to the insured or even an attorney unless there has been a denial of benefits. One way around this is to request that NWM send the IME report to your treating physician and then obtain a copy of same. If you have been on claim for any appreciable period of time you may have reason to be concerned that they want an IME at this point. Please feel free to contact our office should you wish to discuss your claim in greater detail.

    Stephen Jessup Apr 26, 2015  #2

  • I have been paid partial disability payments by Northwestern Mutual (NM). NM has asked that I submit to further medical evaluation (which NM will pay for) with the doctor of their choosing. I am willing to participate in the evaluation, but I want to be provided with a copy of the complete evaluation directly from the doctor’s office. I have experienced difficulty in obtaining complete and truthful information about my claim from NM during the course of my claim. I have been told by their selected doctor’s office that (1) their policy is to only provide NM with a copy with the results of my evaluation and (2) I must petition NM for a copy of my evaluation. In light of NM’s refusal to provide records to the insured in the above case and my aforementioned difficulties, I am concerned that NM would use information against me which I would never see. Am I required to sign a medical records release (my preference is to have all medical records sent to me exclusively, and then for me to provide them to third parties)? Thank you.

    Kathy J. Apr 25, 2015  #1

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