• Northwestern Mutual Disability Benefit Lawsuit Expectations & Legal Tips
  • Northwestern Mutual Doctor & Dentist Disability Benefit Legal Help
  • Northwestern Mutual Long Term Disability Claim Tips
  • Northwestern Mutual Disability Denial Lawyer Help
  • Northwestern Mutual Insurance Disability Claims
  • Beware of Hired Gun Doctors in Disability Insurance Claims (Ep. 23)

Northwestern Mutual Disability Claim Denial Reversed By Court

A Colorado court recently brought down a very harsh ruling against Northwestern for blatantly abusing its discretion in denying long-term disability benefits to a Colorado Family Law Attorney (Mr. M) who suffered congestive heart failure and underwent aortic valve replacement surgery and thoracic aortic aneurysm repair.

Two interesting issues were addressed by the Court in its ruling. The first is the applicability of a certain Colorado statute (Colo. Rev. Stat. § 10-3-1116), and the second is Northwestern’s interpretation of the plan’s own occupation definition of disability in the context of Mr. M being an attorney specializing in the practice of Family Law.

Colorado law does not permit plan or claim administrators to reserve discretion to interpret the terms of the policy or determine eligibility for benefits

Colo. Rev. Stat. § 10-3-1116 states in pertinent part that:

This statute went into effect in August 2008. Mr. M’s policy with Northwestern became effective on March 1, 1995. The Colorado Supreme Court holds clearly that this statute will not apply retroactively. However, Mr. M argued that, because his firm renewed the policy in 2009, the renewed policy is subject to the terms and conditions of the statue.

Unfortunately, the Court did not agree with Mr. M. It found that to apply this statute to the renewal of a 13 year old policy would impose new obligations and restrictions that were not considered when the parties originally executed the policy. Parties should know and understand their obligations under a policy at the time it is issued and it would not make sense for policies to be automatically altered based on the “whim” of Colorado’s legislature.

Northwestern was wrong in its interpretation of the policy’s “own occupation” definition of disability

In its letter upholding the denial of Mr. M’s claim for long term disability benefits, Northwestern explained that it was not required to consider Mr. M’s occupation specifically as a Family Law attorney or “Divorce Law Litigator”, nor was it limited to considering the types of cases he handled as “high conflict/high asset/children with special needs litigation” cases. Northwestern stated that the Own Occupation definition was not workplace or employer specific, but rather, it referred to a set of duties as they are performed in a typical industry setting. Accordingly, Northwestern analyzed whether Mr. M was disabled based on the general duties of a lawyer and did not take into consideration his specific duties in practicing family law.

The Court determined that Northwestern was wrong by not taking into consideration Mr. M’s specific duties as a family law attorney. In oral argument, Northwestern argued that Mr. M chose not to return to work in the practice of family law and that he could have chosen to practice law in another area because he was qualified to do so as a “general practitioner”. The Court states that, while attorneys are not technically permitted to “specialize” in certain areas of law, the reality is that most do practice within a narrow field and this serves to allow the attorney to hone his/her knowledge of the subject matter over years of practice so that he/she is competent in that area and can effectively litigate claims when presented with diverse and complicated sets of facts patterns. The Court goes on to state that it would be “counterintuitive to hold that an attorney such as [Mr. M], who has practiced family law his entire legal career, could immediately switch to and successfully practice in another area of the law without serious malpractice concerns.”

The Court determined that Northwestern’s denial of benefits based on its interpretation of the “own occupation” definition was unreasonable and that, “To believe Northwestern’s argument, I would have to disregard: (1) the inherent difficulties involved with practicing law; and (2) [Mr. M]’s physical condition after heart surgery. I will not do so.”

Northwestern also abused its discretion by ignoring the medical evidence

Mr. M’s policy provided that the insured shall receive disability benefits, if disabled, on the 91st day of disability. Northwestern denied his claim stating that he did not qualify for benefits because he was not disabled for the required 90 day period. However, upon review of the administrative record, the Court found that Mr. M attempted to return to work in a limited capacity but that the effects of congestive heart failure prevented him from working and, even in a low stress position, he experienced chest discomfort, tightness and some anxiety. One of Mr. M’s treating physicians stated that, “it does not appear to me that [Mr. M]’s heart has reverted to normal”, and that, “we know that [Mr. M]’s heart is still structurally abnormal”¦”.

A second treating physician initially stated in 2009 that Mr. M was able to return to full-time work. However, that physician subsequently, in 2010, wrote a letter which stated, “[Mr. M] is currently enrolled and taking part in a cardiac rehabilitation program. Due to his commitment to his recovery he is unable to work during his treatment period. Mr. M is due to complete his program June 13, 2010.” Northwestern, in its review of Mr. M’s claim, discounted the subsequent letter from this physician because it contradicted the previous opinion. However, the Court found that the 2010 opinion coincided with the first physician’s opinion, and that “two doctors state that [Mr. M] is not able to return to work.”

The Court ruled that, starting on his date of disability, Mr. M had a physical injury/illness that impaired his ability to perform the material duties of an attorney as it is usually performed in the general economy and that he was disabled for the required 90 day period under the policy. Further, Northwestern’s decision to uphold its denial of Mr. M’s LTD claim was an abuse of discretion and that such decision “does not lie anywhere on the ‘continuum of reasonableness.'” The Court ordered that Northwestern pay the maximum amount of benefits available to Mr. M under the terms of his policy.

Attorneys Dell & Schaefer did not represent Mr. M in his disability claim, appeal or lawsuit. If you have questions regarding your claim for disability benefits, or if your disability claim has been denied, feel free to call Disability Attorneys Dell & Schaefer for a free consultation.

On our website, you can read more about Northwestern Mutual disability claims, user comments and case summaries by clicking here.

Leave a comment or ask us a question

Questions About Hiring Us

Do you help Northwestern Mutual claimants nationwide?

We represent Northwestern Mutual clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Northwestern Mutual disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Northwestern Mutual. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Northwestern Mutual.

How do you help Northwestern Mutual claimants?

Our lawyers help individuals that have either purchased a Northwestern Mutual long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Northwestern Mutual:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Jim F.

My employer offered both Short Term Disability and Long Term Disability insurance as optional benefits among others. The premiums were significant, but since they could be payroll deducted I felt they could be reasonably managed and the security of continued income in the event of a medical disability was well worth the investment. As with the purchase of a first aid kit, most would prefer never having to use it.

I have been very fortunate to have had few illnesses or injuries throughout my life and more specifically my 45 year career as a healthcare professional. It wasn’t until early in 2012 that I was diagnosed with a chronic, progressive disease of the eye. Symptoms were minimal at that time, though regular visits to a retinal specialist, including regular therapy by ocular injection, were necessary to slow its progression, the symptoms did not appreciably interfere with my work. In spite of my treatments the condition continued to progress. In early 2014 the symptoms began to interfere dramatically with my day to day duties. My job required significant computer use and the reading of copious amounts of medical documentation. It became evident to me that I could no longer meet the expectation of my management and clinical position without working frighteningly long hours and enduring the relentless eye strain and other symptoms related to the illness.

Though I had always planned for eventual retirement from my full-time position, like most professionals I had hoped to be able to continue to practice my profession on a part-time basis throughout my retirement as long as I remained competent and able. That was not to be. Thankfully, I had the foresight to elect the disability benefit options offered by my company and have the premiums payroll deducted for many years. I notified my supervisor and HR representative that I had to stop working due to my condition and proceed with the disability application process.

All went very well and after using up my accrued vacation and sick time, my short-term disability benefits commenced. Since my condition is progressive and incurable I felt secure in knowing that once my short-term benefits were exhausted my benefits would continue under the long-term policy. However, much to my surprise, after receiving about a month of benefits I received notification from the insurance company that a decision had been made to terminate my benefits due to lack of objective medical evidence to support my claim, though significant documentation had been provided by my retinal specialist.

I was bewildered and unsure of how to proceed with an appeal of that decision. Since I had 180 days to do so, I decided to research the matter thoroughly. In spite of my being a veteran healthcare professional everything I had been reading on the subject cautioned about attempting to proceed with an appeal on my own. Legal representation was highly recommended.

I then began a review of local attorneys, hoping to find one that provided enough documentation on their website that indicated experience with non-social security disability related cases. I was also interested in seeing evidence of some experience with disability cases related to diseases of the eye and resultant vision impairment. I was unsuccessful.

So I expanded my search to include national law firms. It was then that I discovered Dell & Schaefer. After thoroughly reviewing their website, watching many of the video discussions, noting experience with vision related cases, particular documentation related to the insurance company that handled and then eventually denied my benefits, and reading a significant number of testimonials, I decided to request a free consultation as advertised. It was one of the best decisions I have ever made.

After that consultation, I was very confident that I was in very skilled hands which alone reduced my anxiety level immensely. Attorney Alexander Palamara and his Legal Assistant, Kathleen Bordes, immediately began managing my case, their professional expertise clearly evident.

They worked closely with my retinal specialist, my optometrist and the insurance company in compiling the medical documentation necessary for a successful appeal in an amazingly short period of time, keeping me fully informed all along the way. Shortly after being notified by the insurance company that my benefits would be reinstated and paid through the full term of my short-term policy I received a lump-sum payment.

Once the short-term disability appeal was successfully completed, Alex and Kathy immediately addressed the long-term policy benefits. Again in a remarkably short period of time I was granted those benefits, receiving a lump-sum payment for benefits to date and will receive a payment monthly going forward per the terms of my LTD policy.

I am extremely pleased with how my case was handled and the very favorable outcome. Alex and Kathy were a delight to work with and extremely professional in every way. Incidentally, the fee I paid to Dell and Schaefer for their incredible representation was very reasonable and very well earned.

I highly recommend the services of Dell & Schaefer to anyone who may find themselves in a similar disability-related situation.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us