Northwestern Mutual
NWM refused to have a hematologist review my claim since my "numbers are currently normal." They ignored my primary concern of relapsing
Hi there. I have a chronic autoimmune disease that has temporarily placed me on LTD 5 times over the last 18 years. I currently am in remission although I remain on several drugs that are essential to preventing a life threatening relapse. I am also receiving LTD benefits for an “own occupation” policy I have had for almost 25 years. Over the years I have had multiple rounds of IV chemotherapy, a stem cell transplant and a splenectomy. There have been some complications from the illness that have, for the most part, recovered. I have been a practicing surgeon for many years but at this point I question my capabilities due to the recurrent nature and treatment of my illness. Since another relapse is all but certain I would like to call it quits. My hematologist has documented that I can’t work the intensity and hours of the past because of the threat of relapse and the cumulative impact of my treatments and co-morbidities. NML has refused to have a hematologist review my claim since my “number are currently normal”. I disagree with this line of thinking and view it as a way to ignore my primary concern.
Reply
JP, I think your claim could be in a grey area if the issue is not a current flare up causing disability as defined under the policy, but merely the risk of relapse. Nevertheless, it is arguable that a hematologist should be reviewing your file, though from our experience it would probably be highlighted that your numbers are normal so there should not be any issue from that standpoint. That is not to say that the concerns of a relapse in light of your co-morbid diagnoses would not push you over the threshold for disability. Please feel free to contact our office to discuss your claim in greater detail.
