Prior to filing for long term disability benefits under her private individual disability policy with Northwestern Mutual due to severe gastrointestinal medical conditions, our client was a courtroom attorney in civil practice. Due to the multiple complications associated with her conditions she began to experience ever increasing difficulty being able to maintain the demands of being in Court and began decreasing her case load and outsourcing work to other attorneys. At that time she filed a claim for disability benefits with Northwestern Mutual, which was initially approved on account of her gastrointestinal conditions, a decidedly physical medical condition. For some time there was little concern with Northwestern Mutual, but as time passed she began to experience increased scrutiny, which concerned her and prompted her to contact Attorneys Dell and Schaefer where she began working with Attorney Stephen Jessup. It was shortly thereafter that Northwestern Mutual began a full blown review of her claim.
Physical to Mental…
Despite a lengthy history of claims approval based on the limitations from her physical medical conditions, Northwestern Mutual took a position that from a physical medical standpoint there was no documentation contained in the medical records that would result in restrictions and limitations on her ability to return to full time work as a courtroom attorney. Instead, Northwestern began focusing on the available information relating to the anxiety she was experiencing on account of her gastrointestinal conditions. To perpetuate this agenda Northwestern Mutual required our client undergo an Independent Medical Examination (IME) with a gastroenterologist, who opined that she would not be prevented from performing the duties of her occupation based on her gastrointestinal conditions.
Based upon the opinion of the IME doctor, Northwestern Mutual determined that our client was only disabled due to anxiety. This is in spite of the fact that it was abundantly clear that any anxiety our client experienced was secondary to her concerns over the nature of her physical medical conditions. In rendering this decision Northwestern Mutual effectively limited our clients continued disability benefits to two years under the limitations for mental health conditions under the policy.
… and back to Physical.
Although it would initially seem that the change in Northwestern Mutual’s position was a detrimental blow to our client’s right to collect continued benefits, Attorney Jessup was able to ensure our client would continue to receive continued monthly benefits under the two year mental health limitation while he appealed the decision. Attorney Jessup coordinated with our client to obtain additional treatment to support continued disability on account of her physical medical conditions, and reached out to her doctors in an effort to systematically attack the basis of Northwestern Mutual’s decision. After a short period of time, with the increased treatment and information gathered, processed and presented, Northwestern Mutual overturned its decision to deny our client’s claim for benefits based on her physical condition, reinstated her benefit due to her physical conditions and lifted the two year mental health limitation from her claim.
Is your insurance carrier approving benefits based upon an incorrect medical condition?
It is not uncommon for an insurance company to approve benefits for a medical condition which has a limited time period for payment under the terms of the policy. Quite often depression and anxiety are “secondary” to a physical medical condition. It is imperative that this fact and the information supporting it are properly presented to the insurance company in order to avoid having your claim for benefits subject to a limitation under the policy.
If you have concerns over your insurance company’s determination as to your disabling condition, or your insurance company has already advised you that it is only approving benefits under a limitation in your policy please feel free to contact Attorneys Dell and Schaefer for a free consultation.