Northwestern Mutual Claim Denied

Northwestern Mutual is a massive insurance company that offers a variety of insurance policies, including life insurance, long-term disability, and short-term disability insurance. As a mutual company, it is owned by policyholders rather than shareholders. That doesn’t mean it isn’t profit-driven, however; in 2021 alone, its revenue was $34 billion.

If you have a disability insurance policy through Northwestern Mutual, you may be surprised to learn just how common claim denials are. Fortunately, there are options if Northwestern Mutual denies your claim for long-term disability. A long-term disability attorney can review your claim and help you file an appeal with the insurance company.

Based in Cherry Hill, Bross & Frankel advocates for people with disabilities in both New Jersey and Pennsylvania. Our goal is to help our clients get the disability benefits they deserve, whether they are applying for short-term disability, long-term disability, or Social Security disability benefits. Reach out today to schedule a free claim review with a member of our legal team.

What Happens If Your Northwestern Mutual Disability Claim Is Denied?

Long-term disability insurance policies are crucial to protecting your financial stability in the event that you are unable to work due to a medical or mental health condition. Unfortunately, actually receiving benefits can be challenging. This is particularly true when it comes to claims filed with Northwestern Mutual.

After a long-term disability claim denial, Northwestern Mutual is required to provide you with a written or electronic denial letter that contains the following information:

• Why your claim was denied, including any disagreements with medical professionals or vocational experts;
• Which part of the policy the denial is based on;
• That you are entitled to receive all documents related to your claim at no cost;
• Any rules, policies, protocols, and other guidelines that were used to deny your claim for long-term disability benefits; and
• A description of the appeals process, including any applicable time limits.

If your disability insurance was purchased through or provided by your employer, then your claims will be governed by the Employee Retirement Income Security Act of 1974 (ERISA). This federal law contains very specific rules that insurance companies must follow when processing and denying a claim. For example, an insurer must make an initial decision on a claim within 45 days of filing (although they can request up to two extensions and additional information from the employee).

However, if you purchased your own disability insurance, then the policy is considered a contract. Any disputes that arise will be covered by state law. Northwestern Mutual still has obligations to you under the terms of the policy (contract) and can be held accountable for wrongful denials.

There are many different reasons why a claim for long-term disability benefits may be denied. For example, Northwestern Mutual may deny your claim if you failed to provide sufficient documentation of your disability, including medical records, chart notes, and results of medical tests. Alternatively, your claim may be denied if your condition is not covered by your policy or if you have a pre-existing condition that is causing your current health issue.

Like other insurance companies, Northwestern Mutual may also scour your social media accounts to find proof to refute your claim. They also employ a team of doctors to review disability claims. Because many physicians are not skilled at drafting notes designed to support a disability claim, Northwestern Mutual’s doctors may be able to claim that you lack sufficient medical evidence to support your claim.

For some professionals, particularly those who are self-employed, Northwestern Mutual will take a close look at your financial history to determine the type of work that you were performing before you filed a claim. If you do not submit adequate financial documentation – such as tax returns, profit and loss records, or even your appointment calendar – then they may deny your claim on the basis that you haven’t proven that you cannot prove that you are unable to work.

Long-term disability claims can be complicated. For most people, the best option is to work with a seasoned disability lawyer when filing your initial claim. They can help to ensure that all of the appropriate paperwork is filed correctly and that all supporting documentation is included. 

If Northwestern Mutual denies your claim, don’t assume that this is the end of the road. You can – and in most cases should – file an appeal of the denial. A seasoned disability benefits attorney can help you with the process.

Appealing a Denial of an LTD Claim By Northwestern Mutual

It is possible to appeal Northwestern Mutual’s claim denial. The first step in the process is to closely examine the notice that the company sent to you to understand why exactly your claim was denied. In some cases, it is simply a matter of providing additional medical evidence to support your claim for disability insurance benefits.

You have a limited period of time in which to file an appeal. Be sure to look at the notice to make sure that you can file your appeal on time. If you fail to do so, then you may not be able to pursue an appeal. Importantly, even if Northwestern Mutual denies your appeal, you can still file a lawsuit in federal or state court to appeal the denial.

An LTD attorney can help you in a number of ways, such as by obtaining additional medical evidence or soliciting an opinion from your treating doctor or a vocational expert. They may also be able to make a legal argument based on the terms of your policy and any applicable law.

At this stage, it is important to put together the strongest possible case for Northwestern Mutual’s internal appeals process. If the insurer denies your disability insurance claim again, then you want the record to be as strong as possible for any federal or state court lawsuit. Courts will typically refuse to consider evidence that was not presented to Northwestern Mutual in your original application or appeal.

Even if you didn’t work with a disability benefits attorney to file your initial application with Northwestern Mutual, you can – and should – consider hiring a lawyer to help with your appeal. Your attorney will analyze your disability insurance policy, review the records that you provided to Northwestern Mutual, and develop a strategy for your appeal. Having legal representation is the best way to protect your rights and maximize the likelihood of a successful outcome.

If your policy was offered through an employer and, as a result, if subject to ERISA regulations, it is critical that you get assistance before you file an appeal.  Because of the unique treatment of “ERISA” policies by the courts, once an appeal is filed and Northwestern issues its final denial you are usually prevented from adding any additional evidence, or presenting any testimony in court.  Based on this, many attorneys will decline a case when a lawsuit needs to be filed if they did not have the opportunity to prepare and help build the case during the appeals process. 

How Bross & Frankel Can Help

When you are dealing with a stressful medical condition, the last thing that you want to do is deal with the bureaucracy of a disability insurance company. Unfortunately, filling out the paperwork correctly and submitting the right information is critical to having your claim approved. If Northwestern Mutual – or another insurance company – denies your claim, our law firm can help.

Bross & Frankel is dedicated to helping individuals with disabilities get the benefits that they need. With decades of combined experience in disability law, we have the knowledge to help you achieve the best possible outcome for your disability benefits claim. To learn more or to schedule a free claim review with a New Jersey disability benefits lawyer, call us today at (866) 327-2383 or fill out our online contact form.

What Type of Evidence Could Help Me Win My Disability Denial Appeal?

The answer to this question depends on the reason why Northwestern Mutual denied your claim. For example, if you failed to provide sufficient medical evidence to support your claim, it may be necessary to submit further documentation. For medical conditions, objective tests like MRIs, x-rays, and blood tests are often incredibly helpful to prove that you are disabled.

In some cases, it may be necessary to submit a written opinion from a vocational expert who can explain your limitations and how they affect your ability to work. A skilled disability benefits attorney can help you determine the type of evidence you may need to provide – or the legal arguments that you need to make – to successfully appeal a claim denial. In New Jersey or Pennsylvania, call Bross & Frankel to schedule a free initial consultation.

If Northwestern Mutual Denies My Appeal, What Can I Do?

The appeal process always starts with an appeal filed with the insurer itself. If the insurance company denies your appeal, then you may be able to file a lawsuit against them. For employer-provided disability benefit plans, this lawsuit will be filed in federal court under ERISA. Otherwise, the lawsuit will be filed in state court under a breach of contract and/or bad faith theory.

You must exhaust your administrative remedies (administrative appeals) before you can file a lawsuit. If your Northwestern Mutual disability benefits claim has been denied, time is of the essence. Reach out to Bross & Frankel today to learn more about your rights and options for filing an appeal.