Successfully litigating cases against Northwestern Mutual can be extremely difficult due to Northwestern Mutual’s reputation for conducting thorough reviews of disability insurance claims prior to the denial of a claim. Our attorneys have extensive experience in representing insured at all levels of the claims process with Northwestern Mutual to include litigation. No two disability claims are ever the same, and as is the case with Northwestern Mutual, no two disability policies are either. It will take an extensive review of your entire file to be able to determine what the likelihood of your success in court against Northwestern Mutual would be. A proper review of your claim would include, but not be limited to, the following factors:
- Is your disability policy an employer provided group disability policy governed by ERISA or a privately purchased individual disability policy (IDI policy);
- Your disabling medical condition and how your policy may limit or deny coverage based on your medical condition;
- How accurately and thoroughly does your medical information support medical restrictions and limitations;
- The medical reviews conducted by Northwestern Mutual;
- Your pre-disability occupation and whether your claim for benefits is based on your inability to perform your “own occupation” or any occupation based on your training, education and experience;
- The occupational reviews performed by Northwestern Mutual to determine what your pre-disability occupation was, or any other occupations that Northwestern Mutual asserts you could perform based on your education and experience.
What type of disability insurance policy do I have?
Northwestern Mutual writes both individual disability income (IDI) policies as well as employer provided group disability (ERISA) policies. If you received your policy from your employer then it would be considered an ERISA group disability policy and if you purchased it on your own through an agent then it would be a private IDI policyFighting Northwestern Mutual in court under an ERISA policy versus an IDI policy is a night and day experience.
What to expect in court if your policy is governed by ERISA
Lawsuits brought against Northwestern Mutual under ERISA to secure disability insurance benefits are, as a default, unfair for the insured. Unlike what most people understand the concept of a “trial” to mean, ERISA litigation is uniquely different in the following ways:
- There are no jury trials. Your case will be decided by a Federal Judge alone.
- You, nor your doctors, will be allowed to testify at trial. Under ERISA there is no live testimony from any party to include anyone from Northwestern Mutual.
- You do not have the ability to depose any of Northwestern Mutual’s staff, employees or doctors.
- The court can only consider the information contained in your claim file. The claim file is comprised of the information you submit in furtherance of your disability and any information created by Northwestern Mutual in reviewing your claim.
- After a final denial of your claim following your appeal no new information is allowed to be added to the claim file for a judge to consider.
- The default Standard of Review (the amount of deference the court will give to Northwestern Mutual) is what is known as the Arbitrary and Capricious Standard of Review is extremely favorable to Northwestern Mutual.
As the video illustrates, litigating under ERISA is unfair to the insured, especially if the information in your file, with specific attention to the information submitted in support of your appeal to Northwestern Mutual’s denial does not provide strong evidence supporting your disability.
What happens if you win your case in court under ERISA?
Under ERISA, if you convince the judge that Northwestern Mutual did not have a reasonable basis to deny your claim the only court can only order Northwestern Mutual to pay you your past due benefits and, if applicable, place you back on claim. It is at the discretion of the court whether you will get an attorney fee award. Even worse, the judge cannot guarantee that your claim will not be denied by Northwestern Mutual in the future and once you are on claim Northwester Mutual will proceed with their monthly review of your claim to determine continued eligibility for benefits. Under ERISA Northwestern Mutual is not subject to bad faith, pain and suffering or any other form of extra contractual damages.
What to expect in court if your policy is a private individual disability policy.
Litigating against Northwestern Mutual under an individual (IDI) policy is a completely different experience than litigation under an ERISA governed disability policy. Although this is a good thing, it also comes with difficulties that those with ERISA policies never encounter. A lawsuit under an IDI policy is an action for breach of contract action. You are essentially arguing that you have a contract with Northwestern Mutual (the policy) and they breached the contract by not paying you. Under a breach of contract action:
- You will have a right to a jury trial.
- You will be allowed to testify at trial and call witnesses, such as your doctors and experts to testify on your behalf.
- There will be open “discovery” in which you can make requests for documents and responses to questions to ascertain facts regarding your case that may not be in your actual file with Northwestern Mutual.
- You will have the right to depose Northwestern Mutual’s employees along with any medical or vocational professional, or any other agent of Northwestern Mutual that played any role in the denial of your claim.
- You can pursue all legal remedies available to you such as bad faith, extra contractual damages, pain and suffering.
- The standard by which a jury will determine who will be victorious is by the preponderance of the evidence.
Litigation under an IDI policy is what most people envision when they think about going to court. These actions typically require a sizeable investment in money by Northwestern Mutual in defending the case and the financial risks to Northwestern Mutual in the event of losing at trial are much greater than they would be under an ERISA policy. However, having the ability of being able to really go after Northwestern Mutual for wrongfully denying your claim is also a double edged sword as Northwestern Mutual will have the ability to make life unpleasant. Northwestern Mutual will depose you, your colleagues, doctors, family members and friends. Through the discovery process Northwestern Mutual will seek to obtain all levels of imaginable information from you to include items such as financial records, banking information, investment information, personal information that could lead to discoverable material for the defense of their case. In essence, Northwestern Mutual and its attorneys will seek to bury you in mounds of information requests.
What you can do to avoid finding yourself in court with Northwestern Mutual
Northwestern Mutual is a very reputable insurance company that is known for its very thorough review of disability claims. Northwestern Mutual’s denials are typically predicated on extensive reviews of your medical, financial and vocational information, as opposed to other major insurance companies who seem to deny a claim for the smallest of reasons. If you have received a denial letter from Northwestern Mutual you can almost be assured that they have performed an extensive workup on your file before denying your claim. As such, the best way to avoid finding yourself in court is to make sure that your claim is presented in the strongest light. This entails, amongst other things: detailed medical information that clearly establishes restrictions and limitations; the proper presentation of your pre-disability occupation and other applicable vocational considerations; and ensuring that there is a strong and clear connection between your medical condition and how it prevents you from working.
What to do if your disability claim has been denied by Northwestern Mutual
It is important to understand what you are getting into when filing a lawsuit against Northwestern Mutual to secure your disability benefits. A legal case is only as strong as its foundation, but if you find yourself in a position where you have to file a lawsuit against Northwestern Mutual to secure your benefits you will need lawyers experienced in disability insurance litigation. The risks involved in litigation go well beyond your financial security so you want to make sure you are represented properly.
If Northwestern Mutual has denied your ERISA or IDI disability claim, or you are concerned that a denial may be forthcoming contact our office to speak to one of our disability insurance attorneys today.