Northwestern Mutual Disability Claim Tips for Dentists
Our law firm has extensive experience filing and litigating Northwestern Mutual disability claims for dentists. Our attorneys understand how Northwestern Mutual operates and what it takes to file a successful Northwestern Mutual disability claim, and are happy to set up a free consultation to discuss your particular Northwestern Mutual claim.
Below are some answers to the most common questions our attorneys receive from dentists about the disability claim process, generally, and their Northwestern Mutual disability benefits, specifically.
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10. When should I contact an attorney about my Northwestern Mutual (NML) dentist disability claim?
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1. Do Northwestern Mutual (NML) disability policies for dentists have “true” own occupation disability definitions?
While Northwestern Mutual policies sold to dentists are often marketed as “own occupation” policies, they may not, alone, be “true own occupation” policies, as our disability attorneys define it. In our estimation, a “true” own occupation policy allows a totally disabled dentist to collect total disability benefits and earn income in a different, unrelated profession.
While Northwestern Mutual does have “own occupation” coverage, not all Northwestern Mutual policies provide “own occupation” coverage for the entire benefit period. For example, the policy definition of Total Disability might read:
Until the end of the Initial Period, the Insured is totally disabled when he is unable to perform the principal duties of his occupation. After the Initial Period, the Insured is totally disabled when he is unable to perform the principal duties of his occupation and is not gainfully employed in any occupation.
In other words, it starts out as an own occupation policy, but changes after a certain period of time that is usually set forth at the beginning of the policy, in the policy schedule. If you select the option and pay the requisite premium, you can select an “Initial Period” that lasts until the end of the max benefit period, ensuring that the “own occupation” coverage lasts for the entire benefit period. Most dentists end up securing this additional coverage, but it does require an extra step that can fall through the cracks if a dentist does not read the coverage options carefully at the outset.
2. What types of dentist disability claims are most often challenged/denied by Northwestern Mutual (NML)?
While there are certainly claims that may not require attorney involvement—for example, a disability claim due to the loss of a limb or something very serious, such as paralysis—in our experience dentist claims are not that straightforward.
Many of our clients have more nuanced conditions, such as slowly progressive musculoskeletal conditions due to degenerative disc disease. Others have conditions like a tremor, that may not prevent them from working in other jobs, but have a significant impact on their ability to work as a dentist. Others have mental health conditions (anxiety disorder, panic attacks, PTSD) that cannot be verified by a single, definitive objective test.
Obviously, if your claim is denied or you have a dispute over policy interpretation, you may need an attorney to become involved to resolve the matter. That being said, lawsuits with insurance companies are often costly, stressful, and, in some instances, can drag out over several years, all to the insurance company’s advantage. Even if you prevail, it can be an exhausting process, and companies typically appeal, which can take at least another year or more, all the while you are not getting paid benefits.
In our view, it is more prudent to approach your claim carefully from the outset and have your attorney address any concerns that Northwestern Mutual may have over the course of the investigation itself, so that you are not placed in a position where benefits have been cut off, you are not working and your only option is a lawsuit.
In our experience, the most common areas where complexities can arise in dentist’s disability claims include:
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- The timing of the claim (particularly in situations where a disabling condition is slowly progressive);
- Claims made by dentists who own their practice and need to decide whether to sell, bring on new associates, or keep working in a limited capacity;
- Claims where the underlying condition is difficult to diagnose or is diagnosed by exclusion;
- Claims involving pain/musculoskeletal conditions;
- Claims involving mental health conditions;
- Claims involving multiple co-morbid conditions; and
- Claims involving recommendations for or against certain treatments or surgery.
3. As a dentist, how do I go about filing a disability claim under a Northwestern Mutual (NML) disability policy?
In order to file a Northwestern Mutual disability claim, you must submit the proof of loss required under your Northwestern Mutual policy. Most Northwestern Mutual policies require this proof to be submitted in writing and within a certain time frame—typically within 60 days from the date of loss.
Northwestern Mutual allows claims to be initiated online, via Northwestern Mutual’s website, or by calling in to request that the initial proof of loss packet be sent to you.
If you call in, our attorneys have observed that Northwestern Mutual may subject you to an impromptu interview, so you should be prepared to answer important questions impacting your claim the very first time you are on the line with them.
If you are planning on having an attorney represent you on your disability claim, it is better to consult with counsel prior to making this initial call, so that you are not subjected to questioning before securing legal representation.
If you apply online, it is important to answer each question carefully and keep a record of what you submit. The initial proof of loss forms set the foundation for your claim, and you should not finalize or submit them unless you understand the ramifications of the type of claim you are making (partial v. total, etc.) and the date of disability you have selected.
4. I am a dentist with a mental health disability claim. Can Northwestern Mutual (NML) dictate what kind of doctor I see for my mental health condition?
For those with mental health conditions such as anxiety, depression or PTSD, the need for an understanding and supportive treating professional is key. Many insureds will already have established a relationship with a provider prior to filing a disability insurance claim.
When it comes time to file a claim, virtually all disability policies require that the claimant be under the care of a “physician.” But what counts as a “physician” can vary from insurer to insurer and policy to policy.
In the context of mental health claims, Northwestern Mutual policies are notable because many Northwestern Mutual policies add specific languages providing that:
if disability is due to a mental or nervous condition, Licensed Physician means psychiatrist or licensed doctoral level psychologist other than the Insured.
This means that other mental health treatment providers (such as licensed clinical social workers, those with a master of social work, licensed professional counselors, and/or psychiatric nurse practitioners) will not qualify as licensed physicians under the disability policy. Unfortunately, this means that insureds who are only seeing counselors or therapists may need to find new or additional care from a doctoral level provider in order to satisfy this policy requirement.
5. My doctor has suggested surgery, but I’m not sure it will help or get me back to practicing dentistry. Can Northwestern Mutual (NML) make me have surgery in order to receive benefits?
As discussed above, most Northwestern Mutual policies require that the insured be under the “regular care” of a “Licensed Physician” in order to be eligible for benefits. But what exactly does “Regular Care” mean? One example from a Northwestern Mutual Policy defines Regular Care as:
personal care and attention appropriate to the condition causing disability. This care must be a such intervals and frequency as will lead to the Insured returning to the principal duties of the regular occupation.
While this provision doesn’t outright say that you have to undergo a certain course of treatment (such as surgery) in order to qualify for benefits, we’ve seen insurance companies argue that certain treatments are considered necessary in order for an insured to “return to the principal duties of the regular occupation.”
Insurance companies may turn a blind eye to valid concerns about certain treatments, including surgery. An experienced disability attorney can help you navigate this issue should Northwest Mutual attempt to dictate the terms of your care.
6. Northwestern Mutual’s authorization to release information is very broad and I’m not sure how the listed information applies to whether I can practice dentistry. Do I have to sign it?
As part of the claims process, insurers typically request medical records. To do this, they’ll usually request your signature on a HIPAA compliant authorization. However, often these authorizations allow for insurers to collect much more information than medical records, and Northwestern Mutual’s authorizations are very broad.
For example, they allow, among other things, Northwestern Mutual to request not only medical records but also records/information from insurance companies, licensing agencies, law enforcement or government agencies, benefits administrators, financial institutions, accountants and “other persons or institutions.” In addition to patient files and an “entire medical record,” the authorization also authorizes release of “information concerning my education, occupation, employment history, earnings, finances, unemployment benefits, applications for insurance, or eligibility for other benefits.”
As you can see, these authorizations allow for investigation into almost every facet of your life—even if the information doesn’t seem relevant to a claim determination. Northwestern Mutual also tries to keep claimants from restricting what can be gathered by specifically stating in polices that “[a]ny alteration to or limitation of this Authorization will prejudice The Company’s right to independently evaluate your claim and may prevent benefits from being provided.”
So, do you have to sign this Authorization or risk the denial/termination of benefits? This was addressed in the court case of Peterson v. Northwestern Mutual Insurance Company, 4:13-cv-00018-RAW (S.D. Iowa Aug. 19, 2013). During the course of a lawsuit regarding whether Peterson was entitled to total disability benefits, Northwestern Mutual filed a motion to compel Peterson to sign their authorization. Peterson objected that the authorization was overly broad and allowed for redisclosure, and he supplied Northwestern Mutual with a different authorization allowing the collection of medical records only. Northwestern Mutual argued that it needed their release as part of proof of loss requirements.
The Court agreed that the Authorization was overly broad and stated “[w]hatever plaintiff’s alleged disability is . . . it is unlikely to be so extensive as to make plaintiff’s entire lifetime medical and employment history relevant to his claim for total disability benefits,” and it denied the motion to compel.
It is important to note, however, that this was just one case and based on one fact scenario, and this holding may not apply to your claim, in your jurisdiction. If you have concerns about the scope of Northwestern Mutual’s Authorization, you should contact an experienced disability attorney and discuss your particular claim, and particular circumstances.
7. I am a dentist but am having difficulty maintaining my schedule. How do I know if I am partially or totally disabled under my Northwestern Mutual (NML) policy?
In addition to paying benefits for being totally disabled, many Northwestern Mutual policies have provisions for partial (also sometimes called residual) benefits. These provisions allow you to collect a portion of your benefits if you are able to work, but in a reduced capacity.
For example, the policy might state that:
The Partial Disability Benefit is payable for the first six months of partial disability following the Beginning Date and before the end of the Maximum Benefit Period. The amount of the Partial Disability Benefit is 50% of the Full Benefit.
Partial Disability. The Insured is partially disabled when:
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- he is unable to perform one or more principal duties which accounted for at least 20% of the time he spent at his occupation before the disability started; or
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- he has at least a 20% loss of time spent at his occupation.
If the insured qualifies for both the Full and the Partial Disability Benefit, the Full Benefit only will be paid.
Claims, especially those based on slowly progressive conditions (such as many musculoskeletal conditions), can be especially nuanced and it can be difficult to tell when a partial disability claim becomes a total disability claim.
Because of this, Northwestern Mutual may seek to argue that you are able to perform some of the principal duties associated with dentistry and/or are able to work at least some of the time in your occupation. Since partial disability benefits often pay less than total disability benefits (in the example above, only 50%), Northwestern Mutual has a strong incentive to keep a claimant on a partial disability claim.
One example case is that of Klein v. Northwestern Mutual. In this case, Dr. Klein was a dentist who suffered damaged nerves in his left arm, after an IV was improperly inserted following surgery. Dr. Klein began to experience paralysis, where his left thumb did not flex and his left forefinger and middle finger were not fully functional.
As a result of this, Dr. Klein had to significantly limit the types of procedures he was able to perform, limit his work with children, and he could no longer work without an assistant. In fact, he could no longer perform any procedures in the “exact manner that he was originally trained to perform them.” However, he was still able to work on this modified basis and continued to do so.
Northwestern Mutual initially denied his claim, but then began paying partial disability benefits after conducting a medical review. Dr. Klein argued that he should be totally disabled; however, the Court held in favor of Northwestern Mutual, determining that, under the terms of his policy, in order to be totally disabled, Dr. Klein would need to be able to show that he could not perform any principal job duties. The Court concluded that Dr. Klein was still performing some of his principal job duties, even if he was doing so in a different manner than prior to his injury.
8. I wasn’t practicing dentistry at the time I became disabled. Can I still file a claim under my Northwestern Mutual (NML) policy?
Many dentists facing a disabling medical condition opt to take an extended break from practicing, to pursue various treatment or in the hopes that the condition will improve with rest. However, this can cause problems when it comes time to file a disability claim.
Most disability policies, including Northwestern Mutual disability policies, typically define “occupation” as what an insured is doing right before the disabling condition occurred—regardless of what the insured has done for the majority of his/her career.
One case example of this is Hsu v. Northwestern Mutual Life. Dr. Hsu was an interventional pain management doctor who left his position to move to the west coast. Unfortunately, before he was able to begin practicing at his new job, he began experiencing symptoms of constant right elbow pain. He subsequently had surgery and began working at a new practice on a trial basis; however, the surgery was not successful and Dr. Hsu found himself needing to file a disability insurance claim. Northwestern Mutual denied Dr. Hsu’s claim, finding that he did not have a “regular occupation” because he was in between jobs when he became disabled.
Additionally, “regular occupation” in many Northwestern Mutual policies is defined as “all of the occupations of the Insured at the time the disability starts.” This means that taking on “side jobs” to supplement income during breaks from dentistry, or to jump-start back-up sources of income if you can’t return to dentistry, can also impact eligibility for disability benefits.
9. I am a dentist and need to file a disability claim, but I don’t have a copy of my policy. Can I just request it from Northwestern Mutual (NML)?
Many dentists purchase their disability policies years before needing to file a claim and, when the time comes to file a claim, have only a vague recollection of the nature and scope of their disability insurance coverage. For this reason, it is important to keep a copy of both your policy and any applications in a safe spot, where you can easily find it again later if you need to file a disability claim.
While it is possible to request duplicate copies of your disability policy if you lose it, in some cases the insurer does not always have a full copy of the policy.
This is what happened in the case of Falcon v. Northwestern Mutual Life Ins. Co. The plaintiff, Dr. Falcon, was a plastic surgeon who filed a disability claim based on vision loss. Since he filed for benefits prior to reaching age 65, he believed he was entitled to lifetime benefits (as that is what he remembered about his policy). However, Northwestern Mutual claimed that the policy stated that lifetime benefits would only have been payable if Dr. Falcon had become disabled prior to turning 60 years old (and he was over 60 when he filed).
Neither Dr. Falcon nor Northwestern Mutual could produce a copy of the policy as issued to prove their argument. Instead, Northwestern Mutual was only able to piece together some basic information about the features of the policy, and used it to recreate a piecemeal version of the policy. Not surprisingly, Northwestern Mutual’s version of the policy supported its position regarding lifetime benefits.
The case eventually settled, but not before costly and timely litigation ensued, which could have been avoided if Dr. Falcon had been able to locate a copy of the policy he had received at the time he purchased it.
10. When should I contact an attorney about my Northwestern Mutual (NML) dentist disability claim?
Dentists who are considering filing a claim for disability insurance benefits should meet with a disability attorney well-before submitting a claim.
Each disability policy has different, complex language that insurance companies may manipulate to circumscribe and restrict coverage. Before filing, dentists should make a coordinated effort, with an attorney’s assistance, to determine whether their particular claim is covered, and if so, how that claim is best presented to ensure payment.
The information provided above is offered purely for informational purposes. It is not intended to create or promote an attorney-client relationship, and does not constitute and should not be relied upon as legal advice.
Every claim is unique and the discussion above is only a limited summary of information that may be relevant to your claim. If you are concerned that Northwestern Mutual is not handling your claim fairly, an experienced disability insurance attorney can help you assess the situation and determine what options are available to you.
Notable Northwestern Mutual Disability Insurance Cases
Vossberg v. Northwestern Mut. Life Ins. Co., No. 1:22-cv-00364-JRS-KMB (S.D. Ind. Jan. 12, 2023).
Falcon v. The Northwestern Mut. Life. Ins. Co., Civil Action No. 19-404 (W.D. Pa. Nov. 30, 2020).
Armani v. Northwestern Mut. Life Ins. Co., No. 14-56866 (2016).
Klein v. Northwestern Mut. Life Ins. Co., 562 F.Supp.2d 251 (D. Conn. 2008).
Wooten v. Nw. Mut. Life Ins. Co., No. 05-20-00798-CV, 2023 WL 4861777 (Tex. App. July 31, 2023).
Northwestern Mutual Disability Insurance Blog Posts
What Happens if I Miss the Proof of Loss Deadline?
Have I Changed My Regular Occupation?
The Importance of Keeping a Copy of Your Policy: A Case Study
