The Importance of Keeping a
Copy of Your Policy: A Case Study

Do you have a copy of your disability policy?  And, if you think you do, do you know where it is?

Many professionals file their policies away and never look at them again until something happens and they may need to file a claim. By then, the policy has been misplaced or lost, leaving them in the dark and unable to verify  how their coverage works.

This can lead to costly coverage disputes with insurers, particularly if the policy in question is an older policy. Some older policies were underwritten by companies that no longer exist, or have since sold their disability business to other companies. As a result, questions can arise regarding the terms of an older policy, particularly if the company who issued the policy is not the same company administering the claim.

One such example of this is the case of Falcon v. Northwestern Mutual Life[1]Dr. Falcon was a plastic surgeon who filed a disability claim based on vision loss. Dr. Falcon believed that he was entitled to lifetime benefits because he had become disabled prior to age 65. However, he did not keep a copy of his policy.

In response, Northwestern Mutual claimed that the policy did not pay lifetime benefits unless the policyholder became disabled prior to age 60. Notably, Northwestern Mutual could not produce exact copies of policies either. However, they did have a record of basic information about the features of the policy and used that recreate the policy piecemeal. Unsurprisingly, the copy policies supported Northwestern Mutual’s position.

At present, this case is still pending.  It may require a trial to resolve, as neither side is able to definitively show they are right. However, if Dr. Falcon had simply kept a copy of his policy, the matter may have been resolved without the need for a lawsuit.

You can save yourself from this same headache by keeping a copy of your policy and knowing what it says.  If you have a question about the terms of your policy or feel that your insurer is misapplying the terms of your policy, please feel free to contact one of our attorneys directly.

Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned that your claim has not received a full and fair review, an experienced disability insurance attorney can evaluate your claim and help you determine what options are available.

[1] Falcon v. The Northwestern Mutual Life. Ins. Co.,  Civil Action No. 19-404, 2020 WL 7027482 (W.D. Pa. Nov. 30, 2020).


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