An oral surgeon, 51 years young and in the prime of his career, came to us after his claim for disability insurance benefits under a private policy with Northwestern Mutual had not been paid, despite two years of submission of materials and support for the claim. He was frustrated by the process, and the endless requests for information and documentation.
When he first retained us, the overwhelming nature of the claim process and his inability to secure benefits on his claim had him ready to give up. His condition was severe, resulting from an accident that stripped his ability to perform his work, which he loved, and for which he was well compensated.
After getting our client’s doctors involved, we were able to develop the proper support and address the open issues which were claimed to be the impediment to benefits. We were also able to convince Northwestern Mutual that benefits should be paid going back to the onset of his disability, despite the fact that he had returned to efforts at practicing, only to see those effort fail.
Working with the insurance company, we were able to provide the explanations supporting that all benefits were appropriate and were payable back to the claim onset date. In addition, we were able to articulate that our client’s occupation was that of an oral surgeon, not a dentist, due to the specialty work that he was performing, prior to his disability, and tied to the policy language.
The critical issues involved in these types of claims are developing the occupational details, and then working with the treating physician to understand what the occupation required and how and why the insured is unable to perform the rigors of the occupation.
Our client was paid the benefits he was due from the onset of the claim and shall continue to receive his benefits from Northwestern Mutual under his total disability claim.