Mass Mutual is a well-known insurer for private disability insurance policies, also known as “IDI” (Individual Disability Insurance). The sales pitch makes sense for high-income earners; the group long-term disability insurance policy they receive through their job may simply not be enough to cover the cost of living for a professional or executive with a six-figure income.
Purchasing multiple private disability insurance policies is not uncommon for those professionals whose lifestyle might include a large mortgage, luxury cars, and frequent vacations. The same reason that having multiple private long-term disability insurance policies in place is the same reason it is wise to have an experienced disability attorney working on your behalf before filing a claim: there is simply too much at stake.
As one of the largest private disability insurance companies, Mass Mutual (also known as MassMutual) is the subject of many phone calls and emails to our disability insurance law firm. We regularly deal with Mass Mutual, on the claims side and with their attorneys, both in-house counsel and outside defense firms that are retained to battle claimants. They know our firm, and we know their tactics and strategies.
Since we frequently represent doctors and other medical professionals, including chiropractors and finance executives, we see many claim presentations for high-income disability policies, many with lifetime coverage available.
One of the more common tactics we have seen in a recent uptick in claim delays and denials made by Mass Mutual is that the claim is only based on “somatic symptoms.” These are the terms used by the doctors for hire who read claim files and prepare reviews. Somatic symptoms refer to an extreme focus on physical symptoms that result in severe emotional distress that leads to the inability to function.
This is an effort by Mass Mutual to either compel a claim into a limited benefit period for a mental health impairment or to cast aside altogether any impairment, and claim that the symptoms are simply in the claimant’s head. This tactic carries significant danger to a claimant, whether it forms the basis to reject a claim or to limit the amount of benefits. Claimants with lifetime coverage that would be otherwise available are seeing Mass Mutual’s aggressive tactics serve to limit claims substantially.
Another tactic we are seeing relates to medical professionals and the aggressive utilization of Functional Capacity Evaluations (FCEs). They utilize this evaluation to formulate a basis to accuse the claimant of faking or malingering the extent of their impairment. The Functional Capacity Evaluation is a test that demands the utmost of effort from a person, which is never a good idea for someone with a physical disability. Those who try to protect their well-being during the test by moderating their actions are accused of doing so for nefarious reasons.
A disturbing trend that we are seeing from Mass Mutual involves an offer of “recovery benefits” following a claim termination. This lump sum effort of a few months of benefits is offered to “assist” in a transition of return to work, with a form agreeing that reduced capacity is no longer being claimed. This benefit then serves to remove the ability to pursue that claim further, in exchange for a small sum of benefits.
Often a disability insurance company will claim that a person is not totally disabled according to the terms of the policy. The insurance policy is a legally binding contract between the disability insurance company and the claimant. There are very specific terms and conditions in the policy that focus the definition of disabled. Clearly the policies are written to “protect” the insurance company’s interests, although they are marketed and presented as in the best interest of the insured. One of the issues we frequently deal with regarding disputes with Mass Mutual about their disability policies is this definition of total disability.
For an example, let’s look at a case where our client is an attorney suffering intense levels of pain from a back injury. She can no longer engage in complex litigation, where her tasks include analysis and preparation of complex legal documents, developing litigation strategies and managing a team of associates. We take the position that she is disabled and cannot perform the material and substantive duties of her profession.
Mass Mutual’s position will be first to examine medical records to see if the doctor’s notes say she cannot perform the tasks that her job requires, not the level of pain, the treatment for the pain and whether or not she has been compliant with her treating physician’s instructions. If there are no notes to that effect, they may well claim that she is a malinger.
The claims examiner will also look at the doctors involved. Is she being seen by an orthopedist, a neurologist, a chiropractor or a general practitioner? Is there a pain management specialist providing treatment? How consistently is she seeing any or all of these healthcare providers? Gaps between appointments may be looked at as evidence that she is better, even if they are the result of her being unable to leave the house because of her pain.
One more thing to consider with this type of a claim: If the attorney’s salary prior to her disability was approaching $200,000 with bonuses, but she tried to work while disabled, and as a result the number of her billable hours and ability to bring in new business dropped dramatically for a year, the insurance company is likely to focus on that low-income year as her standard income level. They will attempt to base their disability payments not on the fifteen years of earning more than $200,000, but the single year where she earned less than $125,000.
Our long years of experience with Mass Mutual and other insurance companies that provide high-income earners with private disability insurance policies gives us a unique window into what it takes to defend these claims. If you own a private insurance disability insurance policy, we encourage you to call 888-583-4959 to learn how we help with Mass Mutual disability insurance claims.
We offer all new clients a free phone consultation in order to determine the best way to pursue your case.