Long Term Disability Law BlogAttorneys Helping Disabled Claimants Nationwide

Tips for a Mass Mutual Disability Benefit Application Approval & How to Stay on Claim

Most disability policies written by Mass Mutual are individual ones purchased by professionals like doctors, dentists, lawyers, and other business owners. The company has a reputation for being fair, but also for requiring strict compliance with the regulations.

Mass Mutual will thoroughly review all medical records and physicians’ reports of restrictions and limitations and how those restrictions and limitations affect your ability to perform your specific occupational job duties.

GREGORY DELL: Hi. I’m attorney Gregory Dell, here with attorney Stephen Jessup. And we’re going to talk about Mass Mutual Insurance Company and, specifically, some tips on how to get your Mass Mutual disability claim approved when you’re at the initial stages of filing. And Steve, we’ve handled so many claims with Mass Mutual, but Mass Mutual is a unique company in, I would say, a positive manner because of the fact that they primarily write individual disability policies. So we’re not dealing with these group ERISA laws that we’ve spoken so much about.

So when someone gets a policy from them, they’re getting their own contract, where, basically, if Mass Mutual doesn’t pay, then you go after them for a breach of contract, and you say, you have all the rights to a jury trial and everything like that. So that’s a great thing.

Now, I want to get into the policy language of Mass Mutual that’s unique and different things that someone must be aware of because the people who bought Mass Mutual bought it from a very qualified agent were usually sold a good product. But when someone calls you, what’s the first thing that comes to mind for you when they’re looking to apply for benefits?

STEPHEN JESSUP: Well, honestly, the policy itself, because Mass Mutual, like most of the insurance companies and everything, you get what you pay for so there’s a lot of riders that they offer. So the riders are really going to dictate the coverage. The base coverage a lot of times, like we’ve discussed– it’s good, not great. You have to upgrade your riders to make sure you’re getting a true own occupation– COLA increases, partial disability provisions, things like that. So first, it’s the policy. We want to see that, and then really it kind of goes into what the person’s occupation is and how they practice.

And if it’s a doctor, do they have their own practice? A dentist, the same thing, because each profession is going to have their own laundry list of things that we’re going to know that Mass Mutual is going to want to see as part of the initial application.

GREGORY DELL: All right. So with Mass Mutual in particular, a claimant sends you their policy, and you take a look at it, and what’s the common definition of disability that you’re usually dealing with?

STEPHEN JESSUP: Usually, it’s going to be that you’re unable – you’re unable to perform the duties of your regular occupation. So it’s an own occupation type situation. But it can vary as to whether or not you can work in some other occupation and continue to make earnings there and get your full total disability benefit, or if you work in another occupation but not your own, you have to – there’s a reduction in the monthly benefit. So the total disability definition can vary. And realistically, that kind of comes when your agent is signing up for the policy. They’ll make their recommendations, but you ultimately decide what you want to spend the money on.

At the time a lot of people professionals buy these policies, they may not be making a lot of money. So they look to kind of save money, if you will. But later on, that kind of stuff can come back to haunt you much later on when you’re looking to file a claim.

GREGORY DELL: So a lot of our Mass Mutual clients are executives, physicians, very successful people who have had successful careers in their life, and they’ve gotten to a point where they may not be able to do the duties of their own occupation, but they might feel like they’re able to do something else that didn’t have near the requirements of the other job. And the Mass Mutual definition of disability can have something that’s called residual. But also, their total may say you’re totally disabled from your own occupation but not earning any other income but sometimes has a certain threshold of income that you can earn.

So sometimes I call these Mass Mutual disability policies loss of income type policies, as opposed to a true own-occ definition. But how important is it to coordinate with your doctor your medical complaints, your restrictions, and limitations if you’re someone who’s applying who’s thinking you might be able to do something else?

STEPHEN JESSUP: Well, the big thing is is knowing your policy language and what you can and can’t do under, so when you are communicating with the doctor, because the doctor is going to write the notes, and a lot of times, for instance, if this is a doctor who is a potential client going to their own doctor, they’re going to know what’s going need to be documented. But based on that policy language, you also have to be careful about what you say, and the person can and cannot do. So it’s really a matter of understanding that. So it can be conveyed, and your doctor can formulate an opinion as to this idea of disabilities relates to you. If it’s true, you can’t do your own occupation, but your policy allows you to work in another occupation, then making it specific that way.

So really, it’s hard to give a global idea, but we can tell you that Mass Mutual, more than any other insurance company, is going to delve deep into all the information, your medicals. They’re a very, very detail-oriented company, which works great for someone who has all their ducks in a row. But if something seems out of whack a bit, whether it be medical, financials, whatever the case may be, they’re going to go through and really dissect and pick apart. And it’s not they’re trying to like we say they screw you over or anything, it’s just that they do a very, very thorough job so you really have to make sure you’re as prepared as possible.

GREGORY DELL: OK. So let’s carry on that theme of being prepared. And I know we always say the most important thing is strong medical support, and claimants call all the time, and we say, does your doctor support you? And they often say yes. But why is it not enough just for the doctor to write, yes, I support you in your claim, and you shouldn’t work? What’s really going to be required that Mass Mutual is going to be looking for in those medical records?

STEPHEN JESSUP: Restrictions and limitations. They’re going to be looking for how your condition is impacting your ability to work, what portions of your occupation can’t you do because of it. So it’s going to be this idea that if it’s not in your records, they’re going to look it as not existing. If it’s silent, it doesn’t happen. So it has to all be in there in order for them to– a doctor support is one thing. And at least here, if you end up in court, like you said, you have a jury trial, there can be examination of your doctors. And doctors can elaborate their opinions. But you don’t want your doctors having to backtrack their thoughts and opinions, even during the application process.

Going back months earlier, you want that documented then and there because that is going to be – that paper trail is going to be the most important thing you can create with any of these disability policies and claims with Mass Mutual.

Mass Mutual Requires All Treating Physicians to Provide Coordinated Medical Records

GREGORY DELL: A lot of claimants think that applying for long-term disability benefits is as easy as it was when they bought their application, where they just filled out the forms, the agent did most of the stuff, they got some medical history, and they signed it. But when it really comes time to go and approach your treating doctor or doctors, why can that be difficult? And also, why must there be a coordinated effort amongst all of the doctors?

STEPHEN JESSUP: It can be very awkward. A lot of people feel weird approaching their doctors. I mean, if you have a longstanding doctor, it may be easier. They will know what’s going on, issues you may have been having. If it’s a newer doctor or specialist, that’s a very difficult conversation because then they’re going to look at you – are you just coming to me because you’re looking to file for disability?

So it’s important that from the get go in your treatment, you’re honest with your doctors. And like you said, too, in coordinating with all the doctors because Mass Mutual is going to reach out to any doctor who has treated you for it. Some doctors may have a large role. Some may have a small. Some may not be involved anymore, but the opinions that they give if asked questions, questionnaires, or they speak to a medical representative from Mass Mutual, they may not document what’s really going on or say, hey, I never gave restrictions and limitations.

And if you start giving stuff that, even at the end of the day, may not be so vital to the claim and your treatment, it’s still negative medical information that Mass Mutual is going to start compiling against you and taking a deeper look at and really having their doctors really dig into.

GREGORY DELL: I find that our Mass Mutual clients, people who contact us, are very conscientious people. They’ve worked with their financial advisor to buy a good policy. They work really hard. And often, they’ve been working through a medical condition. And we see that all the time. And sometimes, you know the expression, a good deed doesn’t go unpunished– they’ve been working through a back condition, a bad diagnosis, a shoulder, a knee, whatever it may be, whatever it is that’s disabling them. And now they’ve been doing it for a year or two years. How do you go about, at that point in time when you’re submitting the claim, choosing the appropriate date of disability?

STEPHEN JESSUP: It’s going to depend on what the goal of the claim is. If it’s a residual or partial, where you still want to continue to work, then we’re going to take a look at correlating medical with loss of income to verify time where there may have been a downward trend. If it’s a complete cessation – I’m not working at all, going on long term– that can become problematic because the insurance company, Mass Mutual, they’re going to look at it like we’ve been able to do this for this long, so what’s changed?

And if the records aren’t documented that you’re struggling, having to put an extra hours to try to get the same amount of work done, whatever the case may be, they’re going to be like, well, why now? You were able to work with it two years ago. And a lot of things, especially pain-related conditions – they get worse over time, especially if you have problems with your back, structurally speaking. So that’s another reason why that tie-in of making sure that you’re communicating with your doctors, and they’re documenting everything because unless you get in an accident, or you get some type of catastrophic diagnosis, a date of disability is not very often set in stone type thing.

GREGORY DELL: And I’d say it’s more often than not most of our claims are someone who’s been working through the condition because you’re not going to make as much on disability, usually. And so these clients don’t want to stop working. And so they’re trying to work through it, trying to do what they can, and then the disability company says, like you said, why now? And that’s what we have to guide our clients to have the support in the medical records and present their story as to why it is now.

For Your Mass Mutual Claim to be Approved, You must Establish the Duties of Your Own Occupation and Show How Your Medical Condition Makes it Impossible for You to Work

Now, one thing I love about the Mass Mutual policies compared to these other group policies is we’re not dealing with this national economy of how your job is performed in the national economy usually. It’s very rare that we ever see that. So how do you work with a claimant to present their occupation? And what types of things may Mass Mutual be asking for that a claimant should expect when applying?

STEPHEN JESSUP: And like you said, a lot of the people who hold these policies are very savvy, whether they’re doctors, business owners, wherever the case may be. So first and foremost, if you are a business owner, you can expect that they’re going to want to see financials, profit and loss statements, your corporate tax returns, your personal tax returns, stuff like that. If you’re a medical doctor, they’re going to want to see your CPT codes; dentists, are going to look at your ADA codes. That’s how they’re going to verify your occupational duties.

So they’re going to really look into what it is you were doing. That’s why medically, we can get all the codes. More often than not, I have seen situations where people don’t accept insurance, doctors don’t accept insurance, so they don’t really document that well. But nine times out of 10, you’re going to be able to get all those codes to demonstrate what exactly you were doing – how many surgeons you were performing, consoles, things like that.

From a legal perspective, with lawyers, if they’re saying that, hey, I’m a litigator, I litigate, you can get case information, how many cases they’ve had in trial, depositions they’ve done in the past year. So you can really tailor it to the person as to what they are doing because that’s what Mass Mutual really wants to know. They’re going to look at exactly what it is you were doing, and then they’re going to make their determinations based on that.

GREGORY DELL: All right, and they love to grab calendars and pull your docket schedules if you’re a lawyer. If you’re a business owner, looking at your different meetings. They may want to speak– and if you’re an in-line employee working with a big company, they may want to speak to your supervisor or manager, co-workers.

Now, we stop them from speaking to anyone without our permission. That’s another thing you’ve got to be careful if you’re not represented because these authorizations you sign are very general, and they can call an employer, a co-worker, or something like that. Plus, you sign a HIPAA authorization, so they can freely call doctors, which brings up another point to always tell your doctor not to speak to Mass Mutual without first speaking to you, and then we work with the client to guide them about that phone call or try to set that up. Every time I say something, it brings up different scenarios that we’ve seen with Mass Mutual.

In the initial claim, Mass Mutual is going to want to interview the claimant. How important is that interview? And how do you work to prepare a claimant for that video?

STEPHEN JESSUP: I personally think it’s very important because the first time putting eyes on you, and they are assessing you. You’ve already submitted claim forms and everything at that point, so you’ve–

GREGORY DELL: Or sometimes not because you just called them on the phone, and they’re calling you.

STEPHEN JESSUP: Well, if they want to do it in person or after something has already been done, they’ve already got an information on you, so that consistency of information, especially if it’s in person. They’re trying to get to know you, as they’re insured. I mean, I truly believe Mass Mutual is a company where they tried to do right by their insureds, but they are going to evaluate to make sure that a claim is warranted. So the way you present yourself, the way you answer questions, the consistency of the answers provided– all those types of things.

Situations with– for instance, you’re going to want to have a sit-down meeting and say part of the disability is severe lower back pain, and it’s not uncommon for a lot of hard-charging professionals to try to suck things up and just grunt and get through it. But in those, saying, hey, listen, if you need to take a break, by all means, take a break. Get up, move around, stand, do those types of things because everything– it’s like it’s a job interview, if you will. Everything is being scrutinized.

So you really want to be careful, and you don’t want to downplay anything you’re going through. If they’re asking how you’re doing or medically, oh, I’m doing better, I’m doing OK. So you really want to be honest with yourself so you can be honest with them.

GREGORY DELL: So there’s so many things with the application, depending on the medical condition, the language, and the policy. Other disability policies– often, we find our clients have a group policy or other private policies. We’ve had policies that are 30, 40 years old. The language varies over the years. So we have to look at the whole total picture. The important thing is we want you know from this video, you must be prepared, and that also we offer a unique legal service where, as attorneys, we’re using our experience from seeing all of these claims denied to deposing people in Mass Mutual to knowing their internal workings so that we can put you in the best position to get your claim approved.

Then, what we recommend is we offer a free consultation where we review a copy of your policy. Either call us at the number below in our video, or go to our website at diAttorney.com. Click on the free consultation. An email will come to us – either myself or Stephen or one of our other lawyers. One of the attorneys will immediately call you back. We’re going to ask you to email us a copy of your long-term disability policy. We’ll set a free initial phone consultation, where we will answer all of your questions, go through the claim, whether we think you can get approved or not, how we can help you. We’ll let you know about our fees or costs, which are very reasonable, based upon what’s involved with your claim.

All of our clients are located all over the country. So no matter where you live, we’re able to assist you. And we hope that by working with you, we’re able to guide you through the approval of your claim.

At Dell & Schaefer, we know what Mass Mutual is looking for and can make sure we give the company the records it wants. If we are working for you, all communication from the company comes to us. We take the pressure off you and work with your physicians to help educate them on what Mass Mutual needs from them.

The first step is for you to contact us and arrange to email us a copy of your disability insurance policy. We will review it and then call you back for a free consultation where we will discuss with you how we think we can help. We will also discuss with you our fee structure.

Our clients are located all over the country, so no matter where you live, we can assist you. Our goal is to guide you through the approval of your Mass Mutual claim. Call us at 888-699-9438 begin the process.

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