After a very long fight, a former employee of the National Student Clearinghouse is now on claim after an administrative appeal filed by Dell & Schaefer. Prior to filing for disability, our client was a Director of Information Security responsible for security strategy, security programs oversight, and security development for an online national student degree and enrollment verification database. However, a myriad of health issues required seeing more than nine specialists in three different states. Among other issues, our client suffered from Chronic Obstructive Pulmonary Disease (COPD), Emphysema, Cervical And Lumbar Spinal Stenosis, Multilevel Cervical Degenerative Disc Disease, Lumbar Degenerative Disc Disease, Thoracic Degenerative Disc Disease, Multiple Herniated Discs, Diplopia, Obstructive Sleep Apnea Syndrome, Cervical Radiculopathy, Cervical Spondylolysis, Cervicalgia, Chronic Bilateral Low Back Pain, Chronic Pain Syndrome, Memory Deficit, Lumbar Radiculopathy, Arthritis, Fibromyalgia, Autoimmune Disease, Osteoarthrosis, Extreme Fatigue, Dizziness, and Somatic Symptom Disorder.
Despite suffering from these numerous medical conditions, our client was denied all short term and long term disability benefits from his insurer, Mutual of Omaha. In its various denial letters, Mutual of Omaha found he was capable of performing the material duties of his regular occupation. Discouraged by Mutual of Omaha’s decision to deny his claims and uncertain about his future with no income and an inability to work, our client made the right decision to find assistance with his claim by contacting Attorney Alexander Palamara of the Dell & Schaefer law firm.
Appeal by Attorney Palamara
After reviewing the denial letter by Mutual of Omaha and speaking with the former Director of Information Security, it was clear to Attorney Palamara that Mutual of Omaha’s denial was improper and his client was unquestionably unable to work due to serious and debilitating conditions. The claim file from Mutual of Omaha was ordered along with our clients past and current medical records to develop a full understanding of his illness, claim, policy, and Mutual of Omaha’s handling of his claim. After compiling and reviewing all the necessary information, it was clearer than ever that benefits had to be approved.
A detailed review of the claim file revealed Mutual of Omaha denied benefits claiming our client could perform the material duties of his regular occupation even though Mutual of Omaha never even bothered to obtain a job description from our client’s employer. Additionally, Mutual of Omaha was only in possession of a handful of medical records despite our client having provided them with a list of 19 doctors he had treated with.
An appeal was drafted and timely filed. The appeal contained over 1700 pages of medical records that had never been reviewed by Mutual of Omaha. It focused on the objective medical evidence in support of his claim which demonstrated significant physical and mental impairments and highlighted the opinion of our client’s primary treating physician, who indicated our client was unable to perform any type of work on a full time basis. The appeal also highlighted the failure of Mutual of Omaha to perform a full and fair review of the claim and criticized Mutual of Omaha’s reliance on an improper definition of disability used to deny the claim.
Partial Claim Approval
As a result of the appeal, Mutual of Omaha overturned its denial. However, Mutual of Omaha concluded our client was disabled only due to Somatic Symptom Disorder, and only agreed to pay benefits for 24 months due to the Mental Health limitation in the policy. Somatic Symptom Disorder is a mental health disorder wherein a person has significant focus and anxiety about physical symptoms such as pain and weakness. While the approval is a victory and our client will receive benefits for at least 24 months, it is not enough as our client suffers from multiple physical chronic and debilitating conditions which are supported by objective medical evidence. Therefore, the fight will continue. We will use the remaining months of the Mental Health limitation to prove to Mutual of Omaha that our client is physically disabled and eligible for benefits until retirement age.
Since filing our client’s appeal and getting him approved, we have continued to supply Mutual of Omaha with updated medical evidence and letters of support regarding our client’s physical conditions. We will continue to fight on behalf of our client to ensure benefits are paid through age 65 or until our client is able to return to work.
If you have had a similar situation and Mutual of Omaha (or any disability insurance company) has denied your claim, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schaefer for a free consultation.