Can my insurance carrier deny my benefits even if there is no change in my medical condition?
Author: Attorney Rachel Alters
Insurance companies frequently terminate long term disability benefits after paying a claim for several years, even when the claimant’s condition remains the same. It would seem unfair that one’s benefits can be cut off when their disabling condition has not improved or changed in any way. However, it is quite common that a person who has been on disability for several years, who has been approved for “any occupation” benefits will receive a denial letter that their insurance carrier no longer believes that the medical documentation supports disability, when in fact nothing has changed.
In the recent case of Buss v. United of Omaha Life Insurance Company, the Court determined that United of Omaha, also known as Mutual of Omaha, acted arbitrary and capricious when it terminated Buss’s claim when there was no new evidence to support their position that he was no longer disabled. The Court noted that Buss’s complaints of pain were consistent with MRI and X-Ray evidence and that none of the updated medical information reviewed by United of Omaha to approve benefits for many years showed any improvement in his conditions. The Court stated, “Determining a person to be disabled one day and not disabled the next day upon review of the same information fits the very definition of arbitrary.” Unfortunately, this type of behavior is common practice for insurance companies looking for any reason to deny benefits. Fortunately for this plaintiff, and future plaintiffs in similar situations, the court did not let Untied of Omaha get away with this arbitrary termination of benefits.
Although an insurance company can deny a claim for any number of reasons, a denial of benefits based on medical records that indicate no improvement in one’s medical condition is clearly an arbitrary and capricious denial of benefits. Attorneys Dell & Schaefer did not represent Buss in this action, but if your claim has been denied or you are worried that your insurance carrier may deny your claim based upon a faulty medical review please feel free to contact us to discuss how we may be able to assist you.