• Court Overturns Mutual of Omaha's Denial of BenefitsCourt Overturns Mutual of Omaha's Denial of Benefits

Court overturns United of Omaha’s termination of Plaintiff’s benefits after performing an unfair “any occupation” review

In the case of Mokbel-Alijahmi v. United of Omaha Life Ins. Co., the 6th Circuit Court of Appeals affirmed the lower court’s determination that United of Omaha improperly terminated the plaintiff’s benefits after an unfair “any occupation” review. The Plaintiff in this case was a welder who spoke no English but was fluent in Arabic. His previous job required him to be able to lift 40 lbs.; however he did not need to speak English to perform his job duties. He had no other transferable work skills. When he injured his spine, he was no longer able to work in his occupation due to the inability to lift greater than 40 lbs. United of Omaha paid his benefits for 2 years. Then cut them off after performing a transferable skills analysis stating that he was capable of performing several other jobs.

Transferable Skills Analysis by United of Omaha Showed Several Jobs the Plaintiff Was Capable of Performing

According to United of Omaha, the Transferable Skills Analysis revealed several jobs the plaintiff was able to perform, and therefore, he was no longer disabled. According to United of Omaha, the plaintiff could work as a Gate Security guard/Reception; Surveillance System Monitor; Cashier; Small Product Assembler; Semi-Conductor or In-Store Greeter. However, the Vocational Consultant did not consider his inability to speak English nor were they supplied with all the pertinent evidence by the insurance company. Most Important was the fact that the Plaintiff was functionally illiterate in English. Furthermore, the plaintiff had severe limitations due to chronic pain and side effects of medications and had no transferable skills. The vocational consultant’s opinions were based on the plaintiff’s ability to read and understand work-related documents. This he could not do. These were factors that were not considered by the Vocational Consultant. In addition, the Vocational Consultant did not consider the policy’s wage requirement and suggested jobs that fell below that requirement and even suggested a job that no longer exists.

Mutual of Omaha Hired Biased Consultants In Order to Receive a Supportive Opinion

This case is an example of how insurance companies set claims up to be denied by hiring biased experts to render opinions that are beneficial to the insurance company. In this case, United of Omaha failed to provide substantive information to their experts by cherry picking medical records and failing to provide pertinent information in the hopes of obtaining the opinion that the Plaintiff was perfectly fine to work on a full-time basis. Mutual of Omaha left out certain medical records when providing information to the peer review physician and failed to inform the vocational expert that the plaintiff could not speak English and that he had no transferrable skills. These are some of the devious tactics that are used by insurance companies to deny claims.

The Court stated:

A record review that does not include all relevant records is unreliable and clearly inadequate… the omission of much relevant information suggests that United impermissibly “cherry picked” its file in hopes of obtaining a favorable report.

The Court was also suspect of the vocational review stating that:

Sedentary work generally involves sitting 6 hours in an 8 hour work day… At best, the plaintiff was capable of sitting 3 hours in an 8 hour day and must be able to rest frequently and elevate his legs several hours each day and therefore is incapable of even sedentary work.

The Court upheld the lower court’s decision to overturn the denial of benefits, finding United of Omaha’s termination of benefits was arbitrary and capricious. The Plaintiff was put back on claim and paid his back benefits owed.

This case was not handled by our office, but it may provide claimants guidance in their pursuit of compensation when denied disability insurance benefits. If your disability insurance carrier has denied your benefits, please contact attorneys Dell & Schaefer for a Free Consultation.

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