Dell & Schaefer Successfully Appeals Denial of Benefits to Quality Control Inspector


Before going on disability, Mr. M was working as a quality control inspector for Tam International. In 2009, after years of service, Mr. M sustained an injury while at work and he was forced to file a claim for disability with his employer sponsored disability plan. His claim was based on low back pain, osteoarthritis, neuralgia, radiculitis, neck pain, shoulder pain, muscle spasms, headaches, and generalized anxiety disorder.

Ms. M’s Disability and his claim for disability benefits

Mutual Omaha, the claims administrator for Mr. M’s employer sponsored disability policy, approved Mr. M’s claim and paid him disability benefits. After two years of benefits, Mutual of Omaha began a review of Mr. M’s claim to determine if he was disabled from any occupation. Due to the nature of Mr. M’s various conditions, his condition had only worsened over the years and his pain and inability to work had progressed. As a result, Mutual of Omaha approved Mr. M’s continued claim and continued paying him benefits until February 27, 2014.

In February 2014, Mr. M received an 8-page letter from Mutual of Omaha stating that based on a review of Mr. M’s claim for ongoing LTD benefits Mutual of Omaha had determined that Mr. M retained the ability to return to work in his pre-disability occupation as a quality control inspector and that no further benefits were payable on the claim beyond the date of the letter.

At the time, Mr. M had been receiving benefits for over 5 years and there had been no improvement in his condition. Over the years, Mutual of Omaha had periodically reviewed Mr. M’s ongoing claim and had consistently found that Mr. M. was disabled and unable to work in any gainful occupation. Having relied on his monthly benefits for the last 5 years, Mr. M. was put in a difficult position and did not know what to do. Mr. M was given 180 days to appeal the claim decision if he disagreed with their decision.

Mr. M contacts Attorneys Dell & Schaefer for help with his appeal

Mr. M immediately contacted our law firm. We reviewed Mr. M’s denial letter and after discussing his case with Mr. M. it became apparent that Mutual of Omaha had failed to understand the significance of Mr. M’s disabling conditions. Mr. M retained Attorneys Dell & Schaefer to handle his appeal of his LTD denial and we immediately requested a copy of the claim file from Mutual of Omaha and thoroughly picked through the file. During the review, we uncovered major flaws in Mutual of Omaha’s review, which we focused on in drafting the appeal. Of particular significance was the fact that Mutual of Omaha had relied on a Transferable Skills Analysis (“TSA”) dated September 7, 2012 finding that there is no gainful occupation which Mr. M. can perform and, based on that TSA, had affirmed and reaffirmed Mr. M.’s eligibility for benefits. Although Mutual of Omaha had appropriately relied on the September 2012 TSA during its periodic reviews over the years, Mutual of Omaha had completely ignored the TSA report in terminating Mr. M.’s benefits.

A review of the TSA report and the notes in the claim file revealed that the TSA was based on the results of an IME report dated June 19, 2012, which Mutual of Omaha had conveniently left out of the claim file sent to us. The report relied on the following statement from the IME physician:
“I do not think he can go back and do his former job, but he can do a full time sedentary job with no appreciable lifting/carrying of more than 20 pounds occasionally, 10 lbs. frequent. He needs a sit/stand option. I do find that he would be able to drive. He should avoid overhead lifting of more than 10 pounds.”

There was nothing in the claim file suggesting that there had been an improvement in Mr. M’s condition since the June 19, 2012 IME. More importantly, there remains to be no “gainful occupation” of which Mr. M. is able to perform all of the material duties. A review of the claim file revealed that Mutual of Omaha had repeatedly found that there are no occupations that Mr. M qualifies for which meet the gainful earnings threshold required in the policy. Despite the fact that Mr. M’s qualifications have not changed and his condition has not improved Mutual of Omaha wrongly terminated Mr. M’s claim despite knowing that Mr. M continues to be eligible for benefits.

Mutual of Omaha overturns denial on appeal

The appeal submitted to Mutual of Omaha pointed out the flaws in their review and included updated medical records from all of Mr. M’s treating physicians. Additionally, Mr. M underwent a three-hour Functional Capacity Evaluation (“FCE”), which was requested by his attorney, and the results of the FCE were included in the appeal. The FCE report detailed Mr. M’s current limitations. Notwithstanding the results of the FCE, Mutual of Omaha insisted on retaining a doctor of their choice to evaluate Mr. M. once again. Rather than trusting Mutual of Omaha to provide the relevant medical records to its hired physician prior the “Independent” Medical Evaluation (“IME”), Mr. M’s attorney sent the most relevant records to the IME physician for a thorough review.

Although Mutual of Omaha declined to provide a copy of the IME report to Mr. M or his attorney, a letter addressed to us was received days after the evaluation notifying us and Mr. M that Mutual of Omaha had overturned its decision and a check representing all back benefits owed would be sent under separate cover.

Attorneys Dell & Schaefer continues to manage Mr. M’s claim with Mutual of Omaha to ensure he has the best chances of remaining on claim as long as he remains disabled.

Questions About Hiring Us

Do you help Mutual Of Omaha claimants nationwide?

We represent Mutual Of Omaha clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Mutual Of Omaha disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Mutual Of Omaha. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Mutual Of Omaha.

How do you help Mutual Of Omaha claimants?

Our lawyers help individuals that have either purchased a Mutual Of Omaha long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Mutual Of Omaha:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Karen F. (New York)

I applied for and was denied my LTD insurance a little over two years ago. I was distraught, I had no idea they could just refuse you. My Social Security disability lawyer gave me Dell & Schaefer’s name and phone number. I called the next day, and they immediately called me back and set up an appointment the next day, for me to speak to Alex Palamara on the phone. They are located in Florida.

He was extremely empathetic and friendly. He took all of my information and he and Danielle Lauria, who works with the lawyers, prepared a statement to the insurance carrier. They also send me copies of everything that they send out. They sent a very professional and informative letter explaining why I should not be denied the insurance. The insurance company immediately decided to pay me the insurance that I signed up for.

I have always received quick information and phone calls, whenever I request assistance. They did have to do another appeal for me, recently. It was very involved, but written up extremely well. I was offered a settlement, and they were even able to get the in Insurance company to increase it for me. I would recommend Mr. Palamara and this law firm to anyone who has a problem with their LTD insurance. I don’t have a single complaint about the way I was treated. I’m extremely thankful for their help over the last few years.

***** 5 stars based on 202 reviews

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