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

Pre-disability

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.

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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.

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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, GoToMeeting.com 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.

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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.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

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