Our client previously worked as a Senior Accountant/Office Manager for Maccaferri, Inc. Due to her employment at Maccaferri, she was covered under both a Short Term Disability Insurance Policy and a Long Term Disability Insurance Policy that insured that should she become disabled she would be able to receive a percentage of her prior monthly earnings. Although that day was never expected to occur, due to severe and uncontrolled migraine headaches, our client was unable to continue to work beyond February 14, 2014. Our client applied for Short Term Disability benefits shortly thereafter and supplied Mutual of Omaha with all of the required documentation to support her claim. Medical records as well as Attending Physicians Statements from her treating physicians which supported her claim were provided. Unfortunately, Mutual of Omaha determined that our client did not qualify for Short Term Disability (STD) benefits and denied her claim by way of a letter dated April 10, 2014.
Short Term Disability Denial
In its denial letter of April 10, 2014, Mutual of Omaha noted that our client had been working with migraine pain for months before she made this claim for STD benefits. This caused Mutual of Omaha to opine that our client had “no change in (her) functional ability on or near the last day worked that would prevent (her) from performing the material duties of (her) regular job.” It was as if Mutual of Omaha stated that since she was able to attempt to remain at work and not make a claim for disability benefits for so long, then her condition must not be as disabling as she alleges. Mutual of Omaha therefore found no benefits to be payable and denied our client’s claim.
Administrative Appeal filed by Dell & Schaefer
With the help of Attorney Alexander Palamara of Dell & Schaefer, an administrative appeal challenging Mutual of Omaha’s initial determination was timely filed. First and foremost, this appeal loudly criticized Mutual of Omaha’s reasoning to penalize our client for attempting to remain at work and fight through her conditions. The appeal noted that Mutual of Omaha should have thanked our client for fighting to remain at work and attempting not to make a disability claim as Mutual of Omaha would have had to pay disability benefits at an earlier date. In addition to criticizing Mutual of Omaha for their offensive argument, the administrative appeal focused on the overwhelming support from our client’s treating physicians and the medical documentation that showed that our client’s refractory migraine headaches continue to not be under control.
Approval for Short Term Disability Benefits
After the filing of the administrative appeal, our client was informed a few months later that Mutual of Omaha had determined that “(b)ased upon the relevant documentation received on appeal, as well as our review, we are overturning the denial of her disability claim.” Thus our client will be receiving her full short term disability benefit and our attention will now turn to our client’s claim for Long Term Disability Benefits. Our client is assured that the Attorneys at Dell & Schaefer will continue to fight Mutual of Omaha so that her benefits are paid so that she can continue to receive treatment to combat her disabling conditions. If you have been denied Short Term or Long Term Disability Benefits by Mutual of Omaha or any other insurance provider, please do not hesitate to contact the Attorneys at Dell & Schaefer for a free consultation.