Mutual of Omaha disability denial remanded for wrongful evaluation of occupation
Author: Attorney Stephen Jessup
A Mutual of Omaha disability claim was sent back for further evaluation according to a recent decision by a Maryland Federal Judge. The issue dealt with how should Mutual Of Omaha determine the occupation of a disability claimant. Which is a better tool for determining occupation? ONET or DOT?
If O*Net has replaced the DOT, why can an insurance company rely on the DOT?
Unfortunately, there is no simple answer to this question. However, a Federal Court in Maryland asked the same question in the recent case of Patel v. United of Omaha Life Insurance Company (a Mutual of Omaha company). Unique to the disability policy that governed Patel’s claim was the fact that the policy expressly stated that “regular occupation” would be based on a comparable job description as set forth in the most current edition (emphasis added) of the DOT. The Policy went on to state that Omaha had the right to substitute or replace the DOT with a service or other information it determined to be comparable.
In the Patel case, Omaha Life initially approved Ms. Patel’s benefits under the regular occupation definition of disability. However, within a few short months Mutual of Omaha had terminated her claim stating that based upon the information in the claim file she could return to her former occupation. Ms. Patel appealed this determination, but ultimately Omaha Life would deny her appeal and the case would end up in litigation. In motions filed with the court, both Patel and Omaha requested that the Judge decide the case in their favor. Based on a review of the claims procedure and argument made by both sides, the Court ruled that neither side had made convincing enough argument in their motions to prevail. Instead the Court remanded (sent the case back) Ms. Patel’s claim back to Omaha Life for further review. In doing so the Judge ordered Omaha Life to consider the O*Net Occupational definition rather than the DOT to determine whether Ms. Patel was disabled in light of same. The Judge’s logic was if the Policy indicated Omaha Life would determine what constituted Ms. Patel’s regular occupation based upon the most recent edition of the DOT, and if O*Net replaced the DOT, then Omaha should review it in light of O*Net.
So does this mean the Insurance Company can no longer rely on the DOT?
No. The Patel case is the opinion of one Judge as to the application of DOT vs. O*Net. However, it does reiterate the importance of an in depth and complete analysis of an “occupation” based on all available sources. Insurance companies will continue to rely upon the DOT, and that’s why it is important to consult with an attorney who has experience in combating the insurance industry’s position on this matter.
It should be noted that in rendering its decision the Court did not award Ms. Patel benefits. Her claim was simply returned to Omaha Life to conduct further review of her claim in accordance with the Judge’s order. There is no guarantee that in doing so Omaha Life will change its decision to deny benefits.
If you have any questions regarding your rights under a short or long term disability policy please contact Attorneys Dell & Schaefer at 1-800-828-7583 for a free consultation.
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