Dell Disability Lawyers 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 Dell Disability Lawyers 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 Dell Disability Lawyers 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.
Dell Disability Lawyers 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.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong Mutual of Omaha Appeal Package
We work with you, your doctors, and other experts to submit a very strong Mutual of Omaha appeal.
Sue Mutual of Omaha
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Mutual of Omaha.
Protect Your Benefits
Get Your Mutual of Omaha Disability Application Approved
We help claimants throughout the entire application process.
Prevent a Mutual of Omaha Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a Mutual of Omaha Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Mutual of Omaha Reviews
(660)
Policy Holder Rating
5
0%
4
0%
3
0%
2
66%
1
33%
Timely Payments
2.4out of 5
Handling Claim
1.9out of 5
Customer Service
1.8out of 5
Dependable
1.8out of 5
Value
2.1out of 5
Showing 8 of 660 Reviews
Mutual of Omaha
I do not understand how a “medical review team” who has never laid eyes on my wife can say she is able to return to work when her doctors who see her on a regular basis have documented that she can't
My wife fell three years ago and broke her back. She has been found permanently disabled and receives Social Security Disability Benefits. She has also been receiving Bene... read more >
Reply
Mutual of Omaha
THEY SCAMMED ME AND DID NOT CARE
We have had life insurance with Mutual of Omaha since 1998 with a chronic illness rider that we decided to use in 2016. Our policy was for 500k, they approved us for 66,95... read more >
Mutual of Omaha
This company is awful
I think there should be laws put in to place to cover the average Joe. This company is awful. They say so much they don’t even know what lies they have told. My husband ... read more >
Mutual of Omaha
I would encourage anyone who has problems with Mutual of Omaha or United of Omaha to immediately contact an attorney.
I would encourage anyone who has problems with Mutual of Omaha or United of Omaha to immediately contact an attorney. I want to talk about a specific situation in which I ... read more >
Mutual of Omaha
MOO attempted to strong arms me with collection tactics. Now, they're stalling
I was disabled in 2009 with a multitude of medical problems. I started a process with Mutual Of Omaha Disability. After months of jumping through hoops they finally decide... read more >
Mutual of Omaha
MOO stopped my husband's benefits before telling him. They handled his claim terribly
My husband has been on claim for disability insurance since July, 2008. He was found to be able to do sedentary work but had no transferrable skills in 8/2009 and benefits... read more >
Reply
Mutual of Omaha
This company is very corrupt, Be aware
Please hesitate & educate yourself when deciding on short term or long term disability insurance via Mutual Of Omaha. The company is very corrupt. They speak to you like y... read more >
Mutual of Omaha
Mutual of Omaha is a rip off.
Mutual of Omaha is a rip off. When my husband died in 2011, they refused to pay his death benefit because they said he was disabled when I insured him. He retired from his... read more >
Answered Questions by Our Lawyers
(18)
Showing 8 of 18 Answered Questions
Q: Can I ask for another appeal?
A: Giovanna, you should consult with the attorney(s) that represented you in your appeal to the Third District Co... Read More >
Q: I'm in jeopardy of losing everything because of MOO. Can you help?
A: Amy, first and foremost, I am sorry to hear of MOO’s delay tactics and the fact that they sound like they mi... Read More >
Q: Can MOO deny my claim on the basis of preexisting condition when my condition is not preexisting?
A: Doomed, if your claim has been denied then Mutual of Omaha will give you the right to appeal. Pre-existing con... Read More >
Q: What is my "regular occupation" if I started my own business after resigning from my old job?
A: Rachel, the answer depends on when you became disabled. If you became injured after resigning from your accoun... Read More >
Q: Am I able to work part time at a different job that is nothing like the one I was at when I was injured?
A: Russell, whether you can work part time in a different occupation depends on the specific language of the Grou... Read More >
Q: Can I get a lump sum check from MOO?
A: Pam, Mutual of Omaha may be willing to negotiate a lump sum buyout of the remaining time on your policy, but t... Read More >
Q: Should I be able to restrict the release of medical records to under 24 months period?
A: Connie, although you could attempt to limit the medical records to be released to Mutual of Omaha, the likely ... Read More >
Q: Should I write an appeal letter? What should it include?
A: Cam, if you are still within your 180 timeline to file an appeal it is imperative that you go through the appe... Read More >
Helpful Videos
(908)
Showing 12 of 908 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
What is a "Gainful Occupation" under a Disability Insurance Policy?
The overwhelming majority of employer provided group long term disability insurance policies governed by ERISA contain two definitions of disability depending on what stage your claim is in. As discussed in depth throughout our website the two definitions of disability are what are commonly known as the “Own Occupation” and “Any Occupation” definition of disability. As they imply, the former is an eval... Read More >
Can my insurance carrier deny my benefits even if there is no change in my medical condition?
Insurance companies frequently terminate long term disability benefits after paying a claim for several years, even when the claimant's condition remains the same. It would seem unfair that one's benefits can be cut off when their disabling condition has not improved or changed in any way. However, it is quite common that a person who has been on disability for several years, who has been approved for "any occ... Read More >
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >
How Do You Fight a Long-Term Disability Denial?
Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter or a ph... Read More >
Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
After appeal filed by Attorney Jay Symonds, Mutual of Omaha overturned previous denial of short term disability benefits for Maine Senior Software Engineer
Our client, Mr. C, formerly worked as a Senior Software Engineer for a large computer technology company. In April 2016 a number of medical issues including, chronic pain syndrome, failed back syndrome, chronic low back pain, chronic sciatica, and severe lumbar radiculopathy forced Mr. C to stop working and submit his claim for disability benefits under his employer’s short-term disability (STD) policy, whic... Read More >
After an appeal, a former Director of Information Security, gets disability benefits approved for mental health disorder. The fight for long term disability benefits for client’s physical limitations continues
After a very long fight, a former employee of the National Student Clearinghouse is now on claim after an administrative appeal filed by Dell Disability Lawyers. Prior to filing for disability, our client was a Director of Information Security responsible for security strategy, security programs oversight, and security development for an online national student degree and enrollment verification database. Howe... Read More >
United of Omaha overturns decision to deny benefits to disabled Quality Assurance Manager after Appeal discredits its medical review and vocational assessment
In 2016, Cathy, a Quality Assurance Manager for a medical device company, sought surgery for a tear in her right rotator cuff. Cathy fully expected to heal, recover and return to work. However, disappointingly, things did not turn out quite like she expected. After continuing to experience pain, discomfort and restriction in her right shoulder range of motion, she discovered that her shoulder did not heal prop... Read More >
After appeal filed by Attorney Jay Symonds, Mutual of Omaha overturned its previous denial of short term disability benefits for Colorado Senior Manager
Our client, Ms. J, formerly worked as a Senior Manager of a treatment facility. In October 2016 a number of medical issues, including fibromyalgia, chronic pain syndrome, chronic fatigue and depression forced Ms. J to stop working and submit her claim for disability benefits, first under her employer's short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. The STD c... Read More >
Mutual of Omaha Reinstates Benefits of Business Development Manager after Appealing the Termination of Her LTD Benefits
Our Client, a successful Business Development Manager began experiencing severe physical limitations resulting from fibromyalgia, low back pain, L4-5 spondylolisthesis, L4-5 degenerative disc disease and chronic fatigue. As a result she was unable to perform with reasonable continuity at least one of the material duties of her regular occupation on a part-time or full-time basis.Denial Based Solely on Nurs... Read More >
Dell Disability Lawyers Successfully Appeals Denial of Benefits to Quality Control Inspector
Pre-disabilityBefore 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... Read More >
Mutual of Omaha Approves Dell Disability Lawyers Client for Short Term Disability Benefits After Administrative Appeal
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 seve... Read More >
Mutual Of Omaha Overturns Denial of Short Term Disability Benefits for Software Developer With Chronic Back Pain
Regardless of how hard a person attempts to continue working with a disability, it is an effort that gets taken advantage of by the disability insurance company. Prior to filing for disability insurance benefits under her employer provided Short Term Disability Policy administered by Mutual of Omaha, our client was a successful Software Developer with a history of chronic back pain and prior surgery. She was t... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
