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.
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Mutual of Omaha Reviews
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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 >
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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 >
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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
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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 >
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