United of Omaha criticized for relying on in-house medical review and failing to obtain independent examinations

This case was decided by a district court in Illinois and involved United of Omaha Life Insurance Company. An ERISA action was filed by the Plaintiff, Gina Tassone, after her LTD benefits were terminated. She had been paid two-years of regular-occupation benefits for her inability to work as a Finance Manager and like many group disability policies, her insurance policy’s definition of disability changed after two-years of benefits.

During its two-year review, United of Omaha relied on the opinions of two in-house clinical experts who reviewed the medical records, neither of whom ever examined Ms. Tassone. First, an in-house nurse opined that “it would be reasonable to expect Ms. Tassone to be able to sit for 6 hours out of an 8 hour day, lifting no more than 10 pounds occasionally with possible frequent lifting of small objects.”

Next, Dr. Reeder, United of Omaha’s medical director, provided a long list of reasons as to why Ms. Tassone’s medical records were deficient. Interestingly, Ms. Tassone’s file consisted of over 5,400 pages of medical records.

Following his review, Dr. Reeder sent letters to a number of Ms. Tassone’s treating doctors, asking them to respond to his conclusions, including a clarification regarding their treatment and restrictions and limitations. Each of Dr. Reeder’s letters indicated that if he did not get a response within 10 days, he would assume that the recipient was in agreement with his conclusions that Ms. Tassone was able to perform at the sedentary level.

None of the plaintiff’s treating doctors responded to the medical director’s challenge.

United of Omaha argued that by failing to disagree, those treating doctors tacitly agreed. The court disagreed pointing out that the letters were obviously written in a manner designed to lure the recipient into either agreeing with the medical director’s limited and biased review of the records or enter into a war of diagnoses with him. There is no upside for any doctor to engage in a dispute with an in-house physician so the court placed no significance on the doctor’ silence to such a biased letter.

The court placed little weight on the in-house nurse and doctor’s opinions, finding them undoubtedly biased given that both work for the defendant.

The court also pointed out that in-house medical director had been criticized in a similar case for ignoring conditions that cause pain despite the fact that it is the plaintiff’s extreme pain that supports her claim for LTD benefits.

Ms. Tassone was given a fee award and an award of prejudgment interest following the court’s finding that Ms. Tassone was unable to work full time at a sedentary position.


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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

Reviewed by Dwight on November 14th 2017   Verified Policyholder
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
Sent on November 14th 2017 by Attorney Stephen Jessup

Dwight, please feel free to contact our office to discuss the denial of your wife’s claim. It is unfortunately all too common that an insurance company denies benefit... read more >

Mutual of Omaha

THEY SCAMMED ME AND DID NOT CARE

Reviewed by Debbie on January 31st 2017   Verified Policyholder
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

Reviewed by Mike on December 17th 2015   Verified Policyholder
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.

Reviewed by Robbie Winder on July 24th 2015   Verified Policyholder
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

Reviewed by Jeff on February 11th 2015   Verified Policyholder
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

Reviewed by Jerry on January 30th 2015   Verified Policyholder
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
Sent on January 30th 2015 by Attorney Gregory Dell

Jerry, you and your husband are certainly not alone in your dealings with Mutual of Omaha. Please feel free to contact our office to discuss how we may be able to assi... read more >

Mutual of Omaha

This company is very corrupt, Be aware

Reviewed by M. Girmes on January 28th 2014   Verified Policyholder
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.

Reviewed by Genita Hill on November 13th 2013   Verified Policyholder
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 >
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Q: Can I ask for another appeal?

Answered on July 13th 2020 by Attorney Alex Palamara
A: Giovanna, you should consult with the attorney(s) that represented you in your appeal to the Third District Co... Read More >

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Answered on March 3rd 2020 by Attorney Alex Palamara
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 >

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Answered on October 27th 2018 by Attorney Gregory Dell
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?

Answered on September 1st 2018 by Attorney Gregory Dell
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?

Answered on June 5th 2018 by Attorney Gregory Dell
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?

Answered on May 10th 2017 by Attorney Stephen Jessup
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?

Answered on March 20th 2017 by Attorney Jay Symonds
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?

Answered on March 3rd 2017 by Attorney Jay Symonds
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