After appeal filed by Attorney Jay Symonds, Mutual of Omaha overturned previous denial of short term disability benefits for Maine Senior Software Engineer
Author: Attorney Jay Symonds
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, which was funded and administered by Mutual of Omaha (MOO). Under his employer’s disability policies Mr. C would be considered totally disabled if he was prevented from performing the material duties of his regular job. Regular job was defined as the occupation he was routinely performing when his disability began.
MOO denied Mr. C’s claim for short term disability benefits on the basis that he allegedly did not meet the policy definition of disability. Specifically, MOO determined that “restrictions and limitations from normal job duties would not be supported based on the available medical records.” After receiving the denial, Mr. C contacted Dell & Schaefer and discussed his case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in MOO’s denial letter and in the evidence it relied on and agreed to prepare and submit Mr. C’s ERISA appeal with the assistance of his appeal team.
The STD appeal addressed all of MOO’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of MOO’s denial. The appeal next addressed the fact that despite overwhelming medical support from his treatment providers, MOO denied his claim based on a medical records review by a registered nurse that lacked the necessary orthopedic experience to offer an opinion as to Mr. C’s condition or functionality. What’s more, the nurse reviewer misstated and mischaracterized the relevant medical evidence and ignored critical objective testing that confirmed the severity of Mr. C’s multiple conditions. The appeal also addressed the fact that although MOO concluded that Mr. C was not disabled under the terms of the Policy, there was nothing in the claim file indicating or even suggesting that MOO conducted a vocational analysis to determine whether Mr. C’s chronic debilitating physical conditions prevented him from performing the duties of his regular job as a Senior Software Engineer, which was intellectually complex, detail oriented and physically demanding. In fact, MOO never requested or reviewed Mr. C’s actual job description.
Approximately 6 weeks later, and after reviewing the appeal and hundreds of pages of exhibits and medical records as well as the expert reports, MOO overturned its decision to terminate benefits, paid full STD back benefits. Thereafter, Attorney Symonds and his team submitted an LTD claim on behalf of Mr. C, which was approved on initial application. Attorney Symonds continues to represent our client in his LTD claim to best ensure that MOO will not terminate his benefits again. Feel free to call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.