- “other income” provisions that allow for a dollar for dollar reduction for the receipt of Social Security disability benefits, workers’ compensation benefits, and personal injury settlements, and
- A “golden handcuff” on a judge that only allows for a claims denial or termination reversal if Mutual of Omaha’s decision is “arbitrary and capricious.”
Group Non-ERISA Disability Insurance
However, a group plan offered by a church plan, such as the Catholic Church, or by a municipal employer like the City of Baltimore, Baltimore County, or the State of Maryland is NOT generally covered by ERISA. The policy terms are much like those of an ERISA plan but there is one CRUCIAL difference. A claim denial or termination can be challenged in state court and new evidence can be submitted at trial.
State law courts are a much friendlier place for a policyholder than Federal court. You are entitled to a jury trial in a state law claim and not some Federal judge just making a decision based on Mutual of Omaha’s file stuffed full of things that are unfavorable for you!
Individual Disability (ID) Insurance
Without a doubt, the best and most expensive policy is a private individual disability policy known as an ID policy. The policy terms and coverage are broader and more generous. But that means a high monthly premium and a lot of financial exposure that Mutual of Omaha has if you become disabled.
It isn’t uncommon for Mutual of Omaha to invoke a pre-existing exclusion or a medical condition policy rider right out of the box as a way to justify a denial of the claim from the beginning of the claim. That is just one reason why it is so important for a policyholder to contact me BEFORE they stop working and apply for benefits.
Let say, for example, you are a dentist who has a policy that excludes any claim for disability as a result of carpal tunnel syndrome but you now can’t work because of a herniated cervical disc. The symptoms of carpal tunnel syndrome can mimic those of a herniated cervical disc that causes tingling, numbness, and weakness of the hand.
You can bet that Mutual of Omaha will be looking for a way to say that you are disabled as a result of carpal tunnel syndrome and not a herniated cervical disc. Do you know what your medical records say about your medical history, your carpal tunnel complaints, how your complaints are different because of the herniated cervical disc, or how the impact on your practice is different than your carpal tunnel symptoms?
Mutual of Omaha fights an individual disability claim as hard, if not harder than an ERISA claim and costly mistakes can be made at the initial application and appeal stages of a case.