Disability Representation For Your Disability Claim


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Mutual of Omaha Disability Claims Lawyer > Mutual of Omaha Disability Claims Lawyer

mutual of omaha disability lawyerDedicated Mutual of Omaha Disability Claims Lawyer

Mutual of Omaha was founded in 1909 and is based in Omaha, Nebraska. It owns United of Omaha, and from this point forward when I will use the term “Mutual of Omaha” to mean both companies, as they play from the same playbook. Both companies offer a variety of insurance options, including group disability insurance products. It was one of the first companies that offered disability insurance to non-professional workers.

Mutual of Omaha will:

  • Use in-house nurses to review medical records and reach medical conclusions about the policyholder’s restrictions and limitations even though those nurses may have no training in or qualifications to render any opinions about the policy holder’s medical conditions,
  • Use biased medical peer review providers to create medical justifications for a claim’s denial,
  • Use surveillance to discredit the policyholder’s complaints,
  • Use in-house vocational evaluators to misclassify the policy holder’s occupation, perform questionable transferrable skills analysis, and misinterpret the wages of and availability of other occupations it will claim the policyholder can do to justify the denial or termination of benefits.

Courts across the United States have criticized Mutual of Omaha’s claims handling.

Mutual of Omaha is known to make endless and multiple requests for medical, financial, and vocational information before it figures out a way to deny benefits. This delay and denial strategy drains the policy holder’s bank accounts as they try to stay financially afloat.

Mutual of Omaha rarely tells a denied policyholder the real reasons the claim was denied. You need an experienced disability claims lawyer who battles Mutual of Omaha Life daily.

A Mutual of Omaha Disability Claims Attorney Will Help You By:

  • Reviewing your policy,
  • Reviewing your medical records,
  • Creating a pre-claim strategy to get your benefits on the initial application,
  • Appeal a wrongful denial or termination by writing an appeal letter 25 to 60 pages long that is the trial of your case and goes to Mutual of Omaha in a box,
  • Protecting you from aggressive claims handling by Mutual of Omaha, including the delay game, the “we need more information game,” we “want to take your statement game “or “we want to have you under an independent medical examination or FCE, “
  • Aggressively litigating your case, if need be.

Mutual of Omaha plays games with initial applications and makes endless and multiple requests for medical, financial, and vocational information before it figures out a way to deny benefits. This delay and denial strategy drains the policy holder’s bank accounts as they try to stay financially afloat. It is their business model.

Mutual of Omaha uses “liar for hire” doctors who give them the ammunition it needs to justify a claim’s denial or termination. Mutual of Omaha rarely tells a denied policyholder the real reasons the claim was denied. Worse yet, Mutual of Omaha Mutual of Omaha claims by an experienced lawyer who battles Mutual of Omaha daily.

Don’t think that Mutual of Omaha doesn’t play the claims delay, denial, or termination game with individual disability policies. They do and the policy benefits at stake are often much higher so there is much more to lose if you aren’t represented by a Mutual of Omaha individual disability attorney.

Our Mutual of Omaha Disability Claims Lawyer

Some Mutual of Omaha policyholders make the mistake of going it alone and they pay dearly for “doing it yourself.”

Once the appeals process is exhausted (and that really means you are exhausted by the endless requests for information and battling with Mutual of Omaha), the only recourse is to file a lawsuit. If you purchased your insurance through your employer, the policy is most likely governed by the Employee Retirement Security Act or ERISA.

Despite its name, the ERISA statute and regulations are NOT policyholder friendly.  You CANNOT add anything to the claims file after the last denial so all the Federal judge gets to see is what is in Mutual of Omaha’s file which is stuffed with medical and vocational opinions that are favorable to Mutual of Omaha. You didn’t know enough to get the claims file when you appealed, didn’t know enough to add medical, vocational or lay evidence to the file, or didn’t make the right arguments, you have all but destroyed your case.

An appeal of a denied Mutual of Omaha claim is the trial of your case. Taking on a tough insurance company like Mutual of Omaha is an endeavor for a specialist. A federal judge will give Mutual of Omaha the benefit of the doubt because your Mutual of Omaha policy requires you to prove they are wrong and not the other way around. You owe it to yourself and your family to have an experienced disability attorney take on Mutual of Omaha. After all, this is about getting the disability benefits you deserve and you paid for.

Some policyholders have bought their own disability policy through an agent, and that is known as an individual disability insurance policy. The game is the same but the playing field is more level because any claims denial can be challenged in state court which is a friendlier place to be if you have to sue Mutual of Omaha.

There Are Three Types of Disability Policies Offered By Mutual of Omaha

The type of policy that you have will determine your rights and whether you are playing on a level playing field.

Group ERISA Disability Insurance

Mutual of Omaha offers disability policies through employers which are governed by ERISA. A Mutual of Omaha ERISA policy generally has the following:

  • strict definitions of disability and occupation,
  • limitations on how long payment will be made for mental conditions or subjective conditions like  headaches, pain, fibromyalgia or chronic fatigue,

It is crucial that you understand the terms of your policy as many plans have limitations on how long benefits will be paid for subjective or self-reported conditions.

For example, in the case of Curran v. United of Omaha Life Insurance Company, No. 15-56599, U.S. Appeals 9th Circuit, August 30, 2017, the policy limited that payment of self-reported symptoms (SRS) to just two years if there was no objective evidence of disability. Curran suffered from fibromyalgia and the diagnosis was based on the 18 point trigger point test since there is no gold standard objective test. The court said “too bad, so sad” since there was no objective evidence.

  • “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.

How to File a Claim for Disability Insurance

A disability insurance policy provides financial protection to individuals and families in the event of an illness or disabling injury. If you have disability insurance through Mutual of Omaha, you can obtain the claims form directly through the company. You can call them or write to them. Mutual of Omaha informs policyholders that they need the following documents to process a disability claim: 

  • Employee statement;
  • Employer statement; and
  • Physician statement. 

To file a successful disability claim, you will need evidence that demonstrates that disability, illness, or medical condition prevents full-time work. If you have specific questions about preparing or filing a short-term or long-term disability claim with Mutual of Omaha, an attorney can help. Make sure that you file a disability claim before any applicable deadline expires. 

How to Calculate Short-Term Disability

Your disability payments will depend on the terms of your policy and the nature of your medical condition. As a baseline, we should note that short-term disability insurance through Mutual of Omaha typically covers between 40 percent and 65 percent of a policyholder’s weekly gross earnings. In addition, most policies carry a maximum available benefit—often around $1,000 per week. Check the terms of your policy to confirm how much disability compensation is available to support you and your family. 

When Does Mutual of Omaha Disability Run Out?

Disability insurance obtained through Mutual of Omaha varies in its duration. Most of the short-term disability insurance policies offered provide between three months and six months of benefits. Though, some short-term policies offer greater protection. 

Mutual of Omaha’s long-term disability plans generally pay out over two years, five years, ten years, or until a worker’s date of retirement. Make sure to review your policy documents to determine exactly when benefits expire. If your short-term disability coverage has run out, you may be able to file a long-term disability claim.

How Do I Request a Long-Term Disability Settlement from Mutual of Omaha?

Mutual of Omaha has been known to offer settlements or buyouts of long-term disability benefits. It may be in your best interest to seek a settlement or lump-sum payment for your disability claim. Whether or not this is an advisable option depends entirely on your unique circumstances. Do not request a long-term disability settlement until you know the full value of your claim. Mutual of Omaha is interested in protecting its own profits. They want to settle a long-term disability claim for the lowest amount possible. 

Before requesting a settlement from Mutual of Omaha, it is highly recommended that you consult with an experienced disability attorney. Getting a long-term disability settlement paid is a complicated matter. You and your family need a settlement that reflects the full and fair value of your long-term disability claim. Do not accept less than you are entitled to receive from Mutual of Omaha or any other insurance company. 

Contact Our Mutual of Omaha Disability Claims Lawyer Today

If you are seeking to file a disability insurance benefits claim, or if your claim was denied by Mutual of Omaha, don’t go it alone. Get the legal help you need by calling The Law Office of Nancy L. Cavey now.