Mutual of Omaha Insurance Company employs several doctors who have the title “Medical Director.” My client had her claim reviewed by a “Medical Director” for Mutual of Omaha Insurance Company. We believe those physicians also do work for United of Omaha Life Insurance Company because United of Omaha Life Insurance Company has no employees, and services on behalf of United of Omaha Life Insurance Company are performed by Mutual of Omaha Insurance Company – – United of Omaha Life Insurance Company’s parent corporation – – under an intercompany administrative services agreement.
As a Medical Directors for Mutual of Omaha Insurance Company, these doctors primarily: (1) review medical records; (2) prepare “medical reviews” of those medical records; (3) write letters to treating doctors asking them if they agree with the Medical Director’s opinions about their patients’ conditions and capacity to work; and (4) sometimes recommend that medical specialists be hired (that is other doctors who don’t work directly for Mutual of Omaha) to review medical records and make recommendations concerning those records.
INADEQUATE REVIEW OF MY CLIENT’S CLAIM
In my client’s case, a Medical Director wrote a medical review, wrote letters to treating doctors, recommended the use an outside medical specialist, and wrote the questions to be asked of that outside specialist, regarding a claim for long-term disability benefits by one of our clients. In our opinion, there were many flaws in the Medical Director’s work on our client’s claim. For example, he:
- Mischaracterized our client’s occupation;
- Noted restrictions of fatigue and memory loss following her cardiac arrest and cardiac conditions, but failed to evaluate all the possible causes for that fatigue and memory loss;
- Did not accurately or adequately address the fact that our client suffered from cardiac arrest, cardiogenic shock, myocardial infarction, and reduced left ventricle ejection fraction;
- Did not request or obtain treatment records for many of our client’s known medical conditions, including those conditions discussed in her cardiac treatment records, such as, PTSD and anxiety—both very common consequences for persons who suffer cardiac arrest;
- Did not obtain any records related to our client’s fibromyalgia diagnosis and did not properly consider the limiting effects of that condition, concluding instead that he did not find “documented evidence of ongoing functional loss/impairment related to. . Fibromyalgia and/or Chronic pain syndrome,” reasoning that “this condition would not be expected to result in any significant ongoing or long-term functional loss/impairment and is typically treated with recommendation for an increased (i.e., as to decreased or no) physical/aerobic activity. . . .”
In our opinion, Mutual of Omaha’s Medical Director should have requested and reviewed records concerning our client’s PTSD, anxiety, panic attacks and but did not, and unreasonably assessed our client’s co-morbid fibromyalgia condition when he evaluated her claim for Mutual of Omaha.
IF YOUR CLAIM WAS DENIED BY MUTUAL OF OMAHA, BASED ON A REPORT BY ONE OF IT’S MEDICAL DIRECTORS CALL US, WE WANT TO TALK TO YOU
If your claim for long-term disability benefits from Mutual of Omaha Insurance Company or United of Omaha Life Insurance Company was denied and if Mutual of Omaha Insurance Company or United of Omaha Life Insurance Company relied on opinions or letters or recommendations by one of its Medical Directors, we would like to talk to you. Please call us or send us an email with the subject line: “I want to discuss Mutual of Omaha’s Medical Director,” and we will call you to discuss.