If your claim for individual disability benefits from Mutual of Omaha Insurance Company was denied, we can help you. Mutual of Omaha as a matter of standard practice, improperly and inadequately investigates claims for individual disability benefits and falsifies its files concerning such claims.
MUTUAL OF OMAHA’S INADEQUATE INVESTIGATION AND FALSIFICATION OF OUR CLIENT’S CLAIM FILE
Here is an example: one of our clients became disabled when she suffered from a cardiac arrest, was revived, but thereafter continued to suffer from cardiac conditions, as well as fibromyalgia, Post-Traumatic Stress Disorder (PTSD) and a panic disorder (which are very common consequences for persons who suffer from a cardiac arrest).
This client had purchased a long-term disability policy from Mutual of Omaha six years before her cardiac arrest. After her cardiac arrest, she applied for long-term disability benefits and her claim was assigned for investigation to a benefit claims specialist. In our opinion, that benefit claims specialist was not properly trained or supervised and did not properly investigate or decide our client’s claim:
- He didn’t get any records from our client’s therapist who was treating her for PTSD;
- He didn’t get any records from our client’s general practitioners who diagnosed her with fibromyalgia;
- When my client told the benefit claims specialist that she was receiving cardiac rehabilitation therapy, he did not get those records; and
- When my client notified the benefit claims specialist that she had been awarded Social Security Disability benefits, he did not get those records, either.
The benefit claims specialist not only failed to properly investigate my client’s claim, he also falsified our client’s claim file. Mutual of Omaha Insurance Company solicited a medical review from an outside vendor. When the benefit claims specialist received the report by the doctor provided by the outside vendor, the benefit claims specialist noted errors in the report and emailed the outside vendor asking to have the errors corrected. The corrections were made and a new report was provided. Then the benefit claims specialist deleted or omitted from the claim file his emails about the errors in the initial report and the original report. He claimed the first, uncorrected report and the emails were not “pertinent,” so he did not include them in our client’s claim file.
MUTUAL OF OMAHA’S SECRET “TRIAGE MEETINGS”
Although all of the letters and communications sent to our client during her claim were signed by her benefit claims specialist, he did not have authority to approve or deny her claim for benefits. During his deposition, the benefit claims specialist who denied our client’s claim explained that he is required to make a recommendation to either grant or deny benefits during secret meetings with his manager and director, which meetings are not documented in claim files. These meetings are called “triage meetings.” At these secret triage meetings, a benefit claims specialist makes a presentation and provides a recommendation to either grant or deny a claim for individual disability benefits to his or her manager and director, who then approve or disprove the recommendation.
In our client’s case, on two separate occasions, the same benefit claims specialist recommended to his manager and his director that our client’s benefits be denied. The benefit claims specialist testified that his manager and director agreed with his recommendations to deny our client’s claim for benefits even though he informed them that our client: was being treated for PTSD by a therapist but he did not get the records; had been awarded Social Security Disability benefits on application, but he didn’t get the records; was receiving cardiac rehabilitation therapy, but he didn’t get the records; and was also suffering from fibromyalgia in addition to her cardiac conditions, but he didn’t get those records, either.
IF YOUR CLAIM WAS DENIED BY OF MUTUAL OF OMAHA, CALL US, WE CAN HELP YOU
The responsible benefit claims specialist testified in his deposition that he was never criticized or disciplined for his work and received a bonus every year he worked for Mutual of Omaha.
If your claim for individual disability benefits from Mutual of Omaha Insurance Company was denied, you need to understand how Mutual of Omaha operates in order to get the benefits you are owed. We can help you. Please call us or send us an email and we will call you to discuss.