Do you have a policy for individual disability insurance issued by Mutual of Omaha Insurance Company? Have you made a claim on that policy? Was your claim denied? If your claim for individual disability benefits from Mutual of Omaha Insurance Company has been denied, we would like to talk to you.
MUTUAL OF OMAHA’S DENIAL OF OUR CLIENT’S CLAIM
We represent a person who purchased an individual disability insurance policy from Mutual of Omaha Insurance Company in 2014. In 2020, she suffered a cardiac arrest, was revived, and thereafter- – -as is not uncommon – – experienced symptoms of and was diagnosed with post-traumatic stress disorder (PTSD) relating to her cardiac arrest. She applied for disability benefits from the Social Security Administration, which were granted. She also made a claim on her individual disability insurance policy which she bought from Mutual of Omaha Insurance Company, which claim was denied.
Before we filed suit, we requested and obtained a copy of our client’s claim file from Mutual of Omaha Insurance Company. After we filed suit, Mutual of Omaha Insurance Company provided another copy of her claim file along with a list of knowledgeable persons who were involved in my client’s claim. None of those materials or records provided identify the person who actually approved the decisions to deny my client’s claim for long-term disability benefits.
SECRET “TRIAGE MEETING” WITH DIRECTOR OF INDIVIDUAL CLAIMS
From the information we have learned to date it appears that the decisions to approve the denial of our client’s claim were made by the Director of Individual Claims for Mutual of Omaha Insurance Company.
We have learned that when Mutual of Omaha Insurance Company receives a claim from one of its insureds for individual disability benefits, the claim is assigned to a benefit claims specialist to investigate – -and, if the benefit is granted, – – to manage. The benefit claims specialist does not have authority to grant or deny or terminate benefits. The benefit claims specialist can only make a recommendation that benefits be granted, denied or terminated. That recommendation is made at a secret “triage meeting” which is not documented in the person’s claim file. At that secret “triage meeting” the benefit claims specialist makes a presentation to his or her manager and to the Director of Individual Claims. During that secret meeting, they decide whether or not to approve a recommendation to grant or deny or terminate benefits. And, of course, since the Director of Individual Claims is the highest ranking person at these secret triage meetings, as a practical matter it seems that likely the Director is the person who decides whether or not to deny or terminate individual disability benefit claims submitted to Mutual of Omaha Insurance Company.
IF YOUR CLAIM WAS DENIED BY MUTUAL OF OMAHA, CALL US, WE WANT TO TALK TO YOU
If you made a claim for individual disability benefits from Mutual of Omaha Insurance Company and that claim was denied or terminated, it is likely the Director of Individual Claims was the person who had the final say on your claim. It is likely that person’s name appears nowhere in your claim file and nowhere in any correspondence you received from Mutual of Omaha Insurance Company. Nonetheless, that person was likely the person who approved the decision to terminate or deny your benefits.
If your claim was denied by Mutual of Omaha after February 2021, we would like to talk to you. Please call us or complete an intake email referencing the “Director of Individual Claims” and we will call you to discuss.