Mutual of Omaha is a Fortune 500 company with assets totaling over $46 billion. It provides life insurance, long-term care insurance, short- and long-term disability insurance, and various supplemental insurance products. As is often the case, Mutual of Omaha’s disability products are among its most profitable. Those profits are realized by taking in its insured’s premiums, while minimizing its liabilities (frequently by denying meritorious claims and refusing to cover individuals who present a higher risk).
How Mutual of Omaha Denies Claims
All disability insurers employ third-party or in-house physician consultants to evaluate claims for benefits. The insurers present the medical opinions generated by these doctors as unbiased, independent, and therefore trustworthy, both to their insureds and to the court in the event of a lawsuit. The reality, however, is that many insurers return to the same doctors over and over for opinions that tend to favor the insurance company and disfavor the insured.
An entire cottage industry has sprung up around the insurance industry designed to satisfy disability insurers’ need for favorable reviews. A large number of third-party vendors now exist that provide review services solely to insurance companies and employers in the context of disability, workers’ compensation, health insurance, and personal injury lawsuits. These companies never offer their services to claimants. Because these companies rely solely on insurance companies and employers for their income, they naturally tend to provide reviews that allow their clients to save money and keep them coming back for more. Some of the biggest companies who follow this business model are Exam Coordinators Network (ECN), Genex, ExamWorks, ReedGroup, Medical Consultants Network (MCN), MLS Group of Companies (MLS), and Network Medical Review (NMR).
Many of the doctors that perform these insurance company reviews employ the same rationales in claim after claim to justify denying benefits, and insurers frequently know the result before they have even received the doctor’s report. The actual reasons stated by the doctors differ depending on the case, but they are frequently plausibly scientific on their face. Some of the most common rationales are:
- Claiming there is a lack of “objective medical evidence” to support reported symptoms or the degree of work restrictions;
- Ignoring or attempting to discredit a claimant’s reported symptoms because they are “subjective” or “based on self-reports.” This is especially common with symptoms such as pain or headaches;
- “Cherry-picking” favorable-sounding notations from the medical records, such as notes that the client is “improving” or that their symptoms are “getting better,” and taking them out of context to claim those statements mean the claimant is not disabled;
- Mischaracterizing the medical evidence, such as objective medical test results, to conform to the insurer’s preferred narrative;
- Challenging the validity of the claimant’s diagnosis and then ignoring their reported symptoms; and
- Substituting their own opinion of the claimant’s physical “restrictions and limitations” and discarding the treating physicians’ opinions, even where all other information remains unchallenged. The consultant physician’s opined restrictions and limitations are almost always less restrictive than the treating physician’s, but usually just enough to supposedly allow the claimant to return to work. Moreover, if one of your treating physicians either does not provide any restrictions or provides only light restrictions that would allow you to work, the consultant physician will frequently focus on that doctor’s opinion, regardless of what your other doctors say.
In our experience, Mutual of Omaha is a habitual offender in this respect. Mutual of Omaha utilizes both third-party medical reviews and its own internal physicians to deny claims. Reviews obtained through third-party vendors are always suspect, as those companies rely financially on repeat business from the insurance industry.
In our experience Mutual of Omaha’s case internal reviews by employee-physicians have been unusually suspect. We have seen the same physician, years-removed from the practice of any kind of medicine, opine on the disabling nature of conditions ranging from autoimmune disorders to complex traumatic brain injury to mental health disorders. Predictably, these reviews overwhelmingly support Mutual of Omaha saving money at its insured’s expense, frequently consulted on high-value claims.
Denying Long-Term Disability Claims
If you’ve filed a claim with Mutual of Omaha and are wondering when they’re going to get back to you, you may be wondering what you should do next.
While insurance companies have every incentive to pay as little as possible on policies, they are also required by law to act in good faith.
If you’re experiencing any of the following, it may be time to discuss the matter with an insurance lawyer.
- The insurance company is demanding a medical review from a doctor outside of the specialty of your ailment.
- The insurance company denies the claim without sufficient investigation.
- The insurance company requests the same information multiple times.
- The denial letter doesn’t acknowledge evidence you presented to your insurance carrier.
- The insurance carrier has failed to render a decision in a reasonable amount of time.
- Failing to inform the claimant concerning what information they need to process the claim or failing to inform the claimant concerning deadlines.
Insurance companies count on policyholders not bothering to fight the decision. They count on policyholders taking bad settlements to avoid prolonging the claims process any further. If you’re in this situation, having paid into a disability plan for several years, then you should know that the insurance company is taking advantage of you. You can and should fight back.
How Our Disability Insurance Lawyers Can Help
If your claim is denied after being reviewed by a doctor from one of the third-party vendors discussed above, or by one of Mutual of Omaha’s employee-physicians, the attorneys at Robinson & Warncke may be able to help. We have seen every trick in the book and have successfully fought every one of the tactics discussed above. We have also been successful on multiple occasions in both convincing Mutual of Omaha to reverse claim denials and, in cases where Mutual of Omaha was more stubborn, in suing them in federal court.
If you are insured by Mutual of Omaha and your claim has been denied or is in jeopardy due to an unfavorable medical review, call us today.