Mutual of Omaha Denied Your Long-Term Disability Claim in DC
As long-term disability lawyers, we know that as a high-income earner, you’ve relied on Mutual of Omaha or another insurance company to provide long-term disability benefits while you can’t work due to an injury or medical condition. Usually, there are two instances when they deny or terminate your long-term disability benefits. When they make this decision, Mutual of Omaha or your insurance company will send you a letter informing you.
Here are two common situations involving long-term disability benefits being denied, and what to do about it.
Mutual of Omaha denies your initial application for long-term disability benefits.
After a serious injury or illness that left you unable to work, you probably applied for long-term disability benefits, either through a private policy you purchased and paid the premiums on, or one provided by your company or employer.
If the policy is provided by your company or employer, your HR specialist will usually get you the application and forms you need to get started, and you’ll get a packet of information from Mutual of Omaha, (and this is true whether you’re applying for long term or short term disability benefits. ,
One of your first steps is to get a copy of your long-term disability insurance policy from Mutual of Omaha.
The long-term disability benefits policy will include all of the terms, conditions, and definitions that apply to the policy, or insurance contract, and the information you need to apply for disability benefits. You want to analyze that insurance policy and understand all of the policy provisions.
Mutual of Omaha will usually call you to get information and probably send you forms for you to fill out, asking for information such as:
- Work History
- Health History
- Job Description
- List of health care providers
- How the injury or medical condition occur or when you were diagnosed
They will also include an Authorization for the Release of Medical Records. Once you sign this form, it will give the insurance company the right to obtain your medical records and information to verify your medical condition or injury and the fact that you are disabled because of it, and it may allow them to talk to your physicians as well (you want to avoid this if you can).
It’s critical to work with your doctors throughout the long-term disability process.
Mutual of Omaha, like other disability insurance companies, will have specific definitions of disability, what conditions are covered, and for how long. It’s important to analyze the policy and then work to educate your doctors so that they understand the terms and conditions (for our clients, we meet with and talk to physicians, specialists, and expert consultants).
If your doctors are like most practicing physicians, they will only take a minute to look at a form or listen to you about this – or they will delegate it to a staff member. Let’s face it, most doctors already think they know what it means to be disabled and they often don’t give a lot of support for the opinions they put in their medical reports.
The reality is, that they don’t understand your disability policy definitions and don’t have the time to review the policy.
Many doctors want to help, but they end up hurting your claim for long-term disability because they use the wrong definition, or include medical conditions that are secondary but may limit your ability to get disability benefits. It’s hard work convincing them, even though they mean well.
Here’s a common reason Mutual of Omaha and other insurance companies deny a claim for long-term disability.
This is another problem with just sending a form to your doctor and expecting he will take care of it for you.
After completing and sending in your application for long-term disability benefits, signing everything, and requesting the supporting medical evidence from your doctors, you think you’re done.
But you’re just getting started.
When Mutual of Omaha, or any long-term disability insurance company, doesn’t receive all of your information, they will write to you asking for more time to get it (almost all long-term disability cases are covered by ERISA, a federal law, that has deadlines and regulations for when claims need to be filed and decided by).
It is your responsibility to get Mutual of Omaha the medical records and other information they request for your long-term disability claim – you can’t rely on your doctor’s office to comply with their request. And even if Mutual of Omaha requests it for you, it’s not their responsibility to do this for you.
Naturally, we take care of this for our long-term disability clients.
Remember, if you don’t get those medical records to Mutual of Omaha on time, they can deny your claim for long-term disability benefits. Unfortunately, many people with legitimate medical conditions and injuries that prevent them from working don’t realize what they need to do about it, and when.
What to do when Mutual of Omaha denies your claim for long-term disability benefits?
ERISA is the federal law that governs most long-term disability insurance claims and, in addition to the statute and federal case law decisions, has a set of implementing regulations with requirements both you and the insurance company need to comply with.
First, Mutual of Omaha will send you a letter telling you that your claim for long-term disability has been denied. The letter should review the evidence they had, what they reviewed, and what actions they took (for example, having your medical records reviewed by a doctor of their choosing). The letter will set out the long-term disability insurance policy definitions, terms, and conditions that they say apply to your specific situation, where to send your appeal, and the date it is due (under ERISA, that is 180 days from the day you receive the letter denying or terminating your benefits).
There have been recent regulations that have extended the filing time limit due to Covid, but an appeal requires significant work, analysis, medical testing, working with medical specialists, preparing witness statements, vocational evidence, legal analysis, and drafting, so you want to get started right away.
Get an Experienced Long-Term Disability Lawyer to Analyze the Letter Denying Benefits.
If you received a letter denying or terminating your long-term disability benefits, our team will review and analyze your denial letter absolutely free of charge, with no obligation whatsoever, and will outline some of the steps you need to take to generate the strongest and most persuasive appeal you can.
Once you have this valuable resource, you can use it as a basis for drafting and filing your own appeal (it’s a lot more than just filling out a form). Eventually, you may be in federal court (ERISA is federal law) where a federal judge will decide the case based on the appeal you filed and the evidence you submitted to support it.
Fax or Email Us the Letter You Received that Denied or Terminated Your Long-Term Disability Benefits
To send us a letter you received from Mutual of Omaha or any other long-term disability insurance company, just email it to clientexperience@dkllp.com with the subject line: Denial Letter, or fax it to us at (202) 393 – 3324.
Or call us today at (202) 393 -3324 to get our valuable resources and to get started.