More on United Mutual of Omaha - Insurance Carrier Spotlight

Welcome to Season 3, Episode 17 of Winning Isn't Easy, the podcast that dives deep into the world of disability insurance claims. In this episode, we shine the spotlight on another prominent disability carrier: United Mutual of Omaha.

Join us as we explore the intricacies of dealing with United Mutual of Omaha in disability claims. We'll discuss their policies, practices, and common challenges faced by claimants. By listening to this episode, you can gain valuable insights into navigating the claims process, understanding policy language, and effectively advocating for your rights as a policyholder.

Our host, Nancy L. Cavey, a seasoned disability attorney, shares her expertise and experiences in handling United Mutual of Omaha disability claims. Nancy will provide valuable tips and strategies to maximize your chances of a successful claim outcome.

Whether you're currently dealing with United Mutual of Omaha, or simply seeking to deepen your understanding of disability insurance carriers, this episode is packed with valuable information that can help you navigate the complexities of United Mutual of Omaha disability claims.

Tune in to empower yourself with the knowledge you need to fight for the disability benefits you deserve.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.    

Transcript

Disability Attorney Nancy L. Cavey: 0:14

Hey, I'm Nancy Cavey , national ERISA and Individual Disability Attorney. Welcome to this week's episode of Winning Isn't Easy. Before we get started, I've gotta give you a legal disclaimer. The Florida Bar tells me that I have to tell you that this podcast isn't legal advice. So now that I've said it, I wanna assure you that nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the games, the disability carriers play, and what you need to know to get the disability benefits you deserve. So, off we go. Today I'm gonna be discussing the United , uh, Omaha, and how they approach disability claims. Now, you may say, my disability carrier plan isn't the United of Oma , so why should I listen to this episode? Well, the reason is that disability carriers and plans generally play from the same playbook, and then they'll sort of modify this playbook to , um, enhance, if you will , or add their own , uh, tools to their denial or termination toolbox. So I'm first gonna talk about Mutual of Omaha's Wild Kingdom of Disability Claims Management. Second, I'm gonna talk about Mutual of Omaha and subjective complaints of pain and how they handle these types of claims. And thirdly, I'm gonna talk about how Mutual of Omaha ignores federal safety regulations in denying claims because of post-traumatic stress syndrome issues. Got it. Made a packed episode. But before we get started, let's take a quick break.

Speaker 2: 1:56

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Speaker 1: 2:16

Welcome back to Winning Isn't Easy. Let's talk about Mutual of Omaha's Wild Kingdom of Disability Claims Management. Now, mutual of Omaha was founded in 1909 and is obviously based in Omaha, Nebraska. It owns United of Omaha. And from this point forward, I'm gonna use the term Mutual of Omaha to mean both companies as they play, as I've said from the same playbook. Both companies offer a variety of insurance options, including group disability insurance products. It was one of the first companies in the United States that offered disability insurance to non-professional workers. I remember watching Mutual Omaha's Wild Kingdom that was hosted by Marlon Perkins and Jim Fowler. He was on TV for over 20 years. And Wild Kingdom, by the way, now has a segment on Animal Planet, which my kids have watched. Unfortunately, however, many of my Mutual of Omaha disability insurance clients feel as if they've been eaten by the lion on Wild Kingdom . All too often, mutual of Omaha rips the financial rug and safety net from under its disability insurance policy holders. And one of the ways that they do that is the games that they play in their claims management , uh, process. What Mutual of Omaha does is , um, do a close review of their disability insurance policy, because they, of all carriers really seem to be , um, looking at the policy terms closely and closely and tightly applying them , particularly in those policies that require objective medical evidence of a diagnosis, or in those cases where they might have a subjective condition limitation. And they're looking through , through the laundry list of conditions where the , uh, benefits are limited and they try to expand or sneak , if you will, you are disabling medical condition in those subjective limitations. So from their playbook, they're starting out with a tight , really review of the terms of the disability policy in terms of the definition of occupation, the definition of material or substantial duties of the occupation , uh, or the , um, main duties of the occupation. Uh, they tightly apply the objective medical requirements. Uh, and in doing this, they have a cadre of medical professionals who , uh, are as tight, if you will, from a medical standpoint as they are in the claims management process. They don't give you a lot of leeway. There's a , a lot of black or white in a mutual , uh, of Omaha claim . Um, and that makes it difficult for , uh, subjectively based medical conditions like , uh, migraines, fibromyalgia , um, uh, me c f s claims, I think to be fairly reviewed. That isn't to say that they don't do the same thing in orthopedic conditions. The cases such as , um, herniated discs , um, MS or pd, it's just that, that in my experience, they don't really leave a lot of wiggle room , uh, to evaluate a claim. It's pretty, as I said, black and white, nothing out of the, of the boundaries, if you will. Um, so you need to understand that unlike other disability carriers or plans, mutual of Omaha is really doing a , an incredibly close scrutiny of the policy, the medical records and the evidence that you're submitting. And if it doesn't fit in their box, they most likely are gonna deny that claim. So you need to understand from the very beginning, if you will, their world perspective in , uh, evaluating a disability claim and deciding whether to pay or whether to terminate the benefits. So now we understand or have some insight in their worldview. Let's take a break before we get on to the next segment. Okay, got it . Welcome back to Winning Isn't Easy, mutual of Omaha and Subjective Complaints of Pain. Now, I've discussed how , um, in my view, mutual of Omaha takes a really tight view of cases, and if it doesn't fit in their box black and white, the claim is denied or terminated. And I referenced , uh, uh, subjective complaint cases and subjective complaint cases generally involve pain. Uh, and we all know the chronic pain can be caused by a number of medical problems including fibromyalgia, rheumatoid arthritis , um, a herniated disc, a shoulder dislocation, you name it, it's chronic pain. And this pain can prevent you from performing your regular occupation and make you eligible for your disability benefits or make you eligible for any occupation benefits if you're unable to perform any occupation by virtue of your , uh, disabling medical condition that prevents you from doing other occupations in view of not only those restrictions but your e education, past work history and skills, regardless of whether it's Antioch or oc , uh, you have the burden to prove that you're disabled. So if you've got one of these Mutual of Omaha chronic pain cases and can't work anymore, what should , should you be doing? Well, obviously, as I've talked about, again, United of Omaha really tightly , uh, reviews and applies their , uh, policy and they have multiple versions of their own disability policy. So you've gotta get yours out, you gotta read it cover to cover so you understand what it is you have to prove to be able to get your disability benefits. You also are going to be looking in that policy or plan for the subjective medical condition limitation. You're also gonna be looking to see whether or not they have an objective medicine requirement. In other words, an objective basis of the diagnosis, an objective basis for your symptoms , an objective basis for your disability. Pain's not objective. There isn't an objective test for pain, and just because you're in pain doesn't mean that you're entitled to your benefits. And that was a Lisa lesson that Lisa Weber learned, and she learned it too late. She was employed by Accelerate Learning, and she suffered from extreme pain and weakness in her right leg. She applied for her benefits, which were paid until Michel Omaha said, nah , we're gonna deny this claim because her complaints of pain were not supported by the medical records. In other words, no objective evidence. And the evidence was there wasn't consistent. And this case was ultimately decided by a federal judge in Texas. Mutual of Omaha had her claim reviewed by multiple liar for hire medical providers. They also always , they used this phrase that I see a lot. Pain was not supported by the medical records. So they cherry pick the pain, the level of the pain, cherry pick , uh, the cause of the pain. They cherry pick the frequency of the pain. They cherry pick the severity of the pain and say, you're not in pain or you couldn't be in as much pain as you are. Or the pain that you do have just isn't supported by your medical records. And the objective testing, that's the combination that we see. Um, and the peer review providers ultimately say, okay, not only isn't your pain not supported, you miraculously pocus pocus have no functional impairments . That's, that's insurance ease that we see in a lot of disability claims, but that would prove fatal to her claim. So what do you have to prove in a chronic pain case? Well, you have to prove that you're disabled as that term is defined by your policy or plan. Make sure your medical records are documenting, one, the nature and complaints of your pain. Two, the organic or physical cause of those complaints. Three, there should be findings on physical examination and diagnostic studies that explain your pain and corroborated. There should be an opinion from your physician regarding your functional restrictions that are caused by the pain or the underlying cause of the pain. And then five, there should be an objective basis for those restrictions and limitations. So that means that you gotta have a positive physical finding on exam of a severity that could cause this pain studies like MRIs, EMGs, nerve conduction study tests. But I think in a subjective pain case, one of the ways to do this is also to have a functional capacity evaluation, which is considered to be an objective measure. Yes, it's in part based on your subjective complaints, but the testing is also , uh, uh, done in a manner that tests range of motion and strength and consistency for , uh, blood pressure and , uh, heart rate. So I think that there is a correlation and court have recognized that correlation. The bottom line is that complaints of continuous pain and weakness alone aren't gonna be the basis for a judge to overturn a claims denial. So I told you what should be in the records, but in Ms . Weber's case, the medical records just didn't provide sufficient proof, and as a result, her the claim denial was upheld. Again, knowing what you need to prove from the very beginning is crucial. Knowing what's in your medical records is crucial. Knowing , uh, how to fix any deficiency in your medical records is key. Knowing how to supplement those records with your own independent medical evaluation or an FCE is key. Got it. All right . Time for a break.

Speaker 2: 12:40

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Speaker 1: 13:16

Welcome back to Winning Isn't Easy. Mutual of Omaha ignores federal safety regulations in denying a commercial truck driver's claim because of post-traumatic stress disorder, I've talked about how Mutual of Omaha tightly , uh, applies its policy terms tightly requires objective proof , uh, and , and how Mutual of Omaha world is kind of black and white. Now, you would think that black and white would be pretty clear in a case involving a commercial truck driving situation, but of course not so much. Um, we all know that commercial truck driving can be dangerous. Drivers are required to follow both federal regulations and company safety standards. Um, that didn't deter Mutual of Omaha in this particular case. And I'm gonna tell you the story of Larry Wetstone, who worked as a long distance commercial driver for seven years. Um, a bus crashed into his eight wheeler tractor trailer while exiting a turnpike, and there was some significant injuries, but he also developed post-traumatic stress , uh, disorder. Um, he had severe mental problems including anxiety, depression, insomnia, irritability, fear of driving his tractor trailer. Obviously that's predictable ex and one would expect gave in the the severity of the , uh, accident and injuries. He sought the care of three doctors, all of whom opined he could not return to commercial driving in his medical condition. He applied for his long-term disability benefits in United of Omaha, denied his claim. Now because Mutual of Omaha tightly interprets its plans terms , uh, and definitions, they always, in my view rely on , um, requirement of objective medical evidence or flip it around and rely on the subjective medical , uh, provisions that limit the payment of benefits. Uh, and I think one of the keys that's important in a subjective medical condition claim is not only physical problems, but psychiatric problems. So for example, you might have a herniated disc that you sustained in an accident, you undergo surgery. Um, the post , uh, operative diagnostic studies are normal, but you still have pain. Uh , if there's a subjective medical condition limitation in the policy, the carrier's gonna say, well, wait a second. This back pain, this muscle spasm, this stiffness, they're all subjective conditions and the benefits are limited in just two years. And by the way, we're gonna apply the mental nervous condition limitations if you're depressed because of your back condition and the pain that we won't pay on. So they use the whipsaw of the subjective complaint or the mental nervous limitations. And that's exactly the whips saw that , um, happened in Mr. Redstone's case. So there are many psychiatric claims for anxiety, depression, and post-traumatic stress. They're all based on self-reported symptoms and disability carriers and policies will , um, generally pay for mental impairments recognized by the International Classification of diseases or the , uh, D S M manual of mental impairments. But mental impairments are generally limited to just two years of benefits , uh, and they want a specific type of impairment. Now, obviously in this case with Mr. Wetstone, they're looking for a reason to deny his claim. So they had his medical records reviewed by a psychologist who opined that even though the totality of the documentation supported his claim of emotional distress after the motor vehicle accident, there was no compelling evidence to support the presence of functional impairment. Their favorite gobby Go denial terms. So the liar for hire peer review determined that West Stone stated inability to drive a motor vehicle was a product of his own, his own self-imposed avoidance rather than a true psychiatric disorder. And this opinion was based on the fact that Westtown Drive drove to and from his medical appointments in his personal vehicle. Now, you know, when I go out of my office today and go home, I'm probably gonna pass an 18 wheel tractor trailer. And I think there's probably a big difference between the size of that big truck and my vehicle. Um, so obviously that's kind of ridiculous. Um, the liar for hire , uh, peer review doctor opined that of Westone was functionally impaired. He'd also have problems with grooming, hygiene, suicidal ideation, poor impulse control, homicidal ideations, paranoia, psychosis, delusional thinking, disorganized thought processing, aggressive and hostile ideations and excessively withdrawn behavior. Now that's somewhat contradictory, but it's also something that I see a lot of. If you were so depe disabled, you should be suicidal or homicidal or da da da da da da da da da . That's not the standard of disability. The disability standard is generally an inability to do your own occupation or any occupation, not whether or not you're suicidal or homicidal. So notwithstanding that opinion, the liar for higher doctor agreed that there was a diagnosis of an adjustment disorder with mixed anxiety and depressed mood, which of course allowed them potentially to argue that he was , um, benefits were limited to just two years under the mental nervous condition. But what did you know United of Omaha do? Well, they rejected those subjective complaints, ignoring the fact there was a psychiatric diagnosis predicated on his self-reported symptoms. Now, that's how the diagnosis is made under the International Classification of Diseases or the , the sm uh, manual. So the fact that they rejected his subjective complaints is like stupid because that's how the diagnosis is made. But that's some of the games the disability carriers play. So this case gets better because the Department of Labor has regulations governing physical qualifications of commercial drivers. So, you know , um, they're narrowly interpreting the, the, the plan terms. They are requiring proof that's not necessarily req required. They're cherry picking the medical records. They have a liar for hire doctor who quite frankly renders a silly opinion, and now they're confronted with, hmm , the Department of Labor's regulations because this could impact is obviously his ability to be a truck driver, but not to be deterred and still looking for a reason to deny the claim. They say, okay, we're gonna ignore 49 CFR three 19.41 , which are the regulations for commercial , uh, truck drivers. These regulations disqualify drivers who possess, in quotes, any mental, nervous, organic or functional disease or psychiatric disorder that would likely interfere with their ability to drive a commercial motor vehicle safely. So of course, United of Omaha gave the thumb, if you will, to those regulations , uh, on the basis that if he could drive his personal vehicle, he ought to be able to drive that commercial truck and he could safely drive that commercial vehicle such that it wasn't a violation of the federal rules and regulations. Ultimately, of course, this case ends up in fe in front of a federal judge, and the judge in Westtown versus United of Omaha, which is an Ohio case, found that this denial was arbitrary and capricious cause there was no substantial basis in the medical records to support the conclusion that he could perform the duties of his job. The judge said, look, you, United of Omaha overlooked and outright mischaracterized several parts of the record that supported the claim. You improperly dismissed his self-reported symptoms and the opinions of the treating mental health providers without even having one of your liar for hire providers examine him. And of course, you failed to consider the Federal Safety Regulations. The judge said, look, these oversights were inexcusable, given the fact that he had of Omaha failed to consider that portion of the regulations that physically disqualified him if he had a mental, nervous, organic, or functional disease or psychiatric disorder, likely to interfere with the ability to drive a commercial motor vehicle safely. Now, the court noted that a commercial truck driver who at any moment could suffer a post-traumatic stress related fear response would be required to immediately pull off the side of the road or react and they could react in a , a fashion that endangered not only them, but others. And Westone had reported having to do this numerous times , uh, because of his , uh, post-traumatic stress disorder issues. And the court found that that fit into the language of the regulation for lack of psychosocial symptoms being homicidal, suicidal, et cetera , et cetera , cited by the liar for higher peer review , doctors were the judge's opinion irrelevant to determining whether or not he could perform them material duties of his occupation and do so pursuant to the regulations. Fortunately, the judge saw through all of these created reasons that United of Omaha used to justify the claims denial and awarded his benefits. This case, I think, gives you a clue as to how United of Omaha and disability carriers are always searching for a reason to deny or terminate benefits. Fortunately, the judge saw through this, I hope you've enjoyed this week's episode of Winning Isn't Easy. Please like our page, leave a review, share it with your friends, and subscribe. I hope you tune in next week for another insightful episode of Winning Isn't Easy. Thanks.