{"id":5231,"date":"2017-01-23T08:34:06","date_gmt":"2017-01-23T16:34:06","guid":{"rendered":"http:\/\/www.roylawpdx.com\/?p=5231"},"modified":"2024-03-13T10:47:14","modified_gmt":"2024-03-13T17:47:14","slug":"noone-v-mutual-omaha","status":"publish","type":"post","link":"https:\/\/www.roylawgroup.com\/blog\/noone-v-mutual-omaha","title":{"rendered":"Noone v. Mutual of Omaha: Benefits Denial by Abuse of Discretion"},"content":{"rendered":"

Maura Noone became severely disabled and claimed long-term disability with her employer-sponsored plan with Mutual of Omaha. As Maura\u2019s health continued to decline, Mutual of Omaha reviewed her claim incorrectly and issued a denial of benefits. Roy Law Group was brought on to battle Mutual of Omaha in an abuse of discretion lawsuit under ERISA. Ultimately, we were able to overturn their denial and get Maura the benefits she rightly deserved. <\/span><\/i><\/p>\n

It all started with a friendly game of kickball<\/h2>\n

Maura Noone worked as a graphic designer for a global advertising firm, Wieden+Kennedy, located in Portland, Oregon. In July 2005, Maura was playing kickball with her coworkers when she suffered a significant head injury. <\/span><\/p>\n

Within the next three years, she experienced a severe decline in her health, including chronic dizziness and imbalance, fatigue, and extreme sensitivity to light and noise. She also had trouble focusing her eyes, had excessive hand tremors, and could not follow conversations. All of her symptoms led her doctors to diagnose her with Meniere\u2019s disease and a post-traumatic perilymphatic fistula. <\/span><\/p>\n

This caused her issues with performing her usual tasks as a graphic designer. You would think that a sedentary job would not exacerbate her injury, but she was far worse than she appeared at the surface. <\/span><\/p>\n

Six years of benefits<\/h2>\n

Maura had to file a long-term disability claim with her employer\u2019s insurance provider, <\/span>United Omaha Life Insurance Company, <\/b>doing business under the name of <\/span>Mutual of Omaha. <\/b><\/p>\n

In 2008 Mutual of Omaha approved Maura’s long-disability claim, determining she could not work in her <\/span>own occupation. <\/span><\/i>Then in March of 2011, they informed Maura that she would continue to be eligible for benefits as she was unable to work in <\/span>any occupation. <\/span><\/i>Based on reports from her doctors, it was determined that, while her symptoms persisted, she was improving and could take care of herself. <\/span><\/p>\n

Read more: Understanding Own Occupation and Any Occupation<\/a><\/em><\/p>\n

Additionally, Maura applied for Social Security Disability in November of 2011 and received retroactive benefits to 2009. <\/span><\/p>\n

Always watching, always reviewing<\/h2>\n

Insurance companies like Mutual of Omaha do not pay out benefits if they don\u2019t have to. Their legal teams of hundreds of attorneys and doctors are actively and consistently looking for ways to deny your benefits. It is not fair \u2014 you pay into a system that you believe will be there for you. However, more often than not, it is not. <\/span><\/p>\n

Insurance companies like Mutual of Omaha do not pay out benefits if they don\u2019t have to.<\/p><\/blockquote>\n

Mutual of Omaha started reducing Maura\u2019s benefits based on her receiving other income benefits from Social Security. It also took all the back pay she received from Social Security to recoup an alleged “overpayment” on her account. <\/span><\/p>\n

Then, in April 2014, Mutual of Omaha reviewed Maura’s medical records, regardless of whether they were related to her injury or not. Her doctor’s documentation indicated slow but steady improvements, and Mutual of Omaha believed that medical evidence no longer supported Maura’s claim. <\/span><\/p>\n

Mutual of Omaha deemed her no longer disabled from any gainful occupation and terminated her benefits.<\/span><\/p>\n

Read more: Why Long-Term Disability Claims Get Denied<\/a><\/em><\/p>\n

Unreasonable expectations across the board<\/h2>\n

Maura filed an appeal, communicating that Mutual of Omaha had misstated her doctor\u2019s medical opinion.<\/span><\/p>\n

The doctor\u2019s report supposedly indicated that she could sit, stand, and walk for eight hours daily. In reality, she could not look up, make sharp head movements, or concentrate without getting dizzy. <\/span><\/p>\n

She was also intolerant of any form of forward bend and could not drive herself to appointments without getting lost. In other words, her Meniere\u2019s disease and post-traumatic perilymphatic fistula were still aggressively affecting her ability to perform any task. <\/span><\/p>\n

Additionally, her doctor was given an unreasonable request to report within a five-day window. Healthcare providers are often tightly scheduled and saddled with clinical responsibilities. Such a narrow window would not allow for that level of reporting to ensure a neutral decision process. <\/span><\/p>\n

It gets worse \u2013 Mutual of Omaha lied<\/h2>\n

During the appeal process, Mutual of Omaha sent Maura to a F<\/a>unctional Capacity Evaluation (FCE)<\/a>. The evaluator determined Maura was unable to work in any<\/em> gainful occupation. But <\/span>that is not what Mutual of Omaha told Maura. <\/span><\/i><\/p>\n

The appeal denial letter that Mutual sent to Maura stated incorrectly that the Functional Capacity Evaluation did not<\/em> come out in her favor. If Maura had trusted that Mutual was telling the truth, she could have easily walked away from the claim. <\/span><\/p>\n

Fortunately, she decided to obtain legal representation to fight the denial. That\u2019s when Roy Law Group got involved.<\/span><\/p>\n

Roy Law Group looked into the case and studied the claim file. Only then did Maura learn the functional capacity evaluation had come out on her side and found her disabled. <\/span><\/p>\n

A severe and obvious conflict of interest<\/h2>\n

Roy Law Group, on Maura\u2019s behalf, determined that Mutual of Omaha had an obvious conflict of interest in their denial of benefits for Maura. Specifically, as the plan administrator, they had zero incentive to pay anything, despite all the medical evidence that pointed to her being utterly incapacitated. <\/span><\/p>\n

Mutual of Omaha distorted and took Maura’s medical records out of context to support their denial.<\/p><\/blockquote>\n

Our team at Roy Law Group helped Maura to take down Mutual of Omaha with an abuse of discretion lawsuit, and she was ultimately awarded the benefits she deserved.\u00a0<\/span><\/p>\n

Read the full court ruling here: Noone V. United of Omaha Life Insurance Co.<\/a><\/em><\/p>\n

The devil and denial are in the details<\/h2>\n

While Maura initially attempted to go at her case alone, she quickly realized that she did not speak the language of the law. She was not an attorney, and insurance companies like Mutual of Omaha have hundreds of attorneys and doctors ready to dispute a claim. They are even willing to misrepresent the facts to support unjustified claim denials. <\/span><\/p>\n

Roy Law Group has a compassionate team of experts in Oregon state and local laws<\/a>. We specialize in disability law and do nothing else. If you\u2019ve been wrongfully denied disability benefits, we can help you to stand up to big insurance companies like Mutual of Omaha.<\/span><\/p>\n

Contact Roy Law Group right away to set up your free consultation.<\/b><\/p>\n","protected":false},"excerpt":{"rendered":"

Maura Noone became severely disabled and claimed long-term disability with her employer-sponsored plan with Mutual of Omaha. As Maura\u2019s health continued to decline, Mutual of Omaha reviewed her claim incorrectly and issued a denial of benefits. Roy Law Group was brought on to battle Mutual of Omaha in an abuse of discretion lawsuit under ERISA.  read more<\/a><\/p>\n","protected":false},"author":2,"featured_media":6176,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[250],"tags":[252,6,254,251,40,255,93,263,216],"acf":[],"yoast_head":"\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\n\t\n\n\n\n