A Federal Court in Nebraska has determined that United of Omaha wrongfully denied a claimant’s short and long term disability insurance claims, and has awarded the claimant her benefits and also awarded attorneys’ fees to her counsel.
The claimant suffered from several medical conditions, including cervical spondylosis with stenosis, chronic pain, fibromyalgia and mental health challenges including depression and anxiety. Her short term disability claim was denied and her appeal denied, as was her claim for long term disability insurance benefits.
The Court determined that United of Omaha was not entitled to deference of its claim determination, both because the policy did not provide discretion, and because of the “considerable procedural irregularities” in the claim review process. In fact, the Court determined that even if deference were required, that United of Omaha abused its discretion.
The Court was led to the conclusion on the basis of the evidence demonstrating that the claimant was impaired, with support from numerous medical providers, in contrast with only a paper review from one doctor for United of Omaha, who the Court noted, mis-characterized the medical evidence in several important respects. The Court noted that some of his statements were “patently false” while others were simply unsupported. the Court was troubled by United of Omaha’s wholesale embrace of this flawed report. United of Omaha also relied upon a cursory vocational review, and failed to account for any functional limitations.
Thus, the Court awarded benefits and attorneys to the claimant.
Johnson v. United of Omaha