Our client was a Capture Specialist at ASI Government. The job basically involved managing multi-million dollar government contract bids. The insurance company was United of Omaha. The disabling conditions were: hearing loss; tinnitus; superior canal dehiscence surgery; a tri-level cervical fusion; chronic pain; and others.
United of Omaha denied the claimant benefits after paying him for 22 months. They did so based on flawed premises. First, they defined his highly specialized job as that of an “administrative assistant.” Second, they analyzed his eligibility for benefits under the wrong definition of disability.
They basically used the wrong policy. He had to prove, merely, that he couldn’t do a single job function. His claim was analyzed for an inability to perform all material duties. Third, they claimed the claimant wasn’t “physically, psychiatrically, or neuropsychologically limited.” The problem was he never claimed a physical impairment. He never claimed a mental illness. And he never claimed he was neuropsychologically impaired.
His claim was, simply stated, that he suffered from severe tinnitus and hearing loss following failed brain surgery, and that his tri-level cervical fusion caused excruciating pain. United of Omaha based its entire denial of benefits on the opinion of a single in-house nurse reviewer. They didn’t even consult a medical professional for such a complex medical case. Most importantly, United of Omaha denied benefits after 22 months without citing any evidence of an improved condition, no change in standards under which the claim was to be judged.
In short, they said he was disabled for 22 months, then changed their opinions without any supporting evidence. In fact, all the evidence supported a worsening of the condition. United of Omaha quickly realized they couldn’t defend the position taken, and reinstated benefits.
