For years, a Virginia healthcare professional built a career around helping people navigate difficult medical situations. Her work required concentration, sound judgment, communication skills, and the ability to stay focused and perform consistently throughout the workday.
Then a serious viral illness changed everything.
What began as an illness developed into lasting respiratory and voice problems, along with chronic pain and other symptoms that made it impossible for her to continue performing the essential duties of her occupation.
She had long-term disability coverage through her employer with Mutual of Omaha. She had paid for that coverage believing it would provide financial protection if illness ever prevented her from working.
When she filed a claim, she expected the coverage to do what it was designed to do.
Instead, Mutual of Omaha denied her long-term disability claim.
Case Snapshot
- Occupation: Healthcare Professional
- Insurance Company: Mutual of Omaha
- State: Virginia
- Medical Conditions: Post-viral respiratory and voice impairment, along with chronic pain
- Claim Type: Long-Term Disability Appeal
- Outcome: Mutual of Omaha reversed its denial, reinstated benefits, and paid past-due benefits.
When Post-Viral Illness Changed Everything
The illness left the claimant with significant respiratory and voice problems, as well as ongoing pain and other limitations.
For someone whose occupation depended on communication, concentration, and the ability to function consistently throughout the day, those limitations were disabling.
She could no longer perform the essential duties of the job she had built her career around.
She had done what her long-term disability policy required: she had paid for coverage and filed a claim when she could no longer work.
But Mutual of Omaha disagreed.
Mutual of Omaha Denied Her Long-Term Disability Claim
Mutual of Omaha’s reviewers concluded that there was insufficient evidence of functional impairment and questioned whether the restrictions identified by her treating providers were adequately supported.
The insurance company’s analysis focused heavily on whether she could perform sedentary work.
But that wasn’t the right question.
The relevant question was whether she could perform the actual material duties of her occupation.
Her job required much more than sitting at a workstation. It required sustained communication, concentration, judgment, and the ability to function reliably throughout a workday.
Those were precisely the abilities her illness had taken away.
The denial failed to fully account for the difference between being physically capable of sitting and being capable of performing a demanding professional occupation.
That distinction became central to the appeal.
How BenGlassLaw Built the Appeal
Building a long-term disability appeal requires more than submitting additional medical records—it requires addressing the specific reasons the insurer denied the claim.
BenGlassLaw rebuilt the administrative record around the question that mattered most: Could she actually perform the material duties of her own occupation?
The team gathered updated medical evidence and obtained support from treating providers connecting her functional limitations to the actual demands of her work.
The appeal also included evidence showing how her limitations affected her ability to function outside the doctor’s office, providing a more complete picture of the disability than the original claim file contained.
Most importantly, the appeal challenged Mutual of Omaha’s characterization of the occupation.
Instead of allowing the insurer to reduce a complex professional job to a generic “sedentary” category, the appeal explained what the work actually required—and why her medical limitations prevented her from performing those duties.
The result was an administrative record that told a much more complete story than the one Mutual of Omaha had relied upon when it denied the claim.
The Outcome
Mutual of Omaha reversed its denial.
The claimant’s long-term disability benefits were reinstated, and past-due benefits were paid for the period during which her claim had been denied.
For her, the result meant she could stop spending her energy trying to convince an insurance company that she was genuinely unable to work.
She could focus on managing her health and rebuilding her life around what she could do.
The case also demonstrates an important lesson for anyone facing an LTD denial:
A disability claim isn’t just about your diagnosis. It’s about what your condition prevents you from doing—and whether the insurance company has accurately evaluated the job you’re actually expected to perform.
We Help People Across Virginia and Nationwide Appeal Long-Term Disability Denials
BenGlassLaw is based in Fairfax, Virginia, and represents long-term disability claimants throughout Virginia and across the country.
When an employer-sponsored disability plan is governed by ERISA, the administrative appeal can be a critical opportunity to build the evidence supporting a disability claim.
A strong appeal does more than argue that someone is sick. It connects the medical evidence to the actual functional demands of the person’s occupation and addresses the reasoning the insurance company used to deny the claim.
If Mutual of Omaha or another insurance company has denied your long-term disability claim, BenGlassLaw can help you understand what the denial means and what options may be available. Contact us today or upload your denial letter for a free review now.
Every disability claim is different. The outcome described here depended on the specific medical evidence, policy language, occupational requirements, administrative record, and other facts involved. This result does not guarantee or predict a similar result in any future case.