Long-Term Disability Insurance Won for Safety and Emergency Manager

Long-Term Disability Benefits Denial by Omaha Life Insurance Company Reversed at Trial for Safety and Emergency Manager with Disabling Hypertension –  Court Orders Omaha to Pay Insured’s Attorney Fees 

Denial of Long-Term Disability Claims for Hypertension, Anxiety, and Panic Attack Victims – Unfortunate, Yet Common

This case was about Omaha Life Insurance Company’s failure to pay disability insurance benefits governed by federal ERISA law. Our client was 64-year-old Bill (not his real name), with hypertension and blood pressure that predictably spiked with the spiking of his anxiety and panic attacks triggered by the high-stress climate of his occupation as a Safety and Emergency Manager. His primary care physician advised him to stop working in his own occupation or risk having a stroke. He was earning $84,645 annually and hated to stop working. But his condition wrecked his personal, family, social, and professional life, and made it impossible for him to work in his stressful job. 

Bill was glad he had a long-term disability insurance plan and policy he paid for to protect him and his family, but the insurance company denied his claim.

Disability insurance companies commonly deny these claims, but you can appeal the denial, and if they deny it on appeal, you can sue them in court. 

Omaha Life Insurance Company Claimed That It’s Policy Language Did Not Cover Bill

Omaha’s policy language said: “Disability and Disabled mean that because of an Injury or Sickness…” [you are] “1. prevented from performing at least one of the Material Duties of Your Regular Occupation on a part-time or full-time basis; and 2. unable to generate Current Earnings which exceed 99% of Your Basic Monthly Earnings due to that same Injury or Sickness…”  “One of the material duties of Your Regular Occupation is the ability to work for an employer on a full-time basis.” 

Even though Bill’s own treating physicians clearly stated that continuing to work in his stressful occupation put him at risk for a stroke, Omaha ignored their opinions and denied his claim for disability benefits, claiming that he could still perform his job duties and was therefore not disabled, nor entitled to benefits under the policy. Omaha further claimed that the evidence he presented was insufficient to prove his case, despite his treating physicians’ unwavering opinions that he was disabled from working. 

So when Omaha denied Bill’s claim, he appealed the denial. But Omaha denied the appeal as well.

Being accustomed to a steady (and high) wage, Bill was scared to death about losing everything. He never imagined having to fight Omaha for the benefits he purchased to protect himself, all while coping with a difficult medical condition.

Taking Omaha to Federal Court for its Bogus Claim Denial, and Learning Bill’s Whole Medical Story to Present it to the Judge

We sued Omaha in federal court and worked closely with him to present his case effectively to the judge, far beyond what he had presented to Omaha before they denied his claim. 

To help Bill, we learned all the details of his story. As we did, we quickly realized that his job was obviously inappropriate given the risk of stroke. Bill simply needed to tell his story more vividly and effectively to the court.

How Bill Won His Case: Presenting His Story Effectively 

With Bill’s help, we were able to speak with some of his treating physicians and create detailed physician notes. These physician notes were made into formal, signed statements. 

We were also able to create a much more vivid, detailed statement for Bill’s own signature in sworn affidavit form, describing his symptoms and how he would have no warning at all that he was about to have spiking blood pressure and a panic attack. 

In Bill’s own words: “If I try to perform my usual job duties, I will begin to get anxiety, and my blood pressure will rise. When this happens, I get headaches, shortness of breath, and blurred vision. Xanax helps, but I need to lay down and decompress for 2-4 hours, depending on the level of stress I have experienced….my required medications cause dizziness and drowsiness, leading to errors and inability to keep pace as required to accomplish any work timely, as my ability to do everything is much slower, including all activities of daily living, attending daily work meetings… I am unable to concentrate on one task, and I experience increased anxiety over the pressure to complete my work. My anxiety grows to the point where I have to physically leave work, take a Xanax, and find a place to lay down for 45-60 minutes. I still experience headaches and blurred vision after taking a 45-60 minute break.” 

We had Bill’s wife and a few close friends complete affidavits attesting that they observed Bill having Panic episodes.

We presented this and other new, overwhelming evidence to the court to support his claim for long-term disability benefits.

A Just Outcome: The Federal Judge Orders Omaha to Pay Full Benefits and Attorney Fees

Thankfully, presented with undeniable new evidence, along with copies of court opinions our case law research found, where judges had awarded benefits under fact scenarios similar to our client’s case, the judge did the right thing. He ordered Omaha to pay full benefits and ordered Omaha to pay Bill’s attorney fees, a measure ordered upon finding Omaha’s denial of his claim to be arbitrary, capricious, and in bad faith.

Victims Of Disability Should Always Appeal Unfair Claim Denials and Always File Suit After a Denial on Appeal

In the end, because he continued to fight, appealing the insurance company’s denial of his disability claim rather than just accepting it as the final word, then suing in federal court when Omaha denied his appeal, Bill was able to maintain his financial security while he took some much-needed time to pursue further treatment and focus on healing. 

Unfortunately, disability insurance companies unfairly deny legitimate claims every day, but anyone faced with an unfair claim denial should continue to fight to the very end. These unfair denials can be overturned with the right strategy and stronger evidence, properly presented. 

Bill deserved the benefits he had paid premium for over the years, and it was an honor to help such a wonderful gentleman overturn such an unfair claim denial.

Results may vary. Every case is different, and no outcome can be guaranteed.