A Michigan court approved disability benefits for chronic back pain against United of Omaha after it denied her short term and long term disability claims.
Ms. Counts filed for disability benefits after suffering from back pain for many years. She worked as a florist in Colorado when she became disabled. As part of her claim, she submitted various types of medical evidence including:
- MRI’s,
- Doctor’s notes,
- Surgical records and
- Treatment history including opioid regime, epidural injections and physical therapy.
As part of the claims process, Ms. Counts also submitted an affidavit from her doctors attesting to her disability and restrictions and limitations. The restrictions and limitations, outlined by her doctors, did not meet the requirements of even a sedentary job.
United of Omaha had a paper review conducted of the medical evidence. Notably, at no point did they have her examined by a doctor. The paper reviewer’s conclusions were inconsistent with the evidence presented. It did not consider all the findings and ignored the restrictions and limitations provided by her doctors. This conclusion raised suspicion for the Court.
Colorado Discretionary Ban
The plan in this case was governed by Colorado law. Colorado has a ban on discretion. This means the discretionary authority often found in insurance policies was not enforceable here. That kind of discretionary authority
Because of that, the Court did not have to defer to the insurance company’s decision. It was able to review the case as a whole and make its own determination without giving deference to United of Omaha.
In sum, the court found Ms. Counts was entitled to short-term, and long-term, disability benefits. United of Omaha was ordered to pay her benefits going back to the first effective date under the policy.
This case is a good example of a strong case medically and procedurally. She provided an overwhelming amount of medical evidence demonstrating her disability. She was also able to show United of Omaha made the wrong decision to deny benefits.
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