Insurance Company Tactics:
Ignoring Evidence

When investigating a claim, most insurers will request proof of disability in the form of medical records and/or certifications from an insured’s treating provider(s). They also may have their in-house doctors perform a medical records review or conduct an independent medical examination of the insured. When an insurer is intent on denying a claim, they may go to great lengths to seek out conflicting opinions in an effort to ignore evidence proving a disabling condition.

The case of Kenneth R. Omasta v. The Choices Benefit Plan illustrates how some insurers are willing to ignore relevant evidence of disability.[1]  Omasta, a vice-president in a high-stress job, worked for his company for 22 years before becoming permanently disabled due to cerebral vascular disease, neurological deficits, and musculoskeletal disease. He filed for long-term disability benefits through his employer-sponsored Reliance policy and submitted certifications from five medical providers (his physicians, psychologist, speech pathologist and chiropractor), along with statements from supervisors and co-workers verifying his disability.

Instead of fairly considering the information submitted, Reliance determined it was insufficient and required Omasta to undergo an IME. Reliance selected Dr. Weight, a psychologist, to perform the IME, and used the IME as a basis for denying the claim in spite of the fact that Omasta had submitted opinions from multiple providers supporting his disability claim.

Omasta later sued Reliance and the Utah District Court reversed the denial of Omasta’s benefits, finding that Reliance’s decision was arbitrary and capricious. In doing so, the Court observed “[t]here is no information that Dr. Weight is in any way qualified to diagnose neurological disease or its symptoms” and concluded that Dr. Weight’s “opinion regarding Plaintiff’s malingering is unsupported by any other information in the record, and is contradicted by the opinions of his doctors, his former supervisors and co-workers and his long and successful employment history.”

This case, while ultimately decided in favor of the insured, shows the length insurance companies will go to deny professionals’ claims by selectively ignoring reliable evidence and turning a blind eye to readily available information.

Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned about how your claim is being administered, an experienced disability insurance attorney can help you assess your situation and determine what options, if any, are available

[1] Omasta v. The Choice Benefit Plan, et al., 352 F. Supp.2d 1201 (D. Utah 2004).

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