{"id":7581,"date":"2021-01-06T22:42:36","date_gmt":"2021-01-07T03:42:36","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7581"},"modified":"2024-01-04T17:24:41","modified_gmt":"2024-01-04T22:24:41","slug":"counts-v-united-of-omaha-court-rules-that-united-of-omaha-must-pay","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/counts-v-united-of-omaha-court-rules-that-united-of-omaha-must-pay\/","title":{"rendered":"Counts v. United of Omaha – Court Rules That United of Omaha Must Pay"},"content":{"rendered":"
Brenda Counts (\u201cCounts\u201d) previously worked as an employee of Denver Wholesale Florist-Flint as a flower sales specialist. Her job title was formally known as \u201cInside Sales Associate\u201d which required \u201cmaking sales calls, pulling product[,] and packing.\u201d Through her job, she held a disability insurance<\/a> policy with United of Omaha Life Insurance Company (\u201cUnited\u201d)<\/a>. Under this plan, \u201cdisability\u201d is defined as the following:<\/p>\n \u201cDisability<\/i><\/em>\u00a0and Disabled<\/i><\/em>\u00a0mean that because of an Injury or Sickness, a significant change in Your mental or physical functional capacity has occurred, as a result of which:<\/p>\n \u201cSickness\u201d was defined as \u201ca disease, disorder or condition, including pregnancy, that requires treatment by a Physician. Disability resulting from a sickness must occur while You are insured under the Policy.\u201d \u201cMaterial duties\u201d are considered \u201cthe essential tasks, functions, and operations relating to Your Regular Job that cannot be reasonably omitted or modified.\u201d<\/p>\n Following a multi-year battle with lower back pain<\/a>, Counts was considered \u201ctotally medically disabled\u201d by her treating physicians. She started out with herniated disc syndrome, and later was diagnosed with \u201clumbar spondylosis,\u201d \u201clumbar degenerative disc disease,\u201d \u201cL4-5 stenosis from ligamentum flavum hypertrophy and facet arthropathy and diffuse disc bulge,\u201d \u201clow back pain,\u201d \u201cneurogenic claudication,\u201d and \u201cbilateral lower extremity radiculopathy.\u201d Counts additionally had several surgeries and eventually was unable to return to work.<\/p>\n She then filed for short-term benefits in June of 2017. After a review of Counts\u2019 medical file, United opted to deny her claim for benefits. Its conclusion explained that \u201cIn summary, the medical documentation fails to support the restrictions and limitations. Therefore, no benefits are payable, and your claim has been denied.\u201d However, United did not provide any further explanation of its denial. At that time, Counts applied for long-term disability benefits, followed by an appeal of her short-term disability claim. She then submitted additional records from a Dr. Hak and a Dr. Fernandez and also supplied an independent medical evaluation from Dr. Todd Best, a rehab specialist. He stated that Counts was \u201ctotally permanently disabled. She is not capable of any competitive employment.\u201d<\/p>\n\n