I’ve handled critical illness claims from every major insurer and what I’m seeing from Mutual of Omaha right now, I don’t like. Unlike most other major insurers offering critical illness policies, Mutual of Omaha’s claim calculation is based almost entirely on the impact to life expectancy for the condition diagnosed. While this may sound fair, they appear to be making their own judgement about the insured’s life expectancy – and, to no surprise, their determinations are falling in their own favor.
I’m getting a call a week from claimants whose claim offers are a fraction of the amount available asking me:
- Does Mutual of Omaha pay their Critical Illness claims?
- Are Critical Illness payouts fair from Mutual of Omaha?
- What is the average Critical Illness payout from Mutual of Omaha?
- Can you help with a Mutual of Omaha Critical Illness claim?
Based on my experience, I’ll address these questions and offer some guidance for navigating the claim process.
Does Mutual of Omaha pay their Critical Illness claims?
Yes, Mutual of Omaha does pay critical illness claims, but they also minimize payouts through their calculation formula.
To file a Mutual of Omaha Critical Illness claim a very brief Claim form will be submitted along with a doctor’s statement. Mutual will request medical records – those it deems are useful. It will very rarely reach out to the treating doctor but, instead, make its own evaluation of the doctor’s notes.
Are Critical Illness payouts fair from Mutual of Omaha?
Probably not.
My question is; if every person with a critical illness is unique in their condition, health history, genetic background, and treatment response, how can an insurer make a fair determination about the person’s life expectancy?
A more fair and robust evaluation should be applied to each claim.
What is the average Critical Illness payout from Mutual of Omaha?
The best way to answer this, again based on what I see from claimants, is that the offers are coming in between 3% and 20% of the amount available. These are low numbers.
Can you help with a Mutual of Omaha Critical Illness claim?
Yes. Whether you need to file a claim, have received a payout offer, or have a claim denial, I can help.
Mutual of Omaha Critical Illness Claims
The biggest challenge with getting a fair offer on a critical illness claim is having help from someone who knows the claim process and will share it with the insured. That’s just not going to come from the insurer.
In order to qualify for a Mutual critical illness claim the insured must have a Covered Condition, have a Policy in good standing, and the Benefit Calculation must have a net positive result.
That’s a lot to handle and very little help is offered by an insurer to complete the Claim form or evaluate the accuracy of a benefit offer.
Start a Mutual of Omaha Critical illness Claim
Step 1. Review the Terms & Conditions of your Policy.
Step 2. Confirm that your illness is a Covered Condition.
Step 3. Contact the Claims Department and request the Claim forms.
Step 4. Inform your doctor you will need a written statement about your condition.
Step 5. Submit the Claim forms and Physician’s Statement.
Step 6. Review the benefit offer before accepting.
Step 7. Seek assistance from me as early in the process as possible.
Tips for Completing the Critical Illness Claim Form
The Claim form asks for basic information about the insured such as name, address, and policy number. It also asks when the person was diagnosed with their condition and who the treating doctor is. Name all the doctors seen, even if they aren’t specialists.
For the condition diagnosed; it’s much better to write out a description of the insured’s diagnosis with as much detail as possible and attach it to the claim form. This helps to ensure the claim examiner doesn’t make any wrong conclusions about the medical condition.
The most important part of the Critical Illness claim form is the Attending Physician’s Statement. This is to be completed by the doctor who is treating the insured. There’s no rule against getting more than one doctor’s Statement.
Remember, the doctor doesn’t know what Conditions are in the policy for any critical illness. For example, the doctor doesn’t know that for a Stroke claim to be approved specific imaging tests have to have been completed and evaluated in writing. Therefore, simply This is why it’s vital to have your own claim representative who knows what the policy says, what the insurer wants, and who can work with the treating doctor directly.
Help with a Mutual of Omaha Critical Illness Claim
The first step to resolving a dispute over a critical illness claim is to engage a critical illness Claim Expert. This isn’t an attorney or insurance agent, but rather it’s someone with specific knowledge and experience with critical illness claims. The method of claim evaluation, the language of the Policy, and the underwriting processes of the insurer should all be investigated. Then, a sound plan of rebuttal can be made with a successful outcome for the insured.
Contact me to discuss your claim.
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