Ortiz Law Firm is dedicated to helping people recover the disability benefits they deserve. We handle group Long Term Disability (LTD) claims, individual disability insurance policy claims, ERISA disability claims, and Social Security Disability claims.

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Ortiz Law Firm Wins Long-Term Disability Appeal for RN with Complex Medical Conditions

We recently won a significant victory for a client who was wrongfully denied long-term disability (LTD) benefits by New York Life (NYL).

Our client, a former registered nurse, has been battling numerous debilitating medical conditions, including pudendal neuralgia, complex regional pain syndrome, Ehlers-Danlos syndrome, PTSD, anxiety, major depressive disorder, and migraines, that have left her unable to maintain gainful employment.

After successfully appealing her claim in 2023, NYL began a new review process when the two-year definition of disability changed from “own occupation” to “any occupation.” During this process, NYL wrongfully terminated her benefits based on deeply flawed and inappropriate evaluations.

The Denial: New York Life’s Missteps

We asserted that NYL’s denial of benefits had numerous legal errors, including the following:

  1. Incorrect Definition of “Any Occupation”: The claims adjuster misinterpreted the policy, applying a definition of “any occupation” without an earnings threshold. This interpretation ignored the plain language of the policy, which required that the client to be unable to perform any occupation that paid at least 60% of her pre-disability income.
  2. Biased IME and Peer Review: NYL ordered an Independent Medical Examination (IME), which acknowledged pain on physical examination, but set light limitations and, shockingly, suggested malingering and diagnosed our client with Munchausen’s Syndrome.
  3. Flawed Transferable Skills Analysis: NYL conducted a transferable skills analysis without a wage threshold and, unsurprisingly, concluded that she could work. This approach blatantly ignored the requirements of the policy.
  4. ERISA Violations: Perhaps most egregiously, NYL failed to provide the IME, peer review, and transferable skills analysis reports to our client or her attorney before terminating her benefits. This deprived the claimant a full and fair review in that it did not give her an opportunity to respond to these flawed assessments before a termination in benefits.

How We Fought Back

Our team at the Ortiz Law Firm immediately sprang into action, filing a comprehensive appeal that dismantled NYL’s rationale for the denial. Here’s how we turned the case around:

  • Evidence of Ongoing Medical Care: We submitted updated medical records and statements from her treating physicians, highlighting her ongoing care and the severity of her conditions.
  • Exposing Flawed Evaluations: We methodically deconstructed the IME and peer review, demonstrating their inaccuracies, bias, and lack of adherence to medical standards.
  • Policy Language: We highlighted the clear policy definition of “any occupation,” which required a 60% earnings threshold, proving that NYL had misapplied its own terms.
  • ERISA Violations: We outlined NYL’s failure to provide our client with a full and fair review.

The Result: A Swift Victory

Faced with overwhelming evidence, NYL reinstated our client’s benefits in less than 30 days. This decision gave her the financial security she desperately needed to focus on her health and well-being.

Need Help with a Denied Long-Term Disability Claim?

If your long-term disability benefits have been unfairly denied, the Ortiz Law Firm is here to help. We fight tirelessly to get our clients the benefits they deserve. Call us today at (888) 321-8131 or fill out our online contact form for a free case evaluation. Let us help you secure your benefits and hold the insurance companies accountable.