New York Life Group Benefit Solutions Long-Term Disability Denial Lawyer

In December 2019, New York Life purchased Cigna’s disability and life insurance businesses and rebranded them as New York Life Group Benefit Solutions (NYL GBS). With this purchase, New York Life became one of the five largest providers of group disability insurance in the world.

The sale had minimal impact on disability claims. The letterhead has changed, but everything else is the same as it was under Cigna. Therefore, claimants who understand Cigna’s claims handling practices prior to the sale will be better prepared for the disability claim process with NYL GBS.

New York Life Group Benefit Solutions Long-Term Disability Denials

If New York Life Group Benefit Solutions denies your long-term disability claim, you are not alone. We speak with people every day who have been denied long-term disability benefits by NYL GBS, or who are worried that NYL GBS will cut off their benefits. Each week, numerous ERISA disability lawsuits alleging unreasonable claim denials are filed against NYL GBS in federal court. Our disability insurance attorney has helped hundreds of disability claimants with administrative appeals and federal ERISA lawsuits against Cigna/NYL GBS.

Why Does New York Life Group Benefit Solutions Deny So Many Long-Term Disability Claims?

Like any other business, New York Life is trying to make as much money as possible. That means collecting premiums and paying out as little as possible on claims. As a result, NYL GBS disability claim denials have become increasingly common.

In our experience, New York Life often overlooks details when evaluating disability claims. They have denied disability benefits without physically examining the claimant (the person making the claim). They give more weight to the opinions of hired doctors than your treating doctors.

In addition, they sometimes use video surveillance to suggest that a claimant can return to work. Many NYL GBS denial letters are issued when the definition of disability changes from an inability to perform one’s “own occupation” to “any occupation.” It’s also common for NYL GBS to cite “lack of objective evidence” as a reason for denial.

Top 10 Reasons for New York Life Group Benefit Solutions Disability Denials

1. The objective medical evidence does not support your subjective complaints.
2. NYL GBS has had your records reviewed by an in-house nurse or medical professional who has determined that there are no restrictions or limitations preventing you from working.
3. NYL GBS sent your file to an outside medical professional who determined that you could work without examining you.
4. NYL GBS agreed that you have some limitations, but that your disability is pre-existing.
5. NYL GBS sent you for an “independent” medical examination and gave more weight to the opinion of the hired physician over the opinions of your treating physicians.
6. NYL GBS hired a vocational expert who determined that there were other jobs you could perform despite your limitations and restrictions.
7. NYL GBS tried to contact your doctor, but did not give your doctor enough time to respond, or your doctor said something that hurt your claim.
8. NYL GBS hired a private investigator to conduct video surveillance and used your daily activities to justify a claim denial.
9. The definition of disability changed from “own occupation” to “any occupation,” and NYL GBS came up with another occupation that you could perform.
10. NYL GBS determined that you have a limited benefit period because you suffer from a specific condition, such as certain mental conditions or musculoskeletal disorders.

RELATED POST: Reasons Why Cigna Denies Long-Term Disability Insurance Claims

What to Do If You Receive a Disability Denial from New York Life Group Benefit Solutions

The first step in appealing a New York Life Group Benefit Solutions disability denial is to request a copy of your claim file and policy. You will want to review your file to see what evidence was used to decide your claim. NYL GBS probably had you sign an Authorization to Obtain Information form, but that does not guarantee that they obtained all of your medical records.

Suppose NYL GBS conducted an internal review of your medical records, ordered video surveillance, or obtained other evidence while evaluating your claim. In this case, this evidence will also be included in your file, and you will have the opportunity to review and comment on this evidence.

The next step in preparing a strong NYL GBS appeal package is to obtain and submit medical evidence. Your denial letter will help you determine if any specific evidence is needed to support your claim, such as missing medical records or a statement from your doctor.

It is also important that you continue to receive medical treatment. It is a good idea to submit any new evidence that supports your claim, such as visit notes from recent doctor’s appointments.

A History of Deceptive Practices

In 2009, the California Department of Insurance fined LINA / Cigna $600,000 and ordered them to reevaluate thousands of improperly denied long-term disability insurance claims.

Then, in 2013, Cigna settled with California, Connecticut, Maine, Massachusetts, and Pennsylvania for improper claims handling practices.  This settlement came after the insurance departments investigated Cigna’s improper denial of long-term disability claims and wrongful termination of existing benefit claims. Some of the specific allegations against Cigna included:

• Failure to adopt and implement reasonable standards for the prompt investigation and processing of disability insurance claims.
• Failure to disclose pertinent facts or insurance policy provisions relating to coverage issues.
• Unreasonably denying claims when it knew the information necessary to approve the disability claim existed, but failed to obtain or review the information before making the denial decision.
• Failing to conduct its own functional testing of its own or to conduct a peer review of medical records on file.
• Failing to consult with health care professionals with appropriate training and experience in the field of medicine related to the underlying disabling condition.
• Improperly terminating claims during the “any occupation” period of the disability policy definition without conducting a transferable skills analysis and labor market survey to identify alternate occupations suitable for the claimant based on the claimant’s restrictions, limitations, education, training, and experience.
• Failure to provide complete information from the claim file to the medical examiner conducting a medical review of the record.
• Failure to clarify a claimant’s restrictions and limitations with the attending physician supporting the disability, when appropriate.
• Failing to give due consideration to the medical findings of independent physicians.
• Disregarding information provided in Social Security disability decisions; and
• Failing to give appropriate consideration to a claimant’s workers’ compensation records.

The settlement required Cigna to pay a $1.675 million fine, improve its claims handling processes, and establish a program to review long-term disability claims that were improperly denied or terminated in 2009 and 2010 (and 2008 for California residents).

However, Cigna continued to improperly deny and terminate legitimate claims. We have seen no improvement in the claims process since New York Life took over.

Learn More About New York Life Group Benefit Solutions Disability Claims and Lawsuits

• You can read about lawsuits against Cigna/NYL GBS nationwide. These cases are summarized here to help claimants understand how federal courts handle long-term disability insurance claims.
• You can also read summaries of some of the Cigna/NYL GBS disability claims that our firm has handled.
• Browse comments from those who have filed claims with NYL GBS, ask questions, or share your story about NYL GBS in our private support group. Attorney Nick Ortiz regularly responds to questions submitted.

Get Help from a New York Life Group Benefit Solutions Disability Denial Lawyer

At the Ortiz Law Firm, we believe that no one who is unable to work due to an injury or illness should be denied the benefits to which they are entitled to under their insurance policy. If you cannot work due to a serious injury or disability and NYL GBS has denied your long-term disability benefits, the Ortiz Law Firm will fight to protect your rights. Having represented individuals across the United States since 2005, long-term disability attorney Nick Ortiz has the skill and insight to help you address a wide range of issues related to your NYL GBS long-term disability claim denial.

Options After a Disability Benefit Denial

Appealing a New York Life Disability Denial

We will work with you and your doctors to prepare a comprehensive NYL GBS appeal.

Sue New York Life Group Benefit Solutions

We have represented claimants in court against NYL GBS nationwide.

Free Resources to Help You Win Your Disability Claim

• Top Ten Mistakes That Will Destroy Your Long-Term Disability Claim
• Disability Insurance Claim Guide & Toolkit
• Disability Insurance Appeals Guide
• Download a Residual Functional Capacity Form: Physical RFC and Mental RFC

Request a Free Case Evaluation

If your New York Life Group Benefit Solutions long-term disability claim has been wrongly denied or terminated, we can help. There are no fees until we win your case. Contact us for a free, no-obligation case evaluation—call (888) 321-8131 today.

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