New York Life Disability Denials

Disability insurance benefits are designed to replace lost income in the event of an accident or illness that prevents you from working. New York Life Insurance Company’s portfolio includes individual disability insurance and group long-term disability products for employers. New York Life’s Group Benefits Solutions division typically handles NYL’s disability claims.

Unfortunately, disability insurance companies like New York Life do not always pay disability insurance benefits as they should, and legitimate disability claims are often denied. If you are looking for a disability lawyer to fight New York Life disability denials, use our contact form to request a free disability case evaluation or call us at (888) 321-8131.

Top Reasons for New York Life Disability Claim Denials

There are many reasons why New York Life Insurance Company may have denied your long-term disability claim, so you will need to review your denial letter to determine the specific reason why New York Life denied your claim. If you are unsure why New York Life Group Benefits Solutions denied your claim, a disability attorney can help you understand why.

Reasons for denial include, but are not limited to:

• Insufficient medical documentation.
• Insufficient objective medical evidence.
• A non-verifiable medical condition or self-reported symptoms.
• Your doctors did not return the attending physician’s statement.
• A peer review physician disagrees with your physician.
• You have exaggerated symptoms to qualify for benefits.
• Video surveillance.
• Social media.
• You missed a deadline.
• You are disabled due to a pre-existing condition.
• You are disabled due to a specifically excluded condition.
• You do not meet the policy’s definition of disability.
• There has been a change in the definition of the term disability and
• You are only partially disabled.

Next, we’ll take a closer look at some of the policy provisions and limitations behind some of the most common reasons for claim denials:

You Do Not Meet the Definition of Disability

New York Life will deny your claim for benefits if it determines that you do not meet the definition of disability as stated in your policy. The following is an example from a New York Life disability insurance policy.

“Covered Total Disability – A Covered Total Disability is an incapacity from the following which an Insured Person suffers while he or she is insured under the Policy:

1. an Illness, but only if such incapacity completely and continuously prevents the Insured Person from doing the material and substantial duties of his or her occupation, provided he or she is not engaged in any occupation for pay or profit; and

2. an organ donation by an Insured Person, if he or she has been continuously insured under the Policy for at least 6 consecutive months on the day of such donation.”

You Have a Pre-Existing Condition

Most insurance companies include a pre-existing condition limitation in their policies. Here is an example from a recent New York Life policy:

“Preexisting Condition means an Illness or any condition related to such Illness for which a person consults a doctor, receives medical services or supplies or takes any medication during the 12 month period immediately before the Insured Person’s Certificate Effective Date, if such Illness or condition is not fully disclosed when a request for initial insurance is made under the Policy.”

Many insurers use the pre-existing condition limitation inappropriately to deny claims. You should seek legal advice if you are denied based on the pre-existing condition limitation. Our team has extensive experience defending disability claims that have been improperly denied due to a pre-existing condition limitation.

You Have a Mental Disorder or Chemical Dependency

Your claim may initially be approved, but most policies will only pay benefits related to a mental disorder or chemical dependency for a limited period of time. Here is an example from a New York Life policy:

“The Maximum Benefit Period for all Covered Disabilities of an Insured Person which are due to or related to Mental Disorders and/or Chemical Dependency while such person is insured under the Policy, whether insurance has been continuous or interrupted, cannot exceed the lesser of: (a) 36 months; or (b) the Maximum Benefit Period for a Covered Total Disability.”

Many insurers misapply mental health limitations to deny claims. You should seek legal advice if you are denied based on a mental health limitation. Our team has extensive experience defending disability claims that have been improperly denied due to a pre-existing condition limitation.

Note: All of the policy excerpts above are taken from an actual New York Life long-term disability insurance policy.

Understanding New York Life Disability Claims

When filing a disability claim with New York Life, it is important to ensure the accuracy and completeness of all documentation is crucial. It is also important to provide all the requested documentation, as incomplete claims may be grounds for delaying or denying your claim. While insurance companies may sometimes delay or deny claims for less obvious reasons, it’s important to minimize this risk as much as possible.

How to File a Disability Claim with New York Life

To file a disability claim, you will need to complete several important forms, including statements from the employee, employer, and treating physician. These forms will require information about you as the claimant and your disability.

In addition, authorization forms may require your signature, which must be accurate and complete. It is imperative that you, your employer, and your physician thoroughly complete their respective sections, as incomplete information hinders the process.

Addressing Delays in Your New York Life Insurance Disability Claim

If you believe that your disability claim is being delayed, your first step should be to contact the New York Life Group Benefits Solutions to inquire about the status of your claim. You can either ask your employer to help you contact NYL GBS, or you can call the customer service line to speak with a representative.

If you are having difficulty obtaining information about the status of your claim, you may want to consult with an experienced disability attorney. We have extensive experience dealing with New York Life. We understand the strategies these companies use to delay benefit payments and will work on your behalf to expedite the process.

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

Despite the promises made when selling their group plan disability insurance policies to employers, New York Life often denies claims for disability benefits. If your claim is denied, you should receive a written copy of the decision by e-mail or mail. The written decision should state why New York Life Group Benefits Solutions has denied your claim, inform you of your right to file an appeal, and state the deadline by which you must submit your appeal to New York Life.

After you receive your denial letter, you should also request a copy of your claim file and disability insurance policy. You will need your claim file to review all the information available for review to New York Life when it denied your claim. This includes your medical records, claim forms, and any other evidence that New York Life obtained during its review of your claim. It would be best if you also had your policy. It is the contract that governs your claim.

How to Appeal a New York Life Claim Denial

Fortunately, a claim denial is not the end for policyholders. The type of disability insurance policy you have will determine whether it is governed by ERISA disability law and the process you must go through to recover your benefits.

• Group Disability Insurance Policies: If you have a New York Life disability policy purchased through a group benefits plan, your policy is likely governed by ERISA. ERISA disability insurance claims have strict appeal procedures and deadlines that you must follow. Under ERISA disability law, you must go through the administrative appeals process before filing a lawsuit against the insurer that denied your claim. You only have 180 days to file an appeal. If you do not file the required appeal within the allotted time, you cannot file a lawsuit against the insurer.
• Individual Disability Insurance Policies: Individual disability insurance claims and policies are not governed by ERISA. Suppose you have an individual disability policy, and your disability insurance benefits are denied or terminated early. In this case, you may not have to file an administrative appeal to enforce your rights. You may be able to proceed directly to go directly to lawsuit against New York Life Insurance Company. However, it may still be beneficial to file an appeal. You should request a free consultation with an experienced disability attorney to determine your legal rights and the best way to obtain your long-term disability benefits.

FREE RESOURCE: Whether you have a group or individual policy, we encourage you to check out our free step-by-step guide to appealing a disability insurance claim denial for appeal templates and residual functional capacity forms.

How a New York Life Disability Lawyer Can Help

If New York Life has denied your long-term disability claim, we can help you get the benefits you deserve. We are not afraid to take on New York Life or any other major disability insurance company.

Most people understandably want to avoid the complexities of pursuing a federal ERISA disability lawsuit. After years of contributing to their insurance, policyholders rightly expect their group long-term disability benefits to be administered promptly and fairly.

A skilled group long-term disability insurance attorney at the Ortiz Law Firm can be instrumental in helping policyholders:

1. Gather and present all of the medical, occupational, vocational, and financial evidence necessary to support a successful claim, administrative appeal, or federal ERISA lawsuit: Insurance companies, such as New York Life, often cite “insufficient evidence to support the claim” to wrongfully deny all or part of a claim. At the Ortiz Law Firm, our experienced long-term disability insurance attorney understands the specific information insurers require to validate a claim. Our recognized attorney is adept at obtaining the necessary supporting documentation and effectively presenting it to the insurance company or the court when filing an administrative appeal or pursuing a lawsuit in federal ERISA court for an improper claim denial.

2. Negotiate with insurance companies using language they understand: Nick Ortiz is an attorney who is well-versed in negotiating with large insurance companies such as New York Life to secure benefits. An attorney with extensive experience in group long-term disability matters, such as Mr. Ortiz, is fluent in the terminology of insurance coverage and insurance law. The Ortiz Law Firm knows the legal rights of policyholders and understands the appropriate pressure to apply to insurance companies to ensure that a claim is fully, correctly, and fairly processed.

3. Advocate for disabled policyholders in administrative appeals and federal ERISA lawsuits: Beneficiaries of New York Life group long-term disability insurance policies have the right to pursue an administrative appeal and, if necessary, to take a dispute over an unfair claim denial to federal court. However, they need competent legal representation in these proceedings. A single misstep early in the administrative appeals process can potentially jeopardize a claim permanently. When an insurance carrier, such as New York Life, wrongly denies a claim in whole or in part, the individuals covered by the policy require the expert guidance of the Ortiz Law Firm’s ERISA attorney. Our attorney will ensure that policyholders present a comprehensive, accurate case at every stage of their administrative appeal and federal ERISA lawsuit, protecting their rights and interests.

Our disability law firm offers a free disability policy review and consultation for those whose long-term disability claims have been denied. Nick A. Ortiz and his experienced legal team are experts in disability law and offer the following services:

• Appeals of New York Life’s denial of individual or government disability benefits.
• ERISA appeals of New York Life’s denial of a group disability claim.
• Appeal of a New York Life wrongful termination of an individual or government long-term disability insurance claim.
• ERISA appeal of a New York Life’ Insurance Company’s wrongful termination of group long-term disability benefits.
• Filing a lawsuit against New York Life after a final denial of an individual or government disability claim.
• Filing an ERISA lawsuit against New York Life after a final denial of group disability benefits.

What About New York Life Group Benefit Solutions Claims?

In 2020, New York Life Insurance Company acquired the group life, accident, and disability insurance business of Cigna Group Insurance and renamed it as New York Life Group Benefit Solutions. The acquisition added more than 9 million customers to New York Life’s book of business, making it one of the largest provders of group disability insurance.

We have experience with New York Life and Cigna group insurance claims, so the acquisition will not affect our ability to help claimants fight back against wrongful long-term disability insurance claim denials and terminations issued by New York Life Group Benefit Solutions.

What If I Also Need to Apply for Social Security Disability Benefits?

It is not uncommon for disability insurance companies to require disabled individuals to apply for Social Security Disability Insurance (SSDI) benefits. This is because most policies allow the insurer to reduce the amount it pays you each month by the amount of the SSDI benefits you receive.

If New York Life requires you to apply for SSDI benefits, we can help you file the application. Much of the medical evidence used to support your disability claim with New York Life can also be used to support a claim with the SSA, so it often makes sense to hire one lawyer to handle both claims.

What Can I Expect If My New York Life Disability Claim Is Approved?

While this is good news, don’t get complacent. In many cases, New York Life will immediately request an update from your treating physician or that you complete additional claim forms. They will continue to reevaluate your claim until you reach your maximum benefit period or they find a reason to close your claim.

At the Ortiz Law Firm, we continue to represent our clients after their claim is approved. This way, our clients are prepared for any unexpected developments, such as receiving a request for updated information or even a denial letter, which can occur without prior notice.

New York Life Case Results

The following are just a few of the NYL claims we have brought to a favorable resolution. Names have been withheld to protect the privacy of our clients.

• Claim Approved Despite Independent Medical Examination: The claimant, a veteran in his 60s suffering from PTSD, Meniere’s disease, migraines, and herniated discs, contacted us after New York Life denied his short-term disability claim. We helped him file a successful appeal, and his STD benefits were paid. We also helped him file a claim for long-term disability benefits, which was initially denied. We appealed the LTD denial, and New York Life overturned the decision and paid the LTD benefits.
• Termination of “Any Occupation” Claim Overturned: The claim was initially approved based on the “own occupation” definition of disability. New York Life later ordered an independent medical examination and a vocational analysis. Based on these findings, New York Life closed the claim, stating that the claimant could perform “any occupation”. We appealed the decision, and after reviewing the appeal, New York Life reinstated the claim.
• Claim Approved Despite Independent Physician Consultant Review: This client contacted us after being denied short-term disability benefits by New York Life Group Benefit Solutions. We assisted with a second appeal and applied for long-term disability benefits. Despite additional evidence, New York Life ordered an independent physician review. After arguing against the results of the review, both the STD and LTD claims were approved.

Request a Free Consultation with a New York Life Disability Lawyer

The Ortiz Law Firm specializes in disability claims with insurance carriers like New York Life, helping people with disabilities get the compensation they deserve. If New York Life Group Benefits Solutions has denied your disability claim, the experienced legal team at our law firm can help.

If you are still gathering information, you can check out our free resources, including:

• A free guide to disability insurance appeals.
• Our collection of LTD frequently asked questions.
• Educational articles on long-term disability claims.

If you’re ready to work with an attorney, you can also request a free case review. We will evaluate the specifics of your New York Life disability insurance claim to determine how we can help you get the benefits you deserve.

Let us help you get your claim approved. Call us today at (888) 321-8131 to request a free consultation with a New York Life disability attorney. We will not rest until we get you the disability insurance benefits you deserve.