New York Life’s Independent Medical Reviews and How to Respond

When appealing a long-term disability (LTD) claim denial with New York Life, the employee reviewing your LTD claim may not be a medical professional, but they will likely consult with one. New York Life (NYL) will often ask an independent physician to re-evaluate a claimant’s medical condition and determine if it is consistent with the reported functional limitations. This article explains what claimants can expect and how to respond to NYL’s independent medical reviews.

Why Does New York Life Conduct Independent Medical Reviews?

The purpose of an independent medical review is to evaluate the claimant’s medical history and current condition in the context of the claim. The reviewer looks at the medical evidence and determines whether it supports the reported limitations. New York Life uses these reviews to ensure that claims and appeals are carefully considered.

Are Independent Reviews Truly Impartial?

These reviews are not always objective. We prefer to call them “compulsory” reviews because the reviewing physicians are not all that “independent”. New York Life’s independent reviewers are selected and compensated by the insurance company, raising concerns about potential bias. They may be influenced to provide opinions that are consistent with the insurer’s interests, especially if they are hired frequently to perform such evaluations.

Furthermore, these reviews are based solely on the claimant’s medical records, and the reviewing physician will never meet the claimant. This can result in evaluations that lack the depth of direct patient-physician interaction, especially when subjective symptoms are involved.

At the Ortiz Law Firm, we understand this dynamic and know how to challenge biased or incomplete evaluations. We work with claimants to obtain strong, objective evidence from treating physicians to counter potentially biased findings in the independent review, ultimately strengthening the claimant’s case. By addressing these issues directly on appeal, we help to ensure that the claimant’s full medical picture is fairly considered.

Questions Asked in an NYL GBS Independent Medical Review

New York Life typically asks specific questions or makes specific requests of its independent reviewers. These may include, but are not limited to, the following:

1. Is the claimant functionally limited and to what degree?
2. Provide the current diagnosis(es) as related to the major source of impairment?
3. What is the adequacy if the medical evidence submitted?
4. Is the claimant physically, mentally, cognitively, and/or behaviorally impaired? If so, explain these impairments.
5. If the claimant is impaired, are work activity restrictions medically required?
6. Does the customer require medically necessary work activity restrictions and if so, describe the restrictions?
7. Please clarify if the claimant can sustain activity 8 hours per day, 40 hours per week, with the work activity restrictions provided.
8. Given the claimant’s conditions and treatment would they produce non-exertional limitations including side effects from medication? If so, please address the severity, duration and frequency and how they would affect the claimant’s cognitive functioning.

These questions will help New York Life determine whether you should receive LTD benefits.

How to Respond to an Independent Medical Review

After receiving the doctor’s findings, claimants are usually given a limited amount of time to respond. Here’s what you should do after you receive the report:

1. Talk to Your Doctor: Share the independent review with the claimant’s doctors and ask them to comment on any issues or provide more information.
2. Submit Missing Medical Records: If the reviewer doesn’t mention all the symptoms or limitations, you can send in recent test results, specialist opinions, or other evaluations to support the claim.
3. Write a Detailed Personal Statement: The claimant may also wish to provide a personal statement detailing the day-to-day impact of their condition on their functional abilities. This can highlight limitations that may not be fully appreciated from the medical records alone, such as the claimant’s difficulty in performing work tasks due to chronic pain or fatigue.

New York Life usually only allows 21 days for a response. You must either meet this deadline or obtain written confirmation of an extension before the deadline passes.

Final Considerations for Independent Physician Reviews

While an independent physician review can feel like an additional hurdle, it is also an opportunity for claimants to strengthen the legitimacy of their disability claim. A well-prepared response, supported by medical evidence and relevant personal insight, can make a strong case for the need for long-term disability benefits.

When responding to an independent physician review, thoroughness and timeliness are key. By proactively working with treating providers to resolve any discrepancies and submitting comprehensive documentation, claimants increase their chances of a favorable outcome in the appeal process.

The Ortiz Law Firm Can Help with New York Life Appeals Nationwide

Long-term disability attorney Nick Ortiz represents clients nationwide in long-term disability appeals. We know that it can be difficult to navigate an appeal of a long-term disability denial from insurers like New York Life. Our team has extensive experience handling NYL appeals for clients across the country. We use our knowledge of ERISA and insurance law to ensure you are treated fairly.

We can help you through every step of the process, from gathering medical evidence to responding to independent medical reviews, so you can present the best case. If you need help with a New York Life LTD appeal, contact us online or call the Ortiz Law Firm at (888) 321-8131 to schedule your free case evaluation today.