University of St. Augustine for Health Sciences Assistant Professor With Cervical Disc Herniation Wins Florida New York Life LTD Insurance Appeal After Second Benefit Termination
New York Life paid our client’s long-term disability benefits for more than three years, lost one attempt to cut him off, and then terminated his claim again. Our client, an Assistant Professor at the University of St. Augustine for Health Sciences, had a herniated cervical disc compressing his spinal cord after a car accident, along with multiple spinal and neurological conditions. Nothing about his spine had improved.
We have seen insurers terminate the same claim twice many times, and we know how to take those decisions apart. Attorney Alexander Palamara filed an administrative appeal of this Florida New York Life disability insurance termination, and New York Life reinstated the claim within weeks.
How that happened holds practical lessons for anyone whose insurer has decided, once again, that a desk job is suddenly possible. If New York Life or any other disability insurance company has terminated your benefits, speak with one of our long-term disability lawyers today. We represent claimants nationwide, and you pay no fee unless your benefits are paid.
Table Of Contents
- 1. Why this case matters for every New York Life claimant
- 2. A cervical disc herniation that never healed
- 3. New York Life terminates the claim a second time
- 4. Dr. Innerfield’s restrictions contradicted her own findings
- 5. Two computer jobs for a man who cannot look down at a keyboard
- 6. The earnings test New York Life never performed
- 7. The FCE: less than sedentary by every measure
- 8. The evidence New York Life left out of its review
- 9. New York Life reverses its decision on appeal
- 10. Speak with one of our lawyers today
Why This Case Matters for Every New York Life Claimant
Can New York Life stop paying disability benefits after you have already won an appeal? This case shows it can try, and it shows how to stop it. A New York Life long-term disability denial for a university professor with a neck injury from a car accident may look like a narrow set of facts. The tactics behind it are not. These are the lessons that apply to almost any claim.
- Your insurer’s own restrictions can defeat its denial. New York Life’s physician limited our client to occasional keyboarding and mousing, then its vocational specialist named two computer-intensive jobs he could supposedly perform. Read every restriction in your denial letter against every job the insurer lists. Contradictions like this one are often the strongest argument an appeal can make.
- Any-occupation denials must pass an earnings test, and insurers often skip it. Many group policies require proof that you can earn a set percentage of your prior income, not just perform some job. New York Life produced no wage data at all. If your insurer has not proven the identified jobs pay enough, that gap alone can sink the denial.
- A paper review should be answered with an in-person evaluation. New York Life never examined our client. A validated Functional Capacity Evaluation replaced the file reviewer’s guesswork with measured results that the insurer could not credibly dispute.
- Sedentary work is not only a physical question. Medication side effects, lost concentration, and the need to lie down during the day can rule out desk work on their own. Ask your treating doctor to document these limits specifically and to say plainly whether you can sustain sedentary work.
- Winning once does not end the scrutiny. New York Life tried to end this claim twice. Claimants who have already won should keep treatment consistent and records current, because the insurer can reopen the question at any time. Our guidance on how to prevent a New York Life disability benefit denial explains what that ongoing protection involves.
A Cervical Disc Herniation That Never Healed
Our client’s disability began with a motor vehicle accident that caused an acute disc herniation at the C4-C5 level of his neck. A cervical disc herniation occurs when the soft inner material of a disc in the neck pushes through its outer layer and presses on the spinal cord or nearby nerves. In our client’s case, it pressed on both. Over the following years, the damage produced a cluster of diagnoses that New York Life itself never disputed:
- Cervical disc herniation at C4-C5 with spinal cord compression and nerve root impingement
- Cervical myelopathy, meaning dysfunction caused by pressure on the spinal cord itself
- Cervical and lumbar radiculopathy, the radiating pain, numbness, and weakness that follow a pinched nerve
- Cervical and lumbar spinal stenosis, a narrowing of the canal that houses the spinal cord
- Peripheral neuropathy affecting the left shoulder, arm, and hand, along with sciatica
- Cervicogenic headaches (headaches that originate in the neck), dizziness, and balance deficits
- Chronic pain in both the upper and lower extremities
These are not the kind of conditions that respond to effort. Our client attended more than 100 physical therapy sessions and underwent cervical facet injections to numb the small joints of the spine. Some measurements improved modestly at times, but the core problem never changed. His neck had lost nearly all of its ability to bend forward, so looking down at a keyboard reliably triggered headaches and muscle spasms.
He also depended on a medication regimen that created problems of its own. The drugs that controlled his nerve pain and involuntary muscle twitching left him with severe morning nausea and retching, often lasting into the early afternoon. For an Assistant Professor at the University of St. Augustine for Health Sciences, whose work was built on teaching, writing, and hours at a computer, the combination was disabling.
Cervical cases like this one are among the most frequently contested neck and cervical disorder disability insurance claims we handle, because insurers know the limits they create are harder to see than a cast or a wheelchair.
New York Life Terminates the Claim a Second Time
Two definitions of disability
Our client’s group policy, like most employer-provided coverage, used two different definitions of disability. An own-occupation definition of disability covers you if you cannot perform the duties of your own job; an any-occupation definition covers you only if you cannot perform any job you are reasonably qualified for by education, training, or experience. Our client’s policy switched from the first standard to the second after 24 months of benefits. The policy defined continued disability this way:
“After Disability Benefits have been payable for 24 months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is: 1. unable to perform the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience; and 2. unable to earn 60% or more of his or her Indexed Earnings.”
The first denial, then the second
The change from own-occupation to any-occupation coverage is the point where many insurers first try to end a claim, and New York Life did exactly that. It denied benefits at the 24-month mark. Our office appealed that first denial and won, and benefits resumed, much as they did in our New York Life appeal for a Daikin Applied Americas safety manager, another 24-month denial we reversed.
A year and a half later, New York Life tried again. Surviving the change in definition does not mean an insurer stops looking for a way out; disability insurance companies continue to challenge claims after the any-occupation review is finished.
A decision made entirely on paper
This time, New York Life did not examine our client, order an independent medical examination, or hire an outside physician. A paper review, also called a file review, is an insurer’s assessment of a claimant’s abilities based solely on medical records, without any in-person examination. Claimants often ask whether an insurer can deny disability benefits based on a paper review alone. It can, and New York Life did.
Its Nurse Case Manager and its Medical Director, Caitlin E. Innerfield, MD, reviewed the file, and a Vocational Rehabilitation Specialist identified two jobs.
New York Life’s letter conceded the obvious and then denied the claim anyway:
“We understand that you have impairments that require restrictions and limitations, however, our review determined you do have Sedentary function.”
The letter also noted that the Social Security Administration had awarded our client disability benefits, then dismissed that award as outdated. New York Life gave the decision some weight on paper and none in practice.
Dr. Innerfield’s Restrictions Contradicted Her Own Findings
The weakest point in New York Life’s denial was the medical review it was built on. Dr. Innerfield, board-certified in Physical Medicine and Rehabilitation, did not dispute that our client was seriously impaired. She conceded nearly everything, then assigned restrictions that could not coexist with her own conclusions.
What New York Life’s Medical Director acknowledged
According to the appeal, Dr. Innerfield accepted that our client had cervical radiculopathy and myelopathy from a persistent C4-C5 disc herniation with cord impingement, confirmed by serial MRIs showing no improvement. She also acknowledged:
- Neck rotation reduced to less than 20 degrees in each direction
- Hyperreflexia, meaning overactive reflexes that signal spinal cord involvement
- Persistent left arm weakness and significant left hand weakness
- Reduced sensation in the fourth and fifth fingers of the left hand
- Nausea, dizziness, drowsiness, and cognitive effects from his prescribed medications
New York Life’s own denial letter went further, stating that “Functional testing reinforced your sitting tolerance to be only 30-45 minutes at a time and were unable to maintain computer posture without worsening pain and radicular symptoms.”
The restrictions she assigned anyway
Having accepted all of that, Dr. Innerfield concluded our client could work full time within these limits:
- Frequently: sitting 30 to 45 minutes at a time for up to six hours a day, standing, walking, reaching, fine manipulation, simple grasping, and finger handling with both hands
- Occasionally: lifting, carrying, pushing, and pulling up to 10 pounds, firm grasping, keyboarding and mousing, stooping, bending, balancing, and driving
- Never: crawling, climbing ladders, working at unprotected heights, or operating heavy machinery
Why those restrictions fall apart
A man who cannot hold a computer posture without worsening nerve pain cannot sit at a desk for six hours a day. Relabeling that total as “frequent” does not change what the job demands. Dr. Innerfield also allowed frequent fine manipulation and finger handling with a left hand she described as significantly weak and numb in two fingers. Those tasks require exactly the grip, sensation, and endurance she admitted were compromised.
She also accepted his medication side effects without accounting for them. Nausea and impaired concentration are disabling in any desk job, and disability insurance companies must consider the side effects of your medications. Recognizing those effects in one paragraph and ignoring them in the restrictions is not a medical judgment. It is a denial written backward from its conclusion.
Dr. Innerfield also dismissed an earlier Functional Capacity Evaluation as “overly restrictive” without identifying a single flaw in it. A prior New York Life peer reviewer, Aaron Levine, MD, had agreed with that same FCE’s conclusion that our client could not work. Dr. Innerfield offered no medical reason for departing from her colleague’s opinion.
Two Computer Jobs for a Man Who Cannot Look Down at a Keyboard
A Transferable Skills Analysis (TSA) is a vocational review that uses a claimant’s education, training, work history, and restrictions to identify other occupations the insurer says the claimant can perform. New York Life’s Vocational Rehabilitation Specialist ran one using Dr. Innerfield’s restrictions and identified two sedentary occupations, listed by their codes in the Dictionary of Occupational Titles, the Department of Labor’s classification of job duties:
- Online College/University Teacher (DOT Code 090.227-001)
- Research Associate (DOT Code 199.267-034)
Both jobs are built around a computer. As attorney Palamara wrote in the appeal, “The contradiction is glaring.” New York Life’s own physician had limited keyboarding and mousing to an occasional basis, and its vocational specialist then chose two occupations that require them nearly all day.
Online teaching is especially unforgiving. Grading, written feedback, course management, and constant text-based communication all happen at a screen, with none of the freedom a classroom offers to stand or move around. The specialist simply assumed our client’s classroom experience transferred to an online-only role without asking what that role physically demands.
The Research Associate position fared no better. Its core duties include analyzing data, preparing statistical tables, and drafting reports and abstracts, which means prolonged sitting, repetitive hand use, and sustained concentration. Every one of those demands conflicts with the limitations New York Life had already accepted.
The Earnings Test New York Life Never Performed
Many any-occupation definitions count a job only if it pays at least a set percentage of the claimant’s pre-disability earnings, commonly 60%. A job title alone does not satisfy that test.
Even if our client could have performed those jobs, the denial still failed. The policy’s any-occupation definition has two parts, and the second requires that the claimant be unable to earn 60% or more of his indexed earnings. New York Life never addressed it. Its vocational analysis contained no wage data, no labor market survey, and no earnings calculation of any kind.
Our appeal supplied the numbers New York Life left out:
- Indexed earnings: $126,900 per year
- 60% earnings threshold: $76,140 per year
- Starting pay for comparable research positions: roughly $12.22 per hour, or about $25,400 per year based on publicly available labor market data
A job paying about one-third of the required threshold does not qualify under the policy. As the appeal put it, New York Life’s failure to analyze earnings “alone is fatal to the denial, as it leaves an essential policy requirement completely unproven.”
This is a gap we find in denial after denial. Insurers name a job title, assume it fits, and never check whether it pays enough to satisfy their own contract.
The FCE: Less Than Sedentary by Every Measure
New York Life decided our client’s abilities without ever watching him attempt a task. We did the opposite. A Functional Capacity Evaluation (FCE) is a standardized, hands-on assessment in which a licensed clinician measures how long a person can sit, stand, walk, lift, and use their hands, and whether that effort is consistent and reliable.
Sedentary work, as defined in federal regulations on physical exertion requirements, involves lifting no more than 10 pounds at a time and sitting for most of the workday, with only occasional walking and standing. Our client was evaluated by a licensed Doctor of Physical Therapy with advanced credentials, who measured the following:
- Sitting: 10 minutes at a time and no more than 30 minutes total in a day
- Standing and walking: 10 minutes at a time and no more than one hour combined per day
- Lifting and carrying: a maximum of 5 pounds
- QuickDASH: a 77% disability rating on a questionnaire measuring how well a person can use their arms, shoulders, and hands, reflecting severe upper extremity dysfunction
- Neck Disability Index: a 70% disability rating
The Neck Disability Index is a validated questionnaire that measures how neck pain limits everyday activities such as reading, driving, concentrating, and personal care. The appeal explained that a 70% score places a patient in the category of complete disability.
The evaluator placed our client at a Less Than Sedentary physical demand level. Less Than Sedentary means a person cannot meet even the minimum demands of a desk job, which typically requires sitting about six hours in an eight-hour day. Our client could sit for a total of 30 minutes.
Just as important, the evaluator confirmed his effort was consistent and valid. Grip consistency testing, heart rate response during lifting, and screening for non-organic signs all ruled out exaggeration. The evaluator concluded he could not sustain full-time work in his own occupation or any other, including sedentary work. That kind of objective testing carried similar weight in our New York Life appeal for a Tata Consultancy engineer with a spinal disorder, which we also won.
The Evidence New York Life Left Out of Its Review
An FCE alone rarely wins an appeal. Attorney Palamara paired it with the medical evidence New York Life had skipped, overlooked, or never waited to receive.
A treating physician’s opinion New York Life never used
Before issuing its denial, New York Life’s Medical Director called our client’s longtime treating physician for a peer-to-peer discussion. His office explained that our client had an appointment coming up. The physician examined our client at that visit and completed a detailed Attending Physician Statement, yet New York Life denied the claim without incorporating it. That statement documented:
- Neck pain that worsens with computer work, and headaches triggered by bending the head to look at a keyboard
- Involuntary muscle twitching and restless legs that worsen with prolonged sitting
- Medications that cause nausea, vomiting, memory problems, and impaired concentration, requiring rest periods lying down
- The need for unscheduled breaks five to seven times a day, with more than 25% of a workday spent off task
- Permanent restrictions and an inability to work in any setting, including sedentary work
This physician had treated our client for more than a decade and examined him in person repeatedly. New York Life instead leaned on records from a physical medicine specialist who had since retired and could not provide any updated information.
Updated imaging and therapy records
New MRIs confirmed the structural damage was progressing, not resolving. The cervical study showed a disc bulge at C6-C7 that had grown more prominent since the prior scan, a bone spur at C4-C5 causing left-sided foraminal stenosis (a narrowing of the passageway where the nerve exits the spine), and a reversal of the neck’s natural curve. The lumbar study showed multilevel degeneration with progression at L4-L5.
Months of updated physical therapy records told the same story. Therapists repeatedly measured our client’s forward neck bending at zero, with rotation limited to 25% of normal. A positive straight leg raise test on the left, a classic sign of lumbar nerve root irritation, appeared visit after visit.
A Functional Capacity Evaluation that never happened
New York Life’s denial letter listed a Functional Capacity Evaluation among the records it reviewed. Our client never underwent an FCE on the date the letter cited. As the appeal pointed out, that error raised a serious question: either New York Life reviewed the wrong records, confused this claim with another, or inserted boilerplate without checking it. Whichever it was, the mistake undermined the credibility of the entire review.
New York Life Reverses Its Decision on Appeal
ERISA, the Employee Retirement Income Security Act of 1974, is the federal law that governs most employer-provided disability insurance, including our client’s policy. Under ERISA’s claims procedure rules, an administrative appeal is the mandatory internal review a claimant must complete, and win or exhaust, before filing a lawsuit. Everything submitted during that appeal becomes the record a federal judge would later review, which is why we build every appeal as if it will end up in court.
This one did not need to. Within weeks of receiving our appeal, New York Life’s appeals unit wrote that “a determination has been made that the prior decision should be overturned.” Our client’s long-term disability benefits were reinstated, and his claim was referred back for payment of all benefits due. It is the same result we secured in our New York Life appeal for a medical technologist with an amputation, a claim cut off after five years of payments.
Had New York Life upheld its denial, the next step would have been a lawsuit under ERISA’s civil enforcement provision. The strength of the appeal record made that unnecessary.
Speak With One of Our Lawyers Today
If New York Life or any other insurer has terminated your benefits, the clock is already running. ERISA appeals typically must be filed within 180 days, and that window is your only chance to build the record a court will see. Contact our office for a free consultation with one of our disability insurance lawyers. We represent claimants nationwide, and you pay no fee unless your benefits are paid.
Established in 1979, our firm has helped tens of thousands of disability insurance claimants recover more than $2 billion in benefits from every major insurer.
