New York Life Approves Disability Benefits for School Teacher With Multiple Sclerosis
Our client, a former elementary school teacher suffering from Multiple Sclerosis, contacted our office after New York Life terminated her claim for short term disability benefits and spoke with Attorney Stephen Jessup. New York Life had initially approved her claim for short term disability benefits, but in doing so awarded benefits only on account of a mental health condition, even though our client had filed her claim for benefits on account of her diagnosis of Multiple Sclerosis and the cognitive limitations resulting from same. New York Life’s prior approval of benefits based solely on a mental health condition is something Attorney Jessup has seen New York Life do in the past as a way to limit its liability under a long term disability policy to 24 months of benefits in accordance with the policy provisions related to mental health claims. It is also something Attorney Jessup has fought insurance companies on for clients who suffer from Multiple Sclerosis. The denial occurring during the short term disability period was also a tactic Attorney Jessup believes was employed by New York Life in an attempt to force the client back to work prior to the transition into long term disability benefits.
Short Term Disability Appeal
In preparation for submitting the administrative appeal, Attorney Jessup reviewed our client’s claim file and in doing so discovered that New York Life only had our client’s file reviewed by a Nurse Case Manager and an internal Associate Medical Director of Neuropsychology, both of whom were employees of New York Life. New York Life did not have her file reviewed by a Neurologist, despite the diagnosis of Multiple Sclerosis nor did New York Life have her file reviewed by an outside, independent doctor. In denying the claim, New York Life’s medical staff relied on a limited cognitive evaluation, which indicated multiple test measures below expectations and markedly impaired relative to her estimated abilities. However, New York Life’s medical reviewers opined that the findings of the evaluation were attributable to mental health conditions, which the client was not actively receiving treatment for, and that the report findings did not contain any restrictions or limitations related to our client’s functional or vocational capacities.
Attorney Jessup knew that the ultimate issue regarding our client’s disability would be verifying applicable restrictions and limitations on account of cognitive limitations related to the diagnosis of Multiple Sclerosis. To verify the presence of same, Attorney Jessup sent our client for a full neuropsychological examination, the results of which did clearly evidence multiple areas of cognitive deficits that were attributable to a neurological process (MS) and not from a mental health condition as New York had argued. In addition to the neuropsychological testing, Attorney Jessup worked with our client’s treating Neurologist to provide additional medical information to support the presence of work related restrictions and limitations.
During the course of the review of our client’s appeal, New York Life once again failed to have the medical file reviewed by an outside doctor and again had our client’s information reviewed by one of its Medical Director employees. Unsurprisingly, New York Life’s doctor ignored the findings of the neuropsychological exam as well as the opinions of our client’s neurologist and echoed New York Life’s prior determination that any deficits were on account of a mental health condition. In turn, New York Life denied our client’s appeal.
Long Term Disability Application
Given his experience in dealing with New York Life when it came to denials of short term disability appeals, Attorney Jessup immediately filed an application for long term disability benefits after receiving notice of the final denial of our client’s short term disability appeal. It would stand to reason that if someone was not deemed eligible for short term disability benefits that a claim for long term disability benefits would be denied as receipt of long term disability requires being found to be disabled during the elimination period of the long term disability policy, which coincides with the period of short term disability. If nothing else, Attorney Jessup’s experience in this case and in the cases of multiple other clients, New York Life’s ability to reason is at times questionable at best.
Providing the same information to the long term disability department that he provided to the short term disability department as part of the appeal in conjunction with updated medical records and claim forms, Attorney Jessup was able to get our client’s claim for long term disability approved. As noted above, the elimination period for the long term disability policy coincides with the period of short term disability benefits. When New York Life approved long term disability benefits they in effect agreed that short term disability benefits were payable. Attorney Jessup has since taken the long term disability approval letter and issued a demand to the short term disability department to pay owed benefits or a lawsuit would be filed.
Has New York Life Denied Your Disability Claim?
If your claim for disability benefits has been denied by New York Life or you are concerned that New York Like is looking to deny your claim please feel free to contact our office to speak with Attorney Jessup or any of our other disability attorneys.
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Q: LTD canceled their request for updated med records?
A: Most Authorizations are only good for two years so depending on when you signed it, it may no longer be valid ... Read More >
Q: Why is New York Life Insurance giving me a hard time?
A: Holly, the requirements of NYL depends on the type of policy that you are inquiring about. I would need to rev... Read More >
Q: NYL LTD also have LLC
A: LLC and LTD,If you receive active income, meaning its not considered passive investment income from the LLC ... Read More >
Q: Can I submit my resignation while on STD with NY Life? I don’t know if I’ll be able to return when they want and I would rather give a 2 weeks notice.
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Q: New York Life LTD offset my disabled adult child.
A: Yes, we have handled cases with fact patterns similar in nature. However, as you are in litigation already we ... Read More >
Q: My father has been in STD Cigna and LTD with New York Life since Jan 2021, diagnosed Pulmonary Fibrosis due to Covid-19. Can insurance and ex job make him return to work?
A: Walt, while no one can force your father back to work, NYL can certainly deny benefits if they believe there i... Read More >
Q: Do I have to sign agreement to pay back difference in LTD payment and SSDI payment?
A: You do not need to sign the agreement to pay back SSDI. Disability companies try to make you do this and you a... Read More >
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