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Information System Security Officer Wins Georgia New York Life LTD Insurance Appeal for Retinal Dystrophy and Vision Loss After Denial at 24 Months

New York Life paid our client’s long-term disability benefits for two years — and the moment the policy definition shifted at the 24-month mark, the insurer cut her off. She had spent 38 years at Lockheed Martin Corporation as an Information System Security Officer in Georgia, doing work built on classified cybersecurity, technical guidelines, sustained computer use, and detailed visual processing. By the time she stopped working, progressive retinal disease layered on top of lifelong monocular vision and bilateral hearing loss had made it impossible to do any of it.

This is a pattern we have seen — and beaten — over and over again. New York Life pays the easy two years under the own-occupation standard, then engineers a paper-review termination the moment the any-occupation definition kicks in, identifying sedentary jobs that just happen to require the exact functions the claimant cannot perform. We filed a New York Life long-term disability appeal, and the insurer reversed the denial in full.

What follows are the specific tactics New York Life used in this case, and the evidence we put together to dismantle them — lessons every claimant facing a 24-month termination should understand before responding. If New York Life or any other disability insurance company has denied your long-term disability claim, our long-term disability lawyers offer free consultations nationwide and we do not charge a fee unless we recover your benefits.

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Table of contents

Why This Case Matters for Every New York Life Claimant

This case is not unusual. Across the thousands of New York Life disability claims our office has handled, the mechanics on display here — the 24-month definition flip, the paper review by a non-specialist, the vocational analysis that identified jobs requiring the claimant’s worst impairments — appear in case file after case file. The lessons translate directly to anyone facing a similar termination.

  • Vision loss and sustained computer-based work do not coexist — and yet that is exactly what the denial assumed. The two alternate occupations New York Life identified, Computer Processing Scheduler and Computer Security Specialist, were both built on prolonged screen use. So was the Lockheed Martin job New York Life had already accepted she could not perform. The denial collapsed under its own logic. This is a recurring problem we see in eye disorder long-term disability claims, where insurers identify alternate occupations that require the very visual functions the claimant has lost.
  • A Nurse Case Manager file review is not an adequate substitute for a board-certified specialist. When the disabling condition turns on retinal disease, macular scarring, and monocular vision, the only review that meets the standard of a fair claim evaluation is one performed by an ophthalmologist. New York Life never arranged one. That alone is grounds to challenge the denial.
  • Always verify what the denial letter says your treating doctor wrote against the form your treating doctor actually filled out. New York Life claimed the treating optometrist had cleared our client to return to work. The Medical Request Form said no such thing. Insurers regularly recharacterize treating provider statements as return-to-work clearances when the underlying document supports continued disability — read every form the denial cites and compare it to the denial’s characterization word for word.
  • An objective Work Simulation FCE with documented consistency-of-effort testing can defeat a paper-review termination on its own. Where the insurer’s denial rests on theoretical job matches generated by a Transferable Skills Analysis, an FCE that puts the claimant in front of the actual tasks — typing, sustained screen attention, mobility — produces evidence the insurer cannot dismiss as exaggeration.
  • The ability to cook, clean, or use a phone for a few minutes is not the same as the ability to hold a job. Insurers routinely conflate intermittent home functioning with eight-hour-a-day sedentary work capacity. They are not the same standard, and the appeal must explicitly draw the distinction.

A 38-Year Career and the 24-Month Trigger

Our client’s job required her to work on computers nearly 100% of the time — creating plans, reading technical guidelines and small print, maintaining inventory, and attending classified cybersecurity meetings. All of it depended on strong visual acuity and the ability to hear and process information in real time. As her hearing and vision declined, her performance suffered.

The vision impairments did not begin recently. She had been monocular since age nine, when complications from her mother’s congenital rubella infection produced a scotoma in her right eye and bilateral sensorineural hearing loss — the classic ocular and auditory pattern documented in the medical literature on rubella retinopathy. For decades she compensated. By her late fifties she could not. Pigmentation changes appeared in her left eye — the only functional one — and her treating retinal specialist confirmed dense central macular scarring on the right and degenerative drusen on the left.

Her clinical diagnoses, as documented across years of treatment with her optometrist and retinal specialist, include:

  • Dystrophies primarily involving the retinal pigment epithelium, right eye (ICD-10 H35.54)
  • Macular scar, right eye (ICD-10 H31.019)
  • Bilateral myopia (ICD-10 H52.10)
  • Bilateral age-related cataracts (ICD-10 H26.9)
  • Macular degeneration with drusen, left eye (ICD-10 H35.362)
  • Bilateral congenital sensorineural hearing loss

In plain terms: the back of her right eye was permanently damaged. Her left eye, while still functional, was showing degenerative changes her ophthalmologist was monitoring closely. Best-corrected vision in the right eye measured 20/150 — meaning what someone with normal vision can read at 150 feet, she could only read at 20 feet — and that did not improve with pinhole testing. She had no depth perception. She could not reliably hear on either side of her head, and she relied on lip reading and closed captioning for routine communication.

New York Life disability denial for eye disease

She stopped working and applied for long-term disability benefits. New York Life initially agreed she could not perform her own occupation and approved her claim. The policy paid benefits during the 24-month own-occupation period.

Most New York Life group long-term disability policies, like most employer-provided LTD plans, contain a built-in trigger: after 24 months, the definition of disability shifts from inability to perform your own occupation to inability to perform any occupation for which you are reasonably qualified by education, training, or experience.

  • Own-occupation disability means you cannot perform the material duties of your specific job.
  • Any-occupation disability means you cannot perform any job within your qualifications anywhere in the national economy.

The any-occupation standard is harder to meet, and that is exactly what New York Life and other carriers count on.

That trigger is where this case turned.

New York Life’s Denial: A Paper Review, Two Computer Jobs, and No Ophthalmologist

When the policy definition was about to flip, New York Life began its review. The review never produced an updated medical examination. It produced one outcome the file had been engineered to support.

A Nurse Case Manager Filling In for a Specialist

A claim built on progressive retinal disease, macular scarring, and monocular vision needs review by a board-certified ophthalmologist. New York Life never arranged one. Instead, a Nurse Case Manager performed a paper review of the records and signed off on termination.

A paper review — also called a file review — is when an insurance company reviewer evaluates a disability claim by reading documents alone, without examining the claimant or speaking to her treating doctors. There is nothing inherently wrong with that as a tool. There is something deeply wrong with substituting a non-specialist nurse’s paper review for an ophthalmologist’s medical opinion in a case that turns entirely on visual function.

What made the substitution worse was that the file already contained a prior peer review by a board-certified ophthalmologist with expertise in orbital disease, oculoplastics, and neuro-ophthalmology, Dr. Ami Shah Vira, whose conclusion was unambiguous: “poor vision in the right eye can make binocular work difficult and limit her function.” New York Life had already obtained a specialist opinion supporting disability. It chose to set that opinion aside and rely on a Nurse Case Manager instead.

Two Computer-Based Sedentary Jobs for a Claimant Who Cannot Sustain Computer Work

New York Life then ran a Transferable Skills Analysis — a vocational tool insurers use to identify other jobs a claimant supposedly can perform based on education, training, and experience. From that analysis, the insurer produced two alternate occupations:

  • Computer Processing Scheduler (DOT 221.362-030)
  • Computer Security Specialist (DOT 033.362-010)

Both classified as sedentary by the U.S. Department of Labor’s Dictionary of Occupational Titles. Both built around prolonged screen use, sustained visual attention, and detailed digital tasks. Both functionally identical in the way that mattered to the disability analysis: they require the precise functions our client’s progressive retinal disease has eliminated.

This is the part of the denial that did not survive contact with reality. New York Life had already accepted that our client could not perform her own occupation — a cybersecurity role built on screen use. The denial then concluded she could perform two other jobs built on screen use. The internal contradiction was not subtle.

A Treating Doctor’s Form Rewritten in the Denial Letter

The denial letter claimed the treating optometrist had cleared our client to return to work. That was not what his Medical Request Form said. He had instead documented that our client was essentially monocular, with very limited vision in the right eye and no depth perception, that she had difficulty with any task involving depth perception, and that she must wear polycarbonate glasses at all times to protect her only functional eye. Nowhere on the form did he indicate she was able to return to work. New York Life’s claim manager Anthony nevertheless wrote: “After we completed a review of your medical records we agreed with Dr. Singh’s assessment that you can return to work while wearing polycarbonate lenses to prevent injury to your left eye.”

That is the difference between what the treating doctor wrote and what New York Life said he wrote.

Cooking Dinner Is Not the Same as Holding a Job

The denial also leaned on our client’s self-reported activities of daily living — that she could cook, clean, drive a mile or two on rare occasions, and use a mobile device. From that, New York Life concluded she could sustain full-time sedentary employment.

This conflation is one of the most common moves in disability insurance denials, and it is wrong every time. Cooking, light housework, and intermittent device use are short-duration, self-paced, low-stakes activities. Competitive employment is sustained, externally-paced, and unforgiving of the breaks our client needed every nine or ten minutes. The two are not comparable. New York Life knew that. It used the conflation anyway.

The Work Simulation FCE: 9 Minutes, 21 Words a Minute, and a Wall to Lean On

A Functional Capacity Evaluation, or FCE, is an objective, multi-hour test of a claimant’s ability to perform the physical and cognitive demands of work. A Work Simulation FCE focuses specifically on tasks that mirror real job demands — sitting tolerance, computer use, typing, sustained attention, mobility within a workspace — rather than abstract physical maneuvers.

We arranged for our client to undergo a Work Simulation FCE with a licensed occupational therapist — a neutral evaluator with no relationship to our office or to the insurance company. The therapist administered consistency-of-effort testing throughout, which is how an FCE distinguishes genuine impairment from poor effort or symptom magnification. Heart rate response to physical demand, grip strength reliability across multiple trials, manual muscle testing, and test-retest reliability all came back valid. There was no basis to dismiss the findings as exaggeration, and no internal medical reviewer downstream tried.

Then the therapist ran the work tasks. The findings were specific, and they tracked the actual demands of the sedentary jobs New York Life had identified:

  • During computer-based tasks, our client could not sustain attention for more than nine to ten minutes before she had to pause, stretch, refocus, or remove her glasses to read closer to the screen
  • On a five-minute typing test, she completed 21 words per minute at 99% accuracy — meaning she could maintain quality only at a speed well below competitive thresholds for sedentary office work
  • When copying from a book to the computer, she leaned in close to the screen and removed her glasses repeatedly to see the text
  • Walking through the testing space, she kept contact with the wall throughout — a compensatory strategy she used at home as well, because she could not reliably see or hear on her sides or behind her
  • She relied on lip reading and closed captioning to communicate, both during the FCE and in daily life

The therapist’s conclusion was direct: our client could not work at any capacity, including sedentary work — that her combined visual and hearing deficits prevent her from performing sedentary tasks on a sustained basis.

That is what an objective Work Simulation FCE looks like when it is done correctly. It is also what New York Life’s review never produced, because New York Life never tested anything. The insurer read records and ran a Transferable Skills Analysis. It did not put our client in front of a computer for thirty minutes to see what would happen.

New York Life Reverses in Full

Attorney Alexander Palamara assembled the appeal package, combining the FCE results, an updated set of medical records from the treating retinal practice, the corrected reading of the treating optometrist’s form, and a direct challenge to the absence of any specialist medical review in the denial. The appeal was filed under 29 U.S.C. § 1133, the section of ERISA that governs the administrative appeal process for employer-sponsored disability claims and requires a full and fair review of every adverse benefit determination.

The appeal pulled no punches. As the appeal letter put it: “Their own cited evidence plainly contradicts their denial rationale.” The treating optometrist’s form supported continued disability. The retinal specialist’s records confirmed permanent macular scarring and progressive degenerative changes. The prior peer reviewer New York Life had retained — a board-certified ophthalmologist — had already concluded the claimant’s right-eye vision limited her function. And the FCE, performed by a neutral occupational therapist with full validity testing, confirmed that she could not sustain sedentary work tasks.

New York Life reviewed the appeal and reversed the denial. The approval letter, issued several months after the appeal was filed, confirmed that the prior adverse decision should be overturned and that our client remains entitled to continued long-term disability benefits under the policy. Back benefits owing from the date of termination were paid, and the claim was reinstated for ongoing payment.

The next step, had New York Life upheld the denial on appeal, would have been a New York Life disability lawsuit in federal court under ERISA. That step was not necessary here. The administrative appeal carried the case.

Two of our prior New York Life appeal wins illustrate the same patterns at work in this case — paper-review denials, vocational conclusions divorced from the claimant’s actual functional capacity, and the role of objective testing in turning the case around:

Frequently Asked Questions About New York Life Disability Appeals

Can I appeal a New York Life long-term disability denial after 24 months of payments?

Yes. ERISA gives you 180 days from the date of the denial letter to file an administrative appeal, and that appeal is your most important opportunity to add new medical and vocational evidence to the claim file. After 24 months of own-occupation benefits, most New York Life policies shift to the any-occupation standard — and that is the most common point at which New York Life terminates benefits. The appeal must directly attack the any-occupation analysis, including the Transferable Skills Analysis the insurer used to identify alternate jobs.

What is a Work Simulation Functional Capacity Evaluation, and will it help my appeal?

A Work Simulation FCE is a multi-hour objective test in which a licensed occupational therapist puts the claimant through tasks that mirror real job demands — sitting tolerance, computer use, typing, sustained attention, mobility — rather than abstract physical maneuvers. When paired with consistency-of-effort testing (heart rate response, grip strength reliability, manual muscle testing, test-retest reliability), the results are validated objective evidence the insurer cannot dismiss as exaggeration. A Work Simulation FCE is one of the most effective tools available to defeat a paper-review termination at the 24-month mark.

Does New York Life have to use a specialist physician to deny a disability claim?

ERISA does not impose a hard rule requiring specialist review, but the regulations require a “full and fair” review of every adverse benefit determination. When the disabling condition turns on a specialty area — retinal disease, cardiac function, neurological impairment, oncology — substituting a non-specialist Nurse Case Manager file review for a specialist’s medical opinion is one of the strongest grounds to challenge the denial on appeal.

What is the difference between own-occupation and any-occupation disability under a group LTD policy?

Own-occupation disability means you cannot perform the material duties of your specific job. Any-occupation disability means you cannot perform any job within your qualifications, anywhere in the national economy, for which you are reasonably qualified by education, training, or experience. Most employer-provided long-term disability policies pay benefits under the own-occupation standard for the first 24 months, then shift to the harder any-occupation standard. The transition between the two standards is the most common termination point in long-term disability claims.

If New York Life Has Denied Your Long-Term Disability Claim

What carried this case was not luck. It was an FCE that put the actual job tasks in front of an actual human being, a careful read of every form New York Life claimed it had relied on, and a focused appeal that exposed the gap between what the file showed and what the denial said. That is the test we apply to every New York Life denial we review. When the insurer’s own peer reviewer, the treating doctor’s own form, and the policy’s own definition of disability all support continued benefits, the denial is built on something other than the evidence. Our job is to expose that — and to put the proof in front of the reviewer in a form that cannot be ignored.

You have 180 days from the date of an ERISA disability denial letter to file an administrative appeal. That deadline is not negotiable, and the appeal you file is the record that governs every later step, including any federal court lawsuit. Filing a weak appeal — or missing the deadline entirely — closes doors that cannot be reopened.

Established in 1979, our office has represented tens of thousands of disability insurance claimants nationwide and recovered more than two billion dollars in benefits. We handle long-term disability claims against every major carrier — New York Life, Unum, Cigna, MetLife, Hartford, Lincoln Financial, Prudential, Standard, Guardian, Reliance Standard, and others — at every stage from initial application through ERISA appeal and federal court litigation.

To contact our office for a free immediate consultation about your New York Life disability claim or any other long-term disability denial, reach out today. We represent claimants nationwide and we do not charge a fee unless we recover your benefits.

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