Planar Systems Strategic Account Manager With Type 1 Diabetes Wins New York Life LTD Insurance Appeal After Initial Claim Denied
New York Life looked at a job that meant hauling and installing heavy display equipment at client sites, climbing ladders, working trade show floors, and flying to international installations — and called it sedentary desk work. Our client was a Strategic Account Manager for Planar Systems, Inc. in Oregon, brought down by insulin-dependent Type 1 diabetes and the cascade of organ failure, cardiac disease, and neurological injury that followed it. His claim for long-term disability insurance benefits was denied outright. He never received a single payment.
Reclassifying a physically demanding job as a sedentary one is not a clerical slip. It is the move that lets a carrier deny a claim without ever having to argue about the medicine — and our disability insurance attorneys have taken that play apart against every major carrier in the country. We appealed. New York Life reversed itself and paid every dollar owed.
How that denial was built, and which two pieces of evidence collapsed it, is worth understanding for anyone whose job has been quietly rewritten on paper by an insurance company. If New York Life or any other disability insurance company has denied your claim, speak with one of our lawyers. We represent claimants nationwide, and there is no fee unless you collect benefits.
Table Of Contents
- 1. Why this case matters for every New York Life claimant
- 2. The medical cascade behind the claim
- 3. New York Life’s denial: a sedentary job our client never had
- 4. The vocational assessment that dismantled the sedentary label
- 5. The functional capacity evaluation New York Life declined to order
- 6. Answering the timing objection before New York Life could raise it
- 7. New York Life reverses and pays the claim in full
- 8. What to do if your insurance company says your job is sedentary
Why This Case Matters for Every New York Life Claimant
New York Life denied long-term disability insurance benefits to an Oregon account manager with Type 1 diabetes and a transplanted kidney — and the denial turned on a job classification, not on a diagnosis. That is the lesson worth carrying away from this file.
- Your occupation gets decided before your medicine does. A carrier that classifies your job as sedentary has already won most of the argument, because almost any set of restrictions looks compatible with sitting at a desk. Challenge the classification first. This is a pattern we see constantly among diabetes disability insurance claimants, whose jobs are frequently more physical than a job title suggests.
- A denial with no examination has a hole in it. New York Life ordered no independent medical examination, no functional capacity evaluation, and never had a physician lay eyes on our client. That vacuum is an opportunity — whatever objective evidence you produce on appeal, the carrier has nothing of its own to weigh against it.
- Performing a task is not the same as holding a job. Our client could complete sedentary-level activities in a testing environment. He could not sustain them for a workday. Policies require performance with reasonable continuity, and that distinction decides claims.
- One condition at a time is how a complex claim gets denied. Reviewed separately, each of his findings looked managed — stable transplant, normal stress test, functioning pacemaker, improving A1C. Reviewed together, with the medication burden layered on top, they made full-time work impossible.
The Medical Cascade Behind the Claim
This was not a claim built on a single diagnosis. It was built on two decades of consequences.
One Organ Failure After Another
It began with severe pancreatitis caused by dangerously high triglyceride levels, which led to a partial pancreatectomy, a cholecystectomy, and a bowel resection. Losing that much pancreas meant losing the ability to produce insulin, and he developed insulin-dependent Type 1 diabetes as a direct result.
Type 1 diabetes is a condition in which the body produces little or no insulin of its own, so blood sugar must be controlled entirely from the outside — by injection or pump, around the clock, for life. From there the damage moved outward. His kidneys failed, requiring a transplant.
Extensive surgical scarring forced removal of his spleen beforehand, leaving him without a functioning immune organ and dependent on lifelong anti-rejection medication. After the transplant surgery he developed a Mobitz Type II heart block — a failure of the electrical signal traveling between the upper and lower chambers of the heart — and required a permanent pacemaker. Two strokes followed, leaving permanent neurological deficits and triggering a seizure disorder.
The conditions documented in his claim file carry the following diagnostic classifications:
- Type 1 diabetes mellitus, insulin-dependent (E10.9), with diabetic retinopathy (E10.319) — damage to the blood vessels of the retina — and polyneuropathy (E10.42), nerve damage in the hands and feet
- End-stage renal disease (N18.6) with kidney transplant status (Z94.0)
- Second-degree atrioventricular block, Mobitz Type II (I44.1), with a cardiac pacemaker in place (Z95.0)
- Sequelae of cerebral infarction (I69.30) following two strokes
- Acquired absence of the spleen (Z90.81)
Each of these carries its own management burden, and the treatments collide. The immunosuppressants that protect a transplanted kidney must be taken for life and drive up blood sugar and blood pressure. The blood pressure medications used to protect the transplant produced edema and had to be cycled repeatedly.
His nephrology records show a running battle across visit after visit — a medication started, a side effect, the medication stopped, pressure climbing again. This is the reality of a multi-system claim, and it is exactly what gets lost when a carrier evaluates kidney disease disability insurance claims as though the transplant were the beginning and the end of the story.
What the Numbers Looked Like on an Ordinary Day
Continuous glucose monitoring gave New York Life something most claims never have: an objective, minute-by-minute record of instability. His average blood glucose ran between 179 and 198 mg/dL. Only about half his readings fell within target range. Some dropped into the 40s and 50s. Others climbed into the 300s and 400s. He was managing this with an insulin pump, mealtime boluses, and a monitor, and it still swung.
Those numbers describe a person who cannot count on his own body from one hour to the next. A blood sugar in the 40s produces shaking, sweating, confusion, and impaired judgment. A blood sugar in the 300s produces exhaustion, blurred vision, and cognitive slowing.
The peer-reviewed literature has studied the link between hypoglycemia and cognitive performance in adults with Type 1 diabetes. Layered on top were the reported side effects of his medication regimen: dizziness, tremors, fatigue, shortness of breath, blurred vision, cramps, joint pain, swollen legs, insomnia, decreased mental acuity, and impaired fine motor skills.
His nephrologist’s notes across this period record persistent fatigue, generalized weakness, multiple falls, dizziness, syncopal-like episodes that stopped just short of fainting, and orthostatic intolerance — the inability to stand up without going weak and lightheaded. In his own account and in correspondence with his employer, the practical consequences were stark: collapsing at a trade show, a diabetic emergency mid-flight, losing coherence during a client meeting.
New York Life’s Denial: A Sedentary Job Our Client Never Had
The policy, underwritten by Life Insurance Company of North America, defined disability in familiar terms. For the first 24 months, an employee is disabled if, solely because of injury or sickness, he is “unable to perform the material duties and substantial duties of his or her Regular Occupation.”
After 24 months the standard tightens to any occupation for which he is reasonably qualified by education, training, or experience. That shift is known as the 24-month definition change, and it is the single most common trigger for a benefit termination in group long-term disability insurance.
Our client never got that far. He was denied under the own-occupation standard — the more favorable of the two, which asks only whether you can perform your own job, not whether you could do some other job somewhere in the economy. He was denied at the outset, before a single benefit payment was made.
A DOT Code Doing All the Work
New York Life took a job description, matched it to the title Systems Architect — DOT code 039.162-015 — under the U.S. Department of Labor’s Dictionary of Occupational Titles, and classified the occupation at the sedentary physical demand level — exerting up to 10 pounds of force occasionally, sitting most of the time, with only brief walking or standing.
A disability insurance company can deny a valid claim without ever disputing your medical condition, simply by classifying your occupation at a lower physical demand level than it actually requires. Everything downstream of that decision was foreordained. Once the job is a desk job, a claimant has to prove he cannot sit at a desk.
The restrictions New York Life adopted — unrestricted sitting, reaching in all planes, fine manipulating, frequent lifting to 10 pounds, occasional lifting to 20 pounds — fit a sedentary job comfortably. They do not come close to fitting the job he actually held. This is precisely why how disability insurance companies evaluate your occupation matters more than most claimants realize when they first open a denial letter.
Six Reviewers and Not One Examination
The carrier’s own letter lists who reviewed the claim: a Claim Manager, a Technical Coach, a Team Leader, a Vocational Rehabilitation Counselor, a Nurse Case Manager, and a Medical Director specializing in Internal Medicine. Six people. Not one of them examined our client.
That is a paper review — a file review in which an insurance company’s staff and consultants reach conclusions about functional capacity by reading records rather than by evaluating the person. No independent medical examination was ordered. No functional capacity evaluation was requested. The Medical Director who signed off on the restrictions had never met him, never watched him move, and never tested his endurance.
A Treating Restriction Overruled Without a Conversation
His primary care physician assistant had already documented what he could not do: no frequent traveling, lifting limited to 10 pounds, standing and walking limited to ten minutes, no climbing, and avoidance of complex problem-solving. She stated plainly that he could not return to work with accommodations or without restrictions, citing episodic flares that brought on dizziness, weakness, fatigue, and cognitive impairment.
When the Nurse Case Manager faxed his endocrinologist seeking clarification of his restrictions and received no reply, the carrier simply proceeded without one.
The letter then leaned on the fact that his physical examinations were largely normal — eyes, respiratory effort, cardiac and lung sounds, extremity movement, neurological findings, mental status.
That reasoning has an obvious flaw. A man whose symptoms arrive suddenly and unpredictably will look fine in a fifteen-minute office visit. His provider had addressed this directly, confirming in a follow-up response to New York Life that his limitations “would absolutely interfere with the ability to safely and reliably perform” his occupational duties.
The letter was signed by a Group Claims Associate identified only as Eric — no surname, no credentials. Its conclusion, in the carrier’s own words: “evidence confirms he is not Disabled, as defined by his policy, therefore, we are unable to support his claim of Disability at this time.” The claim was closed. No benefits were payable.
The Vocational Assessment That Dismantled the Sedentary Label
Attorney Rachel Alters went at the classification first, because the classification was the denial.
Working from the employer’s own job description and written confirmation from the Planar Systems human resources department, a master’s-level Certified Rehabilitation Counselor (CRC) performed a vocational assessment of what the role actually required:
- Managing high-level client relationships and providing on-site technical demonstrations
- Transporting and installing heavy motion capture equipment
- Troubleshooting complex systems in the field and supervising technical staff
- Extensive domestic and international travel, including trade shows and client installations
- Frequent lifting, overhead work, and ladder climbing
- Long days of standing and walking, with sustained cognitive engagement
- A weekly commute exceeding three hours round-trip to a secondary office
Read that list against the phrase “sitting most of the time.” The counselor concluded that the duties were best captured by the Dictionary of Occupational Titles classifications for Camera Operator and Cinematographer, which in combination fall at the medium physical demand level — work requiring lifting of up to 50 pounds, not 10. In plain terms, New York Life had understated the physical demands of the job by a factor of five, and had eliminated the travel, the climbing, and the equipment handling entirely.
That single finding invalidated the determination. A carrier that applies the wrong occupational standard has not decided the claim; it has decided a different claim about a different person. We have made this argument before for a construction project manager whose vocational review we took apart piece by piece — a denial Reliance Standard also reversed once the real job was on the record.
The Functional Capacity Evaluation New York Life Declined to Order
A Functional Capacity Evaluation is a structured, hours-long physical assessment in which a licensed therapist measures what a person can actually lift, carry, sustain, and tolerate under observation. It is the objective functional evidence insurance companies routinely demand — and the one New York Life chose not to obtain.
So we obtained it. Attorney Alters arranged for our client to undergo a comprehensive evaluation as part of his appeal, and the results were not ambiguous:
- He became dizzy and unsafe on several tasks as the session progressed
- He was cognitively fatigued and unable to concentrate or problem-solve by the end of testing
- He showed impaired coordination and difficulty manipulating small components
- He demonstrated postural instability when stooping, kneeling, or reaching overhead
- He could not climb ladders safely, complete repetitive squatting, or maintain control during lifting and carrying
- Pain scores climbed steadily throughout, particularly in his lower back
- His cardiovascular response to exertion reflected declining tolerance
The critical finding was not that he failed the tasks. He passed several of them at a sedentary level. The finding was that he lacked the endurance and physiological stability to keep doing them. The evaluator concluded that he was “not capable of sustaining work on a full-time basis” and specifically could not meet the demands of his occupation.
Then came the detail that mattered most. The evaluator noted that our client’s performance that day represented an “above-average” day for him. His best was still not enough — and his best was not something he could summon on a schedule. That is what unreliability looks like when someone finally measures it, and it is the same evidentiary gap we closed for a warehouse operations manager with uncontrolled diabetes whose testing placed him below the sedentary level, a claim we also won on appeal.
Answering the Timing Objection Before New York Life Could Raise It
There was an obvious counterargument waiting. The evaluation took place roughly nine months after our client’s last day of work. A carrier looking for a reason to discount it would say it measured a later, worse version of him — not the man who stopped working.
We closed that door in the appeal itself rather than waiting to be asked. His nephrology records across the entire intervening period show continued instability, medication intolerance, rising creatinine — the blood marker that tracks declining kidney function — and worsening fatigue with exertion. There is no interval of improvement anywhere in the file. A record of uninterrupted decline makes a later evaluation a valid — and conservative — indicator of function at the date of disability.
Claimants ask us constantly whether a New York Life disability insurance denial can be appealed. It can — and it must be, before any lawsuit is possible. This is why the appeal is not a formality. Because his coverage came through his employer, the claim is governed by ERISA, which requires that a claimant exhaust the insurance company’s internal review before filing suit and guarantees, under 29 U.S.C. § 1133, a full and fair review of a denied claim.
The appeal is where evidence enters the record. If the case later reaches federal court, a judge will generally be limited to the administrative record as it stood when the carrier made its final decision — which means anything you leave out now, you may never get to say. Claimants have 180 days from receipt of the denial letter to file, and understanding how to appeal a long-term disability insurance denial before that window closes is the difference between one shot taken well and one shot wasted.
New York Life Reverses and Pays the Claim in Full
New York Life approved the claim.
The approval confirmed the date of disability, applied the policy’s 90-day elimination period — the waiting period between the onset of disability and the first benefit payment — and started benefits from the day that period ended. The first check was $112,224.00, covering twelve months of retroactive benefits. Ongoing monthly benefits were set at $9,352.00, calculated at 60% of covered earnings.
Nothing about the medicine changed between the denial and the approval. The diagnoses were the same. The records were largely the same. What changed was that someone finally described the job correctly and someone finally measured what our client could do. Those two documents were the entire difference between a closed file and a paid claim.
The claim now continues under monitoring, and the 24-month definition change is on the horizon. We know how carriers approach that review, and preparation for it starts long before the letter arrives.
What to Do If Your Insurance Company Says Your Job Is Sedentary
Our appeal put it bluntly: New York Life’s decision was “flawed, arbitrary, and capricious.” Carriers make decisions like this because they work often enough — most denied claimants never think to challenge the job description buried a few pages into the letter. Yours is worth challenging.
If a disability insurance company has told you that you can perform a job you know you cannot perform, get the denial letter in front of someone who reads them every day. Look closely at how your occupation was described. That description is frequently where the case is won.
Dell Disability Lawyers has represented long-term disability insurance claimants since 1979. We have helped tens of thousands of claimants nationwide recover more than $2 billion in benefits, and we have handled claims against every major carrier. Contact our office for a free consultation with one of our disability insurance lawyers. There is no fee unless you collect benefits — and if your claim has been denied, your appeal deadline is already running.
