Registered Nurse Wins Indiana New York Life Long-Term Disability Insurance Appeal for Long COVID After Denial at 24 Months
New York Life paid our client’s long-term disability (LTD) benefits for two years — then terminated them the instant the policy’s definition of disability changed. Our client is a registered nurse in Indiana who stopped working because of long COVID, followed by a cascade of orthopedic, neurological, and systemic conditions that only deepened over time.
We have seen this exact maneuver many times, both from New York Life and from the Cigna group disability operation it absorbed: an insurer that once agreed a claimant could not work suddenly decides she can — without a shred of evidence that anything actually improved. We appealed, and New York Life reversed itself and reinstated every dollar of benefits.
How our long-term disability insurance attorneys took apart the insurer’s paper-thin medical opinion holds lessons for anyone whose benefits were cut off at the 24-month mark. If New York Life or any other disability insurance company has denied or terminated your claim, you can speak with one of our lawyers anywhere in the country, and we charge no fee unless we recover your benefits.
Table Of Contents
- 1. Why this case matters for every New York Life claimant
- 2. Paid as disabled, then cut off when the definition changed
- 3. The independent medical exam that argued against itself
- 4. A transferable skills analysis built on a single flawed report
- 5. The objective evidence New York Life chose not to gather
- 6. New York Life overturns its denial and reinstates benefits
- 7. Talk to a disability insurance lawyer about your New York Life denial
Why This Case Matters for Every New York Life Claimant
Before the detailed story, here are the takeaways a denied claimant can actually use.
- Once an insurer has paid you benefits, the burden shifts to the insurer to prove you got better. New York Life could not simply re-weigh the same evidence and reach the opposite conclusion. To terminate a claim it had already approved, it had to show that our client’s condition materially improved — and it could not, because the medical record showed the opposite.
- A one-time exam is not functional testing — so we obtained the functional testing the insurer skipped. The carrier rested its entire decision on a brief examination and never measured how long our client could actually sit, stand, walk, or concentrate over a workday. We answered that gap with objective, performance-based evidence.
- A Transferable Skills Analysis is only as strong as the medical opinion beneath it. New York Life’s vocational report was built on a single flawed exam. Once that exam collapsed, the “other occupation” it pointed to collapsed with it.
- The 24-month “any occupation” transition is the most dangerous milestone in any claim. When a policy’s definition of disability shifts from your own occupation to any occupation, it becomes the moment insurers most often terminate benefits — and that is especially true in long COVID long-term disability claims, where carriers exploit the gap between how a claimant looks on paper and how disabled she truly is.
Paid as Disabled, Then Cut Off When the Definition Changed
Our client stopped working as a registered nurse after a COVID-19 infection left her with long COVID — the persistent, post-viral condition now formally coded as post-COVID-19 condition (ICD-10 U09.9). Her symptoms were the ones long-haulers know well: crushing fatigue, brain fog, dizziness, headaches, balance problems, and cognitive difficulty. Over the following two years, a long list of orthopedic, neurological, and systemic conditions piled on top of the original illness.
New York Life reviewed that record and did something important: it approved the claim. Under the policy, disability during the first 24 months means you cannot perform the material duties of your own occupation. New York Life had already classified our client’s nursing role as sedentary, so its approval was an implicit acknowledgment that her impairments had dropped her below the ability to sustain even sedentary work.
Then the calendar turned. After 24 months of benefits, the same policy changes the test: disability now means you cannot perform the material duties of any occupation for which you are, or could reasonably become, qualified based on your education, training, or experience. This 24-month “definition change” — the shift from an own-occupation standard to an any-occupation standard — is the single most common point at which long-term disability benefits are terminated.
In other words, what happens at the 24-month mark is that the policy stops asking whether you can do your old job and starts asking whether you can do any job at all. New York Life terminated our client’s benefits at exactly that point, declaring — in a termination letter signed by its Group Claims Senior Associate, Sobia — that she could now work as a “Medical Call Center RN.”
Nothing in the record explained the reversal. The insurer pointed to no evidence of improvement — because there was none. If anything, the record from the approval forward documented steady worsening.
An insurer is not free to pay a claimant as disabled and then, with no proof of recovery, decide she is suddenly employable. That contradiction sat at the center of our appeal. We see it repeatedly; we recently reversed the termination of a corporate attorney whose long COVID benefits were cut off after they had already been approved and paid — another about-face we overturned on appeal.
The Independent Medical Exam That Argued Against Itself
New York Life’s termination rested almost entirely on an Independent Medical Examination (IME) performed by one of its paid consultants, Dr. Jacob Schultz. An IME is a one-time evaluation performed by a physician the insurance company selects and pays — not a treating relationship, and not, by itself, a measure of what a person can sustain on the job.
The striking thing about this IME is that Dr. Schultz’s own observations argued against his conclusion. During the very same appointment, he documented that our client:
- arrived using a rollator (a wheeled walker) and needed her daughter present to help communicate;
- walked with an unsteady gait and used walls and outstretched arms to keep her balance;
- groaned audibly and showed obvious discomfort standing and moving from sitting to standing;
- had positive Phalen’s and reverse Phalen’s tests — hallmark signs of carpal tunnel syndrome — with tenderness in both wrists and her right ankle; and
- spoke in a pressured, at-times erratic way, with word-finding difficulty consistent with her documented cognitive symptoms.
From that set of findings, Dr. Schultz somehow concluded that our client could “walk with an assistive device for up to 30 minutes at a time, with frequent rests as needed” and that “no additional restrictions are recommended currently.” A person who needs a walker, cannot balance without one, and shows real cognitive strain is not a person an examiner has cleared for full-time sedentary nursing work.
Crucially, the IME included no functional testing of any kind. There was no measurement of endurance, pace, tolerance for sustained sitting, or the constant keyboarding and screen time a call-center role demands. When the insurer later asked Dr. Schultz to reconcile his own finding of moderate bilateral carpal tunnel syndrome with his no-restrictions opinion, his addendum said only that he “did not find any restrictions necessary” — no rationale, no discussion of pain with repetitive hand use, nothing.
Denials that lean on this kind of unexamined, self-contradicting opinion are exactly the cognitive limitations and chronic-symptom cases we handle most often. In one recent example, New York Life denied a technology specialist whose disabling cognitive deficits were dismissed by a reviewer who never examined her and never analyzed the mental demands of her job — a denial we reversed on appeal.
A Transferable Skills Analysis Built on a Single Flawed Report
From the IME, the carrier moved to a Transferable Skills Analysis (TSA). A TSA is a vocational review that uses a claimant’s work history, education, and assigned restrictions to identify other jobs the insurer contends the claimant can still perform. Here, the TSA identified a single alternative occupation — Medical Call Center RN, classified as sedentary — and treated that as proof our client no longer met the any-occupation standard.
The problem is that the TSA was built, by its own terms, on Dr. Schultz’s exam and nothing else. It inherited every flaw of the opinion beneath it. Sedentary work has a specific meaning: under the U.S. Department of Labor’s Dictionary of Occupational Titles, sedentary work involves sitting most of the time and lifting no more than ten pounds occasionally. But a sedentary classification is not the same as sedentary capacity.
A telephonic nursing role demands prolonged sitting, sustained cognitive endurance, rapid triage decisions, continuous multi-screen computer use, and near-constant hand activity — precisely the functions our client’s fatigue, cognitive dysfunction, radiculopathy, carpal tunnel, and visual instability made impossible. Identifying a desk job on paper does not answer whether this claimant could actually sustain it, and the TSA never even asked.
The Objective Evidence New York Life Chose Not to Gather
New York Life’s own medical director had flagged that the file did not clearly describe our client’s functional capacity. Faced with that uncertainty, the insurer had an obvious tool available — and chose not to use it.
The Functional Capacity Evaluation We Obtained
A Functional Capacity Evaluation (FCE) is a standardized, performance-based test that measures how long a person can actually sit, stand, walk, lift, reach, and sustain activity across a simulated workday. It is the closest thing to objective proof of work capacity that exists. The insurer never ordered one. So our client underwent an independent, comprehensive FCE, and the results were unambiguous:
- Sitting: only 30 minutes at a time, four hours total in a day;
- Standing: 10 minutes continuously, one hour total;
- Walking: 15 minutes continuously, 30 minutes total;
- Bending, twisting, squatting, climbing, and overhead reaching: markedly limited, with tasks repeatedly stopped for pain or safety;
- Cognitive and daily-activity testing: required multiple rest breaks, showed emotional lability, and could not sustain concentration — consistent with reports that she cannot shop independently, struggles to prepare meals, and cannot sit through a movie.
The evaluator’s overall finding was that our client performs at a “less than sedentary” level. In plain terms, “less than sedentary” means a person cannot reliably sustain even a desk job — the lowest rung on the physical-demand ladder. She cannot hold up under an eight-hour day or a forty-hour week. This is the objective, functional evidence New York Life declined to gather, and it flatly contradicted the insurer’s paper conclusion.
Her Treating Physician Confirmed the Findings
Our client’s primary care physician then completed an Attending Physician Statement (APS) after reviewing the FCE alongside his own longitudinal examinations. He agreed the FCE accurately reflected her true capacity, rejected the IME’s conclusions point by point, and confirmed she cannot walk 30 minutes at a time, cannot be on her feet up to four hours in a workday, and has restrictions well beyond anything the IME acknowledged.
His bottom line: she cannot perform the material duties of any occupation, including the call-center role New York Life invented. A treating physician who has actually examined a patient over time — and who endorses objective testing — carries far more weight than a one-time consultant.
The Imaging and Diagnoses the Denial Never Confronted
New York Life’s letter also ignored a mountain of objective medical evidence built up across specialty after specialty. The record documented, among other findings:
- multilevel lumbar spondylosis with canal stenosis and foraminal narrowing — a narrowing of the passageways the spinal nerves travel through — with moderate-to-severe degenerative changes at L3–L4 and L4–L5;
- electromyography (EMG) confirming chronic left L5 lumbar radiculopathy (ICD-10 M54.16) and bilateral tarsal tunnel syndrome — pinched-nerve damage in the low back and the feet;
- an MRI showing a near full-thickness tear of the right subscapularis, one of the rotator-cuff muscles;
- moderate bilateral carpal tunnel syndrome (ICD-10 G56.03), confirmed on the insurer’s own examination;
- chronic kidney disease, stage 2 (ICD-10 N18.2) with recurrent kidney stones;
- obstructive sleep apnea (ICD-10 G47.33) requiring BiPAP therapy after episodes of low overnight oxygen; and
- Hashimoto’s thyroiditis, polycystic ovary syndrome, mixed connective tissue disease with positive RNP autoimmune markers, severe obesity, migraines, and intermittent double vision.
None of this appeared anywhere in the carrier’s reasoning. And the persistence of her core long COVID symptoms was not speculative — peer-reviewed research confirms that clinically significant cognitive complaints, fatigue, and pain routinely persist years after infection and undermine a person’s ability to sustain work.
The Burden Was on New York Life to Prove Improvement
Because our client’s claim was governed by the Employee Retirement Income Security Act (ERISA) — the federal law that applies to most employer-sponsored disability plans — she was required to complete an internal administrative appeal before any court could hear the dispute.
An ERISA administrative appeal is that mandatory, non-deferential internal review, and it is governed by the statute’s full-and-fair-review requirements. As attorney Rachel Alters put it in the appeal, New York Life’s termination was “medically unsound, vocationally unsupported, factually incorrect, and procedurally defective.”
Here is the rule that decided this case: once a disability insurer has approved and paid a claim, it cannot terminate benefits without affirmatively proving the claimant’s medical condition improved. When an insurer has already found a claimant disabled and paid benefits, and it later moves to cut them off, the burden falls on the insurer to prove — by the greater weight of the evidence — that the claimant’s condition improved enough that she no longer meets the policy’s definition of disability.
The insurer produced no such proof. It had substituted the impressions of a single paid consultant for the objective testing and consistent treating-provider opinions that pointed the other way. Building that kind of complete, functional, provider-backed record is the same preparation that helps prevent a New York Life disability denial in the first place.
New York Life Overturns Its Denial and Reinstates Benefits
After an independent review of the appeal, New York Life’s Appeals Specialist, Michael, concluded that “the prior decision should be overturned.” Our client’s claim was reinstated in full — benefits restored, back benefits owed from the arbitrary termination date forward, and the ancillary rights tied to the policy, including waiver of premium, preserved. The insurer that had insisted she could staff a nursing call center now agreed, once again, that she could not.
That reversal is not unusual when a denial is confronted with objective evidence and the correct legal standard. We secured the same result for a New York Life executive whose “any occupation” denial leaned on the biased opinions of the carrier’s own in-house reviewers — a denial, and a related waiver-of-premium dispute, we also won back on appeal.
Talk to a Disability Insurance Lawyer About Your New York Life Denial
Claimants often ask whether you can appeal a New York Life disability denial after benefits are terminated at 24 months. You can — and your appeal is your one chance to build the record a federal judge will later be limited to.
If New York Life has cut off your benefits at the 24-month mark, or denied your claim on the strength of a rushed exam or a paper review (a file-only review by a doctor who never examines you), you do not have to accept that decision, and you should not go it alone. Under ERISA, your right to file an ERISA lawsuit depends on getting that appeal right, and the deadlines are strict and unforgiving.
Established in 1979, our firm has helped tens of thousands of claimants nationwide recover more than $2 billion in disability benefits. Speak with one of our long-term disability insurance attorneys for a free review of your denial. We represent claimants in every state, and there is no fee unless we recover your benefits. Contact our office to talk through your options today.
