New York Life denies disability benefits to former Healthsouth Corporation nurse after paying for 11 years

Disability Lawyer Sues New York Life For Denying Long Term Disability Benefits After Paying for 11 Years

In Susan Sheehan Vs New York Life, a disability attorney filed a lawsuit at the District Court District Of Massachusetts claiming that the giant disability insurance company New York Life, had contravened the provisions of the Employment Retirement Income Security Act (ERISA) in its handling of a client’s claim for disability benefits.

The Nature of the Lawsuit against New York Life

The plaintiff Susan Sheehan was a nurse at the St. Joseph’s Hospital in Lowell, a facility acquired by the Healthsouth Corporation. She participated in a long term disability plan (LTD) that was maintained by the Healthsouth Corporation. The Plan was underwritten by New York Life.

Prior to the plaintiff’s LTD benefits being terminated by New York Life, she had a history of suffering from multiple unruptured intercranial aneurysms. Between 1996 and 1997, the plaintiff had undergone no less that three craniotomies/clippings and two EG coilings. She has twelve identified unruptured intercranial aneurisms, eight of which have been repaired to date. As a result of her disabling medical condition, the plaintiff stopped working on September 24th 1997. Since March 1998, the plaintiff has been receiving LTD benefits.

Termination of Long Term Disability Benefits by New York Life After Paying for 11 years

On November 22nd 2009, the plaintiff was informed by New York Life that it was terminating the plaintiff’s LTD benefits on December 18th 2009. New York Life contended that the plaintiff was able to work full time sedentary and light occupations despite her current disabling status.

The Appeals to New York Life’s Decision to Terminate LTD Benefits

In light of New York Life’s decision to terminate the plaintiff’s LTD benefits, the plaintiff appealed that decision on May 10th 2010. Additional medical and vocational documentations were submitted to support the plaintiff’s appeal. Nevertheless, New York Life continued to specify that the plaintiff could perform certain occupation and denied her appeal on July 22nd 2010.

On January 11th 2011, the plaintiff made a second appeal to New York Life’s decision to terminate her LTD benefits. She enclosed a functional capacity assessment and additional medical and vocational information for her second appeal. This second appeal was also denied by New York Life on April 6th 2011. This denial also represented New York Life’s final determination of the plaintiff’s claim for LTD benefits and hence exhausted all her administrative remedies.

The Cause for Legal Action Against New York Life

The plaintiff argued that New York Life’s final denial failed to expressly address the information the Plaintiff provided in her January 11th 2011 appeal. The plaintiff had been approved for Social Security Disability benefits and is still receiving those benefits. She argued that New York Life’s decision

• Was arbitrary and capricious.
• Was not supported by a good faith evaluation of the evidence.
• Is contrary to law.

The plaintiff alleged that this due to the following actions on New York Life’s part:

1. New York Life failed to give appropriate attention to testimonies and clinical documentations of the plaintiff’s disabling medical signs and symptoms by the plaintiff’s attending physicians.
2. New York Life failed to give appropriate weight to the evidence of the plaintiff’s capacity to perform her job, in light of her persistent headaches, pain, loss of balance, visual disturbances, urinary frequency and incontinence, diminished energy levels, and loss of capacity to sustain her efforts.
3. New York Life completely ignored the plaintiff’s non-exertional impairments, aside from her cognitive status, in evaluating her claim.
4. New York Life failed to consider the combined effect of all of the plaintiff’s difficulties that arose from her past brain surgeries.
5. New York Life failed to (at least expressly) consider the results of the functional capacity testing and the vocational assessments which the plaintiff submitted but instead insisted that she was able to perform work for which she was not suited.

Relief Sought by the Plaintiff

As a result of New York Life’s actions, the plaintiff requests the Court for the following relief:

• Assume jurisdiction of the plaintiff’s case
• Declared that New York Life has violated the relevant provisions of the ERISA by its actions in denying the plaintiff the benefits she is legally entitled to receive.
• Or alternatively remand the case for further proceedings to consider and address all of the medical evidence presented by the plaintiff.
• An award of attorney’s fees
• An award of other such relief that the Court finds just and proper.