New York Life

New York Life denied my claim after agreeing that I am functionally impaired

Reviewed by Teri on May 7th 2019   Verified Policyholder
I left work on 03/12/18 in due to incapacitating pain from a rare diagnosis followed by a rare bone fusion surgery due to multiple musculoskeletal conditions. I am in a research study of 250 people nationwide because many physicians are not aware of this diagnosis and dismiss it as a lower back problem. I applied for state temporary disability on 03/13/18 and was approved on initial submission. I then filed for New York Life LTD 09/2018 at the suggestion of my employer’s work comp coordinator. My claim was denied 01/2019 “as I did not satisfy an elimination period and I do not meet the definition of disability”. I appealed with updated medical records in addition to a 3rd party physician 7 page report outlining my disability to work. New York Life denied my appeal based on their review of one of my physicians work restriction that was dated for 03/08/18 – 06/30/18. I had surgery on 05/25/18 which has a minimum recovery time of 9 months. However, New York Life has agreed I am functionally impaired from 05/25/18 to present day. My Appeals Specialist suggested I contact my providers to ask them to “write a letter”.
Reply
Sent on May 7th 2019 by Attorney Rachel Alters

Teri, I am unsure what your questions is. You have the right to file a second appeal with New York Life if you choose to do so.