New York Life

New York Life used another person's medical info to deny my claim and ignored my doctors

Reviewed by Christa on January 3rd 2019   Verified Policyholder
After receiving LTD benefits through New York Life for approximately 5 years, they recently reviewed and denied my claim and it is currently in the appeal process. I’ve had 7 surgeries in the past 5 years, with the 8th upcoming in a couple of weeks. During their routine ‘review’, which subsequently resulted in a denial, I became aware that they used another claimant’s medical information when I received the denial letter. I immediately alerted New York Life to this egregious error, but they merely apologized and advised that the correct information would have resulted in a denial, anyway. I have severe RA, chronic soft tissue calcification (for which I’ve had bilateral rotator cuff surgery), multiple lumbar spine herniated discs and sciatica, bilateral plantar fasciitis, end stage osteoarthritis, and ovarian cysts, for which surgery is scheduled. My doctors have all opined that I am ‘totally disabled’ and have submitted an abundance of medical to support such. My claims manager advised me that, since my treatment is ongoing and additional medical information needs to be submitted, they are ‘stopping the clock’ on the 45-day timeline to decide my appeal. They claim to have reached out to my doctors (my doctors all say they have not), but were unsuccesful. I asked New York Life to provide me with a direct number for their claim reviewer, as my doctors offered to call them during their off hours, and I was told that even New York Life does not have a direct number for their 3rd party vendor who is reviewing my claim on appeal. They suggested an IME, which I was inclined to not agree to, since they would send me to a New York Life-paid doctor, from what I understand. Furthermore, I find it highly suspect that they aren’t giving any weight to my doctors quantifying me as ‘totally disabled’, who have treated me long-term and on a regular basis, yet they are pushing for me to see one of their doctors. At this point, although the appeal is still ongoing, I feel it would be best to consult with an attorney. Thank you in advance for any preliminary advice you can provide.
Reply
Sent on January 3rd 2019 by Attorney Gregory Dell

Christa, New York Life can be difficult to deal with. You should contact one of our attorneys as soon as possible to discuss your options.