New York Life Appeal

Let’s discuss how you can win your New York Life Disability Appeal. New York Life disability denials are usually unreasonable and with preparation of a strong appeal package you can get your benefits paid. There is only one chance to submit a New York Life appeal. It must be drafted strategically in order to win your disability benefits. Our disability insurance lawyers have reviewed thousands of New York Life short and long term disability denials on behalf of claimants nationwide and we are available now to provide you with a free phone consultation. We have seen every type of New York Life disability denial and we know exactly what is required in order to give you the best chance to win your New York Life disability benefit appeal.

Why Is It Important to Prepare a Strong New York Life Appeal? 

We want you to become educated about the New York Life appeal process and learn how our law firm can help give you the best chance to win your New York Life disability appeal. In our NewYork Life Disability Appeal Tips video attorneys Gregory Dell and Cesar Gavidia discuss the following: 

• Why is it important for you to submit a strong appeal package to New York Life?
• What is your first step to appealing a New York Life denial?
• How much time do you have to review a New York Life denial?
• Why is it important to consult with an attorney as part of your New York Life appeal?
• How can we help prepare a strong appeal package to New York Life? 
• What evidence did New York Life rely upon to deny your disability claim?
• Why are custom attending physician statements essential?
• Should you submit additional medical evidence for your New York Life appeal? 
• Does New York Life require objective medical evidence to win benefits? 
• Can New York Life rely exclusively only on the medical opinions of their hired doctors? 
• How does New York Life determine the duties of a job?

How Can You Win Your New York Life Disability Appeal?

With strategy, collaboration and execution you can get your New York Life disability claim approved. Every New York Life disability benefit denial is unique because everyone has different medical conditions that prevent them from working, the definition of disability is different in most New York Life disability policies, and lastly your prior work experience and education will have a big impact on the ability to perform any job. Our law firm’s history of winning disability appeals comes from working very closely and strategically with you, your treating doctors, and vocational consultants. We take a custom approach to how we handle every appeal and we look forward to discussing your New York Life disability denial with you. As you begin the process to get your New York Life disability benefit denial reversed, you should watch our video below:

Most New York Life disability benefit denials are based on New York Life’s determination that you do not have sufficient medical limitations which prevent you from working in a specific occupation or any occupation. While New York Life may first notify you of a disability denial via telephone, the basis for New York Life’s denial is required by The Law to be included in their denial letter and the documents supporting the disability denial must be contained in the claim file. In your New York Life denial letter, New York Life gives you the right to request a complete copy of your claim file and that is the first step we take.

Why is New York Life Required To Send You All Information Used To Deny Your Disability Claim?

ERISA regulations require New York Life to prepare and send your claim file within 30 days of a written request. We draft a very specific request for the claim file so that New York Life cannot hide any documents or information that we think can help to win your appeal. The claim file is supposed to include all information relied upon to deny your disability benefits, which would include medical records, financial records, internal emails, memos and notes, your disability plan documents, video surveillance and any medical reviews and vocational reviews conducted by New York Life. 

The New York Life claim files provided are often intentionally disorganized and require legal experience in order to know what information in the claim file is relevant to preparing a strong a Appeal. Your claim file may contain thousands of pages of evidence, and once we receive your file, we immediately organize and analyze all information so that we can prepare a plan of attack that puts You in the best position to have Your short term or long term disability benefits reinstated.

There is only one chance to submit a New York Life appeal and it must be drafted strategically.

How Does A Plan of Attack Help You Win a New York Life Disability Appeal?

After our lawyers complete a full review of your New York Life claim file and review all of your up to date medical records, we formulate a plan of attack that we believe must be followed in preparation of your New York Life appeal. Every plan is focused on determining what additional medical documentation and support we can obtain to prove your disability. You only have 180 days from your date of the benefit denial to submit an appeal so it’s important to act quickly. 180 days is not a lot of time to obtain and submit as much additional medical and occupational support as possible. It’s not easy to get in quickly for doctor appointments and it takes time for doctors to complete documentation on your behalf. We work with you and your doctors to gather everything that will be needed for your Appeal. 

We Help You Prove That New York Life’s Doctors Are Wrong

New York Life will commonly deny a long term disability claim on the basis that you have insufficient medical documentation and/or support from your doctor and instead New York Life. In the video below Attorneys Gregory Dell and Rachel Alters we discuss the most common Denial Tactics:

New York Life will rely upon their own employed doctors or nurses to deny your disability claim. Regardless of what your doctors may have concluded, New York Life will almost always favor the opinions of their own doctors over yours. The way to overcome this inherent bias is to present strong medical evidence in support of disability that no reasonable person could disagree with. 

As a practical matter, Doctors don’t like dealing with insurance companies, and while they want to help you they get frustrated. Your doctors document your medical records for the purposes of treating you and not for a disability insurance company review. As a result, most doctors do not document all of your limitations and complaints for purposes of a disability claim. 

Through our experience in helping thousands of disability claimants we educate your doctors about your disability insurance policy language and work with your doctors to document your medical conditions, and your restrictions and limitations appropriately.

Obtaining strong written support from all of your treating doctors is usually the most challenging aspect of preparing a New York Life Disability Appeal.

Why Custom Attending Physician Statements Are Essential

Our job during the appeal process is to work with you and your treating doctors to obtain medical evidence that rebuts New York Life’s doctors (or hired doctors) written opinions. The attending physician statements created by New York Life and previously completed by your treating doctors are generic and intentionally designed by New York Life to offer limited support for your claim.

In every appeal we handle, we draft custom attending physician statements for completion by your doctors. Our physician statements are specific to your New York Life Long Term disability policy definition of disability and your specific medical condition(s). With every type of medical condition we know the exact information New York Life and their doctors are seeking as evidence of disability. If you have more than one condition that may impact your ability to work, and are treating with more than one physician, we will reach out to all relevant treating doctors for input.

In addition to a custom physician statement we may suggest additional diagnostic testing or medical consultations with different medical specialists if we believe it will help bolster your claim. In some appeals, we will have you undergo a Functional Capacity Exam (FCE) or an Independent Medical Exam (IME). The results of an IME or FCE are shared with your treating doctors and can provide strong support for your functional limitations based on the results. 

In some appeals, we will submit medical literature from leading medical publications which support your symptoms, limitations, and potential risks associated with your condition. New York Life is counting on you not sending in such information in support of your disability appeal, and New York Life will likely not pursue such information on their own as part of their review of your disability appeal.

New York Life/Cigna Appeal Success Story

In one of our New York Life/Cigna disability appeal cases, we represented a Registered Nurse who worked for Trinity Health Care. She had been diagnosed with multiple medical conditions to include cervical spondylosis, degenerative disc disease, and other back conditions. New York Life denied her claim, asserting that she could perform her own physically and mentally demanding occupation. In the video below Attorneys Gregory Dell and Alex Palamara discuss how we prepare an appeal resulting in Cigna/New York Life reversing the decision on appeal and approving her claim. 

Why Must Your Appeal Contain Strong Occupational Evidence?

In most New York Life disability denials, New York Life will argue that if you can sit in a chair for 6 hours a day then you should be able to work. This is obviously a ridiculous conclusion, but you must submit occupational evidence that any job requires more than just an ability to sit. New York Life’s denial letters will usually misrepresent your job duties or list other jobs they think you can perform for 40 hours a week. Depending upon the applicable definition of “disability” at the time you become disabled, it is critical to review how New York Life has determined the duties of a job they say you can perform. 

The occupational evidence that must be presented in your appeal will depend upon whether your definition of “disability” is either the inability to perform your “Own Occupation” or the inability to perform “Any Gainful Occupation”. Own Occupation and Any Gainful Occupation are defined terms in your New York Life disability policy. In most New York Life disability policies the definition of disability is Own Occupation for the first 24 months and then it switches to the more difficult definition of Any Gainful Occupation. Most New York Life disability denials happen either at the inception of a disability of a disability claim or when the definition of disability changes at the 24 month mark.

How Does New York Life Determine The Duties of an Occupation?

New York Life will rely on their own internal vocational consultant, an employee of New York Life, to determine how either your job is performed in the national economy or how any other job is performed in the national economy. This means that New York Life ignores the way you actually performed your job for your employer and randomly determines how your job is performed nationally. To rebut New York Life’s unreasonable occupational assessments, we regularly work with vocational experts in order to clearly define the duties of a specific job and the physical requirements to perform a specific job for 40 hours a week. A vocational expert will prepare a detailed report which reviews the duties of all jobs suggested by New York Life, review your medical records, review your restrictions and limitations, and explain why you are unable to perform the job duties suggested by New York Life.  

In many denial letters, New York Life will come up with jobs that are not available in your area that make these job suggestions unreasonable. With that in mind our vocational expert may perform a labor market analysis discussing the availability and salaries of specific jobs. As additional occupational evidence, we may also submit employer statements from your co-workers, your job description, a personal statement from you about a typical day at the job, industry reports, and samples of work products produced in your job. 

We provide a lot of detail in our Appeals to explain why you cannot perform the specific job duties of either your job with your employer, another employer in the same job, or any job. Depending upon your definition of disability when you are denied, we also present evidence in our Appeals that can get you approved for benefits if your definition of disability will change at the 24 month mark. We don’t want you to win an Own Occupation appeal only to be denied again because you don’t qualify under the Any Occupation definition of disability.

How Courts Review New York Life Disability Appeals

This section contains some technical legal information and we will try to make it as simple as possible. Most New York Life disability appeals are governed by a law called ERISA and you must understand ERISA laws in order to prepare and write a strategic appeal. There is only one chance to submit a New York Life appeal and it must be drafted in a manner so as to not tell New York Life everything they did wrong. Most people, including lawyers that don’t focus their legal practice on New York Life appeals, will submit appeals where they basically give New York Life a roadmap on how to review the appeal by telling New York Life everything they did wrong on the initial review. They will include unnecessary or dated case law and a detailed criticism of everything New York Life did wrong. This is not the proper way to submit an appeal and really does nothing more than guide New York Life as to how to conduct a “reasonable review” of your initial claim denial.

What Does A Reasonable Review Mean Under ERISA For A New York Life Appeal?

The “reasonable review” language is key because if your appeal is denied by New York Life and an ERISA lawsuit is filed, a judge must review the denial and apply an unfair legal standard called “abuse of discretion”. The abuse of discretion standard requires a judge to first determine if you are disabled. If the Judge concludes you are disabled, then the Judge can only reverse the benefit denial if he or she thinks the review conducted by New York Life was unreasonable. So a Judge can find that you are disabled, but New York Life’s unfavorable review of your claim was reasonable. In this scenario your denial will be upheld as the Judge must defer to the reasonable review conducted by the insurance company.

No matter how big or powerful New York Life may seem, we have recovered disability insurance benefits for more than 95% of our New York Life clients.

Why Drafting A Strategic New York Life Disability Appeal Is Crucial 

Because of the abuse of discretion standard that applies to any New York Life disability policy that contains a “discretionary clause”, we always draft a strategic appeal that focuses on your medical restrictions/limitations and how you are disabled in accordance with your disability policy’s definition of disability, rather than simply saying what New York Life did was wrong. By telling them what they did wrong, it actually helps New York Life create a record for litigation that could be perceived as more reasonable. There are a few states where the discretionary clause is illegal and the judge’s decision on the claim will be final regardless of the reasonableness of New York Life’s appeal review.

Regardless of the standard of review that will apply to your New York Life disability appeal denial, our lawyers have a very specific style of organizing, preparing and drafting New York Life disability appeals letters which have helped thousands of disability claimants nationwide to receive their disability insurance benefits.

Let’s Discuss Your New York Life Disability Denial

When we review your claim we will give you an immediate and honest opinion about your chances of recovering disability insurance benefits from New York Life. Don’t let New York Life or anyone else convince you to handle your Appeal without legal help as you are about to go to battle against a company that generates billions of dollars a year in revenue. To help you learn as much as possible about New York Life and the ERISA Appeal process we encourage you to review all of the helpful information listed below. We welcome you to contact any of our disability insurance lawyers for an immediate free phone consultation.