Registered Nurse With Peripheral Neuropathy Wins New York Principal Life Long-Term Disability Insurance Appeal After Denial at Five Years
Principal Life paid our client’s disability insurance benefits for five years, then cut her off days before her policy’s definition of disability changed. She spent about two decades as a registered nurse at New York-Presbyterian in New York. A pancreatic tumor and a series of cancer surgeries ended that career, and peripheral neuropathy in her hands and feet, along with multiple endocrine, spinal, and balance disorders, kept her from returning to any work.
Terminating a long-paid claim at the exact moment the definition of disability tightens is a tactic our office has confronted, and defeated, more times than we can count. Partner attorney Rachel Alters appealed, and Principal reinstated our client’s benefits in full.
How we won this appeal holds lessons for anyone whose benefits are approaching a definition change. If Principal or any other disability insurance company has denied or cut off your benefits, speak with one of our long-term disability lawyers. We represent claimants nationwide, and you pay no fee unless we recover benefits.
Table Of Contents
- 1. Why this case matters for every Principal claimant
- 2. A registered nurse sidelined by cancer surgery and its aftermath
- 3. Principal’s denial: a file review at the five-year mark
- 4. The evidence Principal never gathered, so we did
- 5. Principal’s own file told a different story
- 6. Principal reinstates benefits and refunds every premium
- 7. Facing a Principal disability insurance denial?
Why This Case Matters for Every Principal Claimant
For disability insurance claimants with peripheral neuropathy, the core problem is that numbness, weakness, and poor balance rarely look severe during a brief office visit. They look severe across an eight-hour workday. This case shows how to make an insurance company see the difference.
- The end of the own-occupation period is a predictable danger zone. After five years of payments, Principal Life Insurance Company terminated this registered nurse’s disability insurance benefits just as the policy stopped asking whether she could work as a nurse and started asking whether she could do any job at all. Nothing about her health had improved. If your policy has a similar switch approaching, start documenting your limits in any occupation now, before the insurer decides for you.
- A paper review is an opinion, not an examination. Principal’s decision rested on a physician who read records and never met our client. The answer was objective, measured testing of what she could actually do. Understanding why a paper review so often leads to a denial is the first step toward defeating one.
- Being able to sit is not the same as being able to work. Principal assumed that anyone who can sit with repositioning can hold a sedentary job. An independent vocational assessment tested that assumption against real job demands, and it failed. Vocational evidence matters most after a change in the definition of disability, when the question becomes whether any job exists that you can perform.
- Your treating physician’s opinion must be current, written, and specific. Principal’s reviewer called our client’s physician three times, heard nothing back, and filled the silence with her own conclusions. On appeal, that physician put his opinion in writing, and an opinion only carries weight when the insurer actually has it in hand.
- Keep paying your premiums while you appeal. A waiver of premium benefit excuses a policyholder from paying premiums while disabled; when Principal terminated benefits, it ended the waiver too. Keeping the policy in force protected our client’s coverage, and when the appeal succeeded, Principal refunded every premium she had paid.
A Registered Nurse Sidelined by Cancer Surgery and Its Aftermath
A physically demanding nursing career
Our client built her career in direct patient care. She held a Bachelor of Science in Nursing and worked about twenty years as a registered nurse at NewYork-Presbyterian Hospital/Columbia, putting in 37.5 hours a week. It is exactly the kind of work that makes disability insurance claims for nurses so hard for insurers to minimize at the start. Principal’s own records describe a job spent almost entirely on her feet:
- Standing, walking, and lifting for most of the day, with roughly one hour of sitting
- Lifting a cumulative 200 to 250 pounds per day
- Admitting and discharging patients, administering medication, and inserting IVs and catheters
- Ventilator care, plus lifting, transporting, and feeding patients
One surgery became many
She stopped working after a pancreatic mass left her exhausted, lightheaded, and passing out. Surgeons performed a distal pancreatectomy (removal of the tail of the pancreas) to treat a well-differentiated pancreatic neuroendocrine tumor, a growth that arises from the hormone-producing cells of the pancreas. Recovery was anything but routine. A leak around the surgical site required drains, repeated imaging, and close surveillance.
Principal approved the claim. Our client was insured under an individual disability income policy rather than an employer group plan, which matters because of how an individual disability insurance claim differs from a group claim in the rules that govern it. Over the following years, her medical record grew to include:
- Papillary thyroid carcinoma (ICD-10 C73), treated by removing the left lobe of the thyroid
- An oncocytoma, a salivary gland tumor, requiring removal of part of the right parotid gland
- Hyperparathyroidism (overactive parathyroid glands that push blood calcium too high); a surgical specialist advised against further neck surgery because of scarring from prior operations
- Osteoporosis
- Peripheral neuropathy (ICD-10 G62.9) affecting both hands and both feet
- Chronic vertigo, dizziness, and balance disturbance
- Cervical spine disease, including a C6-7 disc herniation (a disc in the lower neck pressing into the space where a nerve exits), spondylolisthesis (one vertebra slipping forward over another), scoliosis, and degenerative disc disease (breakdown of the cushions between the vertebrae)
- Pulmonary nodules (small spots on the lungs) requiring ongoing surveillance
- Chronic fatigue and persistent neck, back, and bone pain
The neuropathy at the center of the claim
Peripheral neuropathy is damage to the nerves outside the brain and spinal cord, and its most common symptoms are numbness, tingling, pain, and weakness, often starting in the hands and feet. For our client, that meant dropping objects she could not feel, struggling to grip, and waking with numbness running from her left arm down to her left foot. Her neurologist documented decreased sensation in her fingers, and her records noted difficulty with tandem gait, a heel-to-toe walking test of balance.
Her most recent surgical follow-up found no recurrence of cancer. It also recorded worsening neuropathy that was affecting her balance and mobility, and she was attending physical and occupational therapy to address it. The problem was never the tumor coming back. It was what years of disease and surgery had left behind.
Principal’s Denial: A File Review at the Five-Year Mark
Five years of own-occupation coverage, then a new question
What happens when a disability insurance policy’s own-occupation period ends? The question changes from whether you can do your job to whether you can do any job, which is why a change in the definition of disability so often triggers a denial.
Own-occupation coverage pays benefits when you cannot perform the duties of your own job; any-occupation coverage pays only if you cannot work in any job suited to your education, training, and experience. Under our client’s policy, the own-occupation phase (Principal calls it the “Your Occupation Period”) ran through a 90-day elimination period, which is the waiting period before benefits begin, plus five years of benefit payments.
After that, the policy asked a different question. Principal’s policy defines Total Disability at that stage as follows: “After the Your Occupation Period You are unable to Work in any occupation You are reasonably suited to by Your education, training and experience.” Principal did not wait to see whether our client met that standard. It decided she did not, and it sent its termination letter days before the switch took effect.
A file review by a doctor who never met her
A paper review, also called a file review, is an assessment in which an insurance company’s consulting physician evaluates a claimant’s medical records without ever examining the claimant. Principal assigned the review to Dr. Janie Hendricks, Board Certified in Internal Medicine. Dr. Hendricks called our client’s longtime treating physician three times over four days, never reached him, and completed her review anyway. Principal issued its termination letter two days later.
Dr. Hendricks concluded our client could work full time with these restrictions:
- Sit continuously, with the ability to reposition as needed
- Occasionally stand, walk, reach overhead, bend, twist, and squat
- Frequently perform fine manipulation, use a keyboard, and reach at or below the waist
- Never climb or balance
She attributed those limits to what she called “mild neuropathy” in the fingertips and leaned on a handful of observations: intact strength, normal attention, the ability to fasten buttons and zippers, and a Karnofsky Performance Status score of 80 noted by a nurse practitioner.
The Karnofsky scale is an oncology tool that rates how well a patient manages daily life with illness. A score of 80 means normal activity with effort and some signs of disease. It says nothing about whether someone can sustain a 40-hour workweek.
Principal’s termination letter, signed by disability insurance (DI) claim analyst Jana Wanty, adopted the review wholesale and concluded: “These restrictions would not limit your ability to perform a sedentary job.” Sedentary work is defined in federal regulations as work performed mostly while sitting, with only occasional walking and standing and lifting of no more than 10 pounds at a time. The same letter told our client that Principal would stop waiving her policy premiums.
No examination, no testing, no vocational analysis
An Independent Medical Examination (IME) is an in-person exam by a physician the insurer selects, used to test a claimant’s reported limitations. Principal never ordered an IME or a Functional Capacity Evaluation, the two tools designed to resolve disputes over what a claimant can physically do. It never performed a vocational analysis identifying a single job our client could hold. It simply reasoned that if Dr. Hendricks believed our client could sit, she could work. That is an assumption, not a fact.
As attorney Alters put it in the appeal, “Sedentary work is still work.” A desk job requires consistent attendance, sustained concentration, dependable use of the hands, and the ability to function predictably all day, every day. Insurers skip past these requirements over and over again. In a Sun Life case for a registered nurse with rheumatoid arthritis, the insurer even ignored its own reviewer’s finding that she could not do sedentary work, a termination we also reversed.
The Evidence Principal Never Gathered, So We Did
An appeal of a disability insurance denial is a written request asking the insurer to reconsider its decision, and it is the claimant’s opportunity to add the evidence the insurer lacked. Attorney Rachel Alters used the appeal window to build the record Principal had chosen not to build.
The appeal also closed a door Principal had already used once. Attorney Alters demanded copies of any new reviewer reports before a final decision, so our client’s physicians could respond, and offered to arrange direct conversations between Principal’s consultants and her treating providers. A second paper review would not go unanswered.
The Functional Capacity Evaluation
A Functional Capacity Evaluation (FCE) is a standardized, hands-on assessment that measures how long a person can sit, stand, and walk, how much they can lift, and how well they can use their hands over a sustained period. Our client’s FCE documented:
- Sitting tolerance of about 30 to 35 minutes at a time, and no more than a few hours total in a workday
- A need for frequent position changes because of pain
- Standing tolerance limited to short durations
- Walking limited to brief intervals because of balance instability and fatigue
- Reduced strength in the neck and upper extremities
- Impaired balance, with an antalgic (pain-guarded) and unsteady gait
- Significant limits on repetitive grasping, handling, and fingering
In practical terms, the FCE showed she cannot sustain even a desk job. She cannot sit long enough, and she cannot use her hands reliably enough, to get through a workday. Dr. Hendricks said our client could sit continuously and frequently use her hands. Measured testing showed the opposite, along with rising pain, fatigue, and declining endurance as the evaluation went on.
Her treating physician put it in writing
An Attending Physician Statement is the insurer’s form on which a treating doctor records diagnoses, restrictions, and prognosis.
Our client’s longtime treating physician, the same doctor Principal’s reviewer could not reach, reviewed the FCE and agreed with its findings. In an updated statement, he confirmed that persistent neuropathy and complications of her underlying diagnoses prevent her from working in any occupation, sedentary work included. That opinion came from years of treating her, not a single read of her file, and that is why the support of your treating physician matters so much.
An independent vocational assessment
A vocational assessment translates medical restrictions into real-world job capacity by comparing them against the demands of actual occupations. A certified rehabilitation counselor reviewed our client’s medical records, the FCE, and her work history, and concluded:
- Her sitting limits, need for position changes, reduced endurance, impaired balance, and fine motor deficits are incompatible with the core demands of sedentary work
- Unscheduled breaks and her inability to sustain activity would produce off-task time and absenteeism that no employer tolerates
- Her handling and fingering limits alone eliminate most sedentary occupations, which require frequent or constant use of the hands
- No occupation in the national economy exists that she can perform full time on a sustained basis
This pairing of an FCE with independent vocational evidence is the same combination that carried our Lincoln Financial appeal for a registered nurse whose benefits were cut when her definition of disability changed, a denial we also reversed.
Principal’s Own File Told a Different Story
New evidence was only half of the appeal. The other half turned Principal’s own records against its decision.
Principal’s earlier consultant had already found serious limits
Years earlier, Principal’s own medical consultant, Dr. Akshay Sood, confirmed that our client’s impairments had been present from the day she stopped working. Even under his most favorable reading, he restricted her to six hours a day, five days a week, with up to two additional hours of breaks to rest, nap, and stretch. As the appeal pointed out, “That is not full-time competitive work capacity.”
Her treating physician’s earlier statements were even more direct. He described her as “unable to function” and did not expect her to recover enough to return to work. Principal had all of this in its file when it terminated the claim.
No improvement, no explanation
Principal paid benefits for five years because the evidence showed our client could not work. When it terminated those benefits, it identified no improvement in her symptoms, her testing, or her function. Principal’s own phone interviews with our client, conducted in the months before the termination, recorded that she:
- Could not stand or walk for long periods
- Frequently dropped objects because of numbness in her fingers
- Was afraid to drive because of lightheadedness
- Could not vacuum because of neck pain
Her remaining activities (reading, watching television, preparing food, and attending medical appointments) were done at home, at her own pace, with rest whenever she needed it. None of that resembles a workday. An insurer that pays a claim for years and then reverses course without any evidence of improvement is not reassessing the claim. It is looking for an exit.
Social Security and the people who see her every day
The Social Security Administration awarded our client Social Security Disability Insurance (SSDI) benefits early in her claim. To qualify, a claimant must be unable to engage in any substantial gainful activity, a stricter standard than her policy’s. Principal never reconciled its decision with that finding. A Social Security disability award does not automatically bind a private disability insurance company, but it is strong evidence that an insurer ignores at its own risk.
We have used the same approach, pairing an insurer’s own consultant findings with a Social Security award, in a Reliance Standard claim for an insurance agent with peripheral neuropathy, which we also won on appeal.
The appeal closed the gap between records and real life with a personal statement from our client and letters from her niece and a close friend. They described severe dizziness, difficulty gripping and writing, the need for help with daily tasks, and a constant risk of falling.
Principal Reinstates Benefits and Refunds Every Premium
About seven weeks after attorney Alters filed the appeal, Principal reversed its decision. The approval letter offered no rebuttal of the FCE, no defense of Dr. Hendricks’ review, and no explanation at all. It stated simply that, based on the appeal, “we’ll be able to provide ongoing benefits.” Principal’s reversal included:
- A lump-sum payment of $26,589.46 covering every month since the termination
- Ongoing monthly benefits of $3,816.67, payable for roughly four more years through the end of the policy’s benefit period, as long as she remains disabled
- A refund of every premium she paid after the termination, with premiums waived going forward
This did not happen by accident. Principal did not change its mind because our client’s health changed. It changed its mind because the record no longer left it anywhere to stand.
Principal will continue to review the claim periodically, which is why current, well-documented medical support matters long after an appeal is won.
Facing a Principal Disability Insurance Denial?
Principal had every tool it needed to measure our client’s true capacity and declined to use a single one. As attorney Alters wrote in the appeal: “Principal chose not to use them. Instead, it relied on a paper review that minimized the evidence. That choice speaks volumes.”
Principal gave our client 180 days to appeal. Your deadline may be different, and every week spent waiting is a week the insurer’s version of your file goes unanswered. If Principal or any other disability insurance company has denied or terminated your benefits, contact our office for a free consultation. We represent claimants nationwide, and you pay no fee unless we recover benefits.
Since our firm was established in 1979, our disability insurance lawyers have helped tens of thousands of claimants and recovered more than $2 billion in benefits.
