New York Life Overturns Denial of LTD Benefits to Computer Systems Engineer after Appeal and Independent Medical Examination
Our client was previously employed as a Computer Systems Engineer. In this occupation, he was responsible for support and maintenance of a real-time system that allows pipeline controllers to monitor pipelines across the United States. Unfortunately for him, he was suffering from Lumbar Discogenic and Facetogenic Pain, Lumbar Radiculopathy, Cervical Spine Pain Status Post Fusion, and Piriformis Syndrome, and required narcotic pain medication. Due to his various conditions, he was unable to continue to work and he therefore filed a claim for LTD benefits under a policy he was covered under by way of his employment. Unfortunately, his claim was denied by New York Life who found that he simply did not meet the definition of disability.
In addition to his physical conditions, the claimant was also suffering from severe cognitive deficits as a result of the narcotic pain medication he needed to control his constant and severe pain. Additionally, he was scheduled for an additional back surgery, and as a result, he was unable to return to any type of full time employment. Although his claim was denied, he knew he couldn’t work and he knew New York Life’s conclusion was wrong. As such, he decided challenge this denial by filing an appeal on his own appeal. The claimant provided New York Life with additional medical records and argued his denial should be overturned because the narcotic pain medication caused cognitive deficits. Unfortunately, his appeal was denied.
In denying the appeal, New York Life once again denied LTD benefits despite a finding by New York Life that he was eligible for Waiver of Premium benefits on a life insurance policy based on the same disability. Neither New York Life nor its claim file reviewers provided a reasonable rationale for its contradictory conclusions regarding the claimant’s disability. New York Life also failed to perform a Functional Capacity Examination (FCE) or Independent Medical Examination (IME) to obtain a true assessment of the claimant’s residual functional capacity, even though the policy governing his claim allowed New York Life to have such an examination conducted.
Upset his appeal was denied and still unable to work, the claimant decided he needed assistance with his claim and found Attorney Alexander Palamara of Dell Disability Lawyers.
Appeal by Attorney Palamara
After reviewing the denial letters, speaking with the claimant, and reviewing the claimant’s appeal, it was clear to Attorney Palamara that New York Life’s denial was improper and that his now client was unable to work. The claim file from New York Life was ordered along with our now clients past and current medical records. Those documents were reviewed to develop a full understanding of his illness, claim, policy, and New York Life’s handling of his claim. After compiling and reviewing all the necessary information, it was clearer than ever that his benefits should be approved.
A detailed review of the claim file revealed New York Life found the claimant disabled under its waiver of premium provision for the Life Insurance Policy, but there was no rationale for its contradictory conclusions regarding his disability under the LTD policy. The review also revealed that New York Life failed to perform a thorough review of Mr. Dehart’s medical records and failed to have a medical doctor of the appropriate specialty perform an examination. Instead, New York Life relied on an inadequate and incomplete paper review and a flawed vocational analysis.
An appeal was drafted and timely filed. The appeal focused on the objective medical evidence in support of his claim, highlighting individual records that contradicted specific allegations by New York Life in its denial. Also included were physician statements that the claimant was limited from prolonged sitting, standing, walking and records showing that his necessary medications affected his cognition, memory and decision making skills. The appeal also highlighted the inconsistencies in the opinion of New York Life finding the claimant disabled and eligible for waiver of premium benefits, but not disabled for LTD benefits, and the failure of New York Life to perform an IME in light of conflicting findings between the claimant’s treatment providers.
Claim Approval
After filing the appeal and providing New York Life with ongoing, updated medical records, New York Life noticed the claimant for an Independent Medical Examination (“IME”). The IME was coordinated through Attorney Palamara and took place roughly 4 months after Attorney Palamara filed the second appeal on the claimant’s behalf. One month after the IME was completed, New York Life overturned its denial. Our client’s claim was approved and all back benefits that were owed were paid in full. With the assistance and support of his treating providers and their medical records, Attorney Alexander Palamara was able to successfully argue to New York Life that our client was disabled under the terms of the policy.
Our client is relieved to be on claim and to have received all the money that he was owed. New York Life attempted to deny our client’s claim without conducting an IME and properly investigating his claim, but Attorney Alexander Palamara was successful by providing updated medical records and highlighting the legal deficiencies in New York Life’s denial. Attorney Palamara will continue to do whatever it takes to keep the former Computer Systems Engineer on claim until he is able to return to work or until his policy expires.
If you have been denied disability benefits by New York Life or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell Disability Lawyers for a free consultation.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong New York Life Appeal Package
We work with you, your doctors, and other experts to submit a very strong New York Life appeal.
Sue New York Life
We have filed thousands of disability denial lawsuits in federal Courts nationwide against New York Life.
Protect Your Benefits
Get Your New York Life Disability Application Approved
We help claimants throughout the entire application process.
Prevent a New York Life Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a New York Life Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
New York Life Reviews
(660)
Policy Holder Rating
5
0%
4
0%
3
0%
2
50%
1
48%
Timely Payments
1.9out of 5
Handling Claim
2.0out of 5
Customer Service
2.0out of 5
Dependable
1.8out of 5
Value
1.8out of 5
Showing 8 of 660 Reviews
New York Life
Lyme Disease Disability Claim Denial
I have had repeat claims for genuine medical leave and they have repeatedly been denied by NY Life. I have even been diagnosed with Lyme and going through treatments and t... read more >
New York Life
Disappointed with NY Life Disability Excuses
I am beyond disappointed with NY Life Disability Insurance’s handling of my father’s claim. My father, a 66-year-old man who has suffered two strokes and continues to ... read more >
New York Life
New York Life is a joke!
This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >
New York Life
Claiming They Are Not Receiving Paperwork
After suffering from medical issues from my delivery in February, I had to have a colostomy bag placed. Now New York Life is trying to claim my condition was pre-existing ... read more >
New York Life
Keeps claiming they will not approve claim for pre existing conditions but my illness is not preexisting
I have been appealing a claim for LTD for 8 months! New York Life keeps claiming they will not approve claim for pre existing conditions but my illness is not preexisting ... read more >
New York Life
Payment delays!
I have a Long term disability claim with New York Life. Approval process did not take too long and they did start my LTD just a few days after my STD ended. First check wa... read more >
New York Life
NYL denied my claim
I’ve been an RN for 31 years. I lost 6 family members (3 of those to cancer) in 9 months and suffered a breakdown, I just couldn’t watch people die anymore. Cigna (NYL... read more >
New York Life
Hold up on payments!!!
I have had 3 people on my case since July 2021! This last person Amanda S drag her feet on my claims and payments. I literally have to go to my mom for help! When I contac... read more >
Answered Questions by Our Lawyers
(31)
Showing 8 of 31 Answered Questions
Q: LTD canceled their request for updated med records?
A: Most Authorizations are only good for two years so depending on when you signed it, it may no longer be valid ... Read More >
Q: Why is New York Life Insurance giving me a hard time?
A: Holly, the requirements of NYL depends on the type of policy that you are inquiring about. I would need to rev... Read More >
Q: NYL LTD also have LLC
A: LLC and LTD,If you receive active income, meaning its not considered passive investment income from the LLC ... Read More >
Q: Can I submit my resignation while on STD with NY Life? I don’t know if I’ll be able to return when they want and I would rather give a 2 weeks notice.
A: Generally we do not recommend resigning from your job while on disability to avoid any potential issues with c... Read More >
Q: New York Life LTD offset my disabled adult child.
A: Yes, we have handled cases with fact patterns similar in nature. However, as you are in litigation already we ... Read More >
Q: My father has been in STD Cigna and LTD with New York Life since Jan 2021, diagnosed Pulmonary Fibrosis due to Covid-19. Can insurance and ex job make him return to work?
A: Walt, while no one can force your father back to work, NYL can certainly deny benefits if they believe there i... Read More >
Q: Do I have to sign agreement to pay back difference in LTD payment and SSDI payment?
A: You do not need to sign the agreement to pay back SSDI. Disability companies try to make you do this and you a... Read More >
Q: Can NYLG just stop payment?
A: Moe, unfortunately long term disability insurance companies can deny benefits at anytime without notice. Conta... Read More >
Helpful Videos
(910)
Showing 12 of 910 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
How Will Sale of Cigna Disability Division to New York Life Insurance Co. Affect Disability Claimants?
On December 18, 2019 Cigna entered into an agreement to sell their disability insurance and life insurance division for $6.3 billion. This is a monster deal in the disability insurance world as Cigna was one of the top five largest disability insurance companies in the world prior to the sale. With the purchase, NY Life Insurance company will instantly go from being a small disability insurance company to o... Read More >
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >
How Do You Fight a Long-Term Disability Denial?
Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter or a ph... Read More >
Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >
Disability Denial Reason #1 – Paper Review & IME
At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories - and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
New York Life Approves Disability Benefits for School Teacher With Multiple Sclerosis
Our client, a former elementary school teacher suffering from Multiple Sclerosis, contacted our office after New York Life terminated her claim for short term disability benefits and spoke with Attorney Stephen Jessup. New York Life had initially approved her claim for short term disability benefits, but in doing so awarded benefits only on account of a mental health condition, even though our client had filed... Read More >
New York Life Sued For Failing To Make A Timely Decision on Appeal
If your disability insurance claim has ever been denied you will have received a formal denial letter from your insurance carrier in which you are advised as to the basis of the denial as well as provided guidelines set forth by ERISA as to the filing of an administrative appeal to challenge the denial of benefits. The most important of these ERISA guidelines is the notification that you have 180 days from the... Read More >
NY Life Disability Benefits Reinstated on Appeal Despite Independent Medical Examination
Our client, a former high level medical sales representative, suffered from chronic pain stemming from his neck, back and hip that would eventually result in multiple surgeries to include lumbar fusion, cervical fusion and sacroiliac joint fusion. He initially filed his claim for disability benefits at age 62 due to the increasing pain he was experiencing, which... Read More >
Project Manager with Migraines Gets NY Life Disability Benefit Denial Reversed
Disability due to migraines is very common, but many disability insurance claims deny these long term disability claims because there is no objective evidence of migraines. New York Life will commonly try to limit disability benefits to 24 months and claim that your medical condition is mental and not physical.We were able to stop that from happening in this... Read More >
New York Life Overturns a Waiver of Premium for Group Life Insurance Policy
In early 2019, the widow of a decease man contacted our firm as she was troubled by the actions of New York Life. Prior to contacting our firm, the lady’s husband had died from metastatic prostate cancer in July of 2018. Through his prior employer, the decedent was covered under two insurance policies: (1) a group long term disability insurance policy that provided monthly income replacement benefits sho... Read More >
New York Life Admits Error In Denying Disability Benefits
Our client, a former school teacher, suffering from multiple severe medical conditions including autonomic nervous system damage, small fiber neuropathy, a history of prior back surgery, and severe immune conditions had been receiving long term disability benefits through New York Life for approximately two years under his school system’s group disability policy when he first contacted our office. Like the v... Read More >
New York Life Overturned Their Denial of LTD Benefits for Nevada Healthcare Coordinator
Our client, Ms. G, formerly worked as a Healthcare Coordinator for a large regional healthcare provider. For many years Ms. G suffered from chronic debilitating effects of multiple physical conditions and ailments, including, among other conditions, Intractable Pain, Chronic Venous Insufficiency, which left her with debilitating physical and cognitive impairments. Ms. G was unwilling to give up her career and ... Read More >
New York Life Denies Technology Manager under the Own Occupation Provision & Dell Disability Lawyers Wins Appeal
Our client, Mr. N, formerly worked as a Technology Manager / Vice President for a large bank. For many years Mr. N suffered from chronic debilitating effects of multiple physical conditions and ailments, including, among other conditions, Parkinson’s Disease, Parkinson’s Dementia, Dystonia and Bradykinesia, which left him with debilitating physical and cognitive impairments. Mr. N was unwilling to give up ... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
