New York Life Insurance Company is one of the largest long-term disability insurance providers in the country, with roughly $1.5 billion in in-force premiums. That includes premiums from 9 million or so customers they added to their list in 2021 after purchasing Cigna’s group life and disability business.
If you’ve recently had a long-term disability claim denied by New York Life (or its underwriter Life Insurance Company of America, formerly part of Cigna), hope is not lost—but you will need to act quickly. Almost all group long-term disability policies have very strict deadlines and procedures if you wish to appeal. Missing a deadline or forgetting to include all the evidence in your administrative appeal could permanently bar you from the disability benefits you deserve.
We don’t want that to happen to you. The best thing you can do, right now, is speak with an experienced long-term disability lawyer. You are not alone. An experienced lawyer can provide the best chance at successfully appealing and obtaining your denied disability benefits.
Breaking Down the New York Life Disability Appeal Process
Determine Whether Your Plan Is Governed by ERISA
For most of this article, we’ll assume you have a group long-term disability insurance policy governed by a federal law known as ERISA.
How do you know if you have an ERISA plan? If you get your long-term disability insurance through your employer, and your employer is not either a religious or government entity, you have an ERISA plan.
On the other hand, if you purchased individual disability insurance directly from New York Life (for example, if you are self-employed or purchased supplemental coverage on top of your employer-sponsored coverage), your long-term disability insurance is not subject to ERISA regulation.
We will discuss appealing non-ERISA claims later in this blog. For now, let’s look specifically at appealing a New York Life group benefit denial.
RELATED: ERISA Governed Benefits – Bryant Legal Group (bryantlg.com)
Review Your Claim Denial Letter
When New York Life Insurance denies an ERISA claim, they are required to provide policyholders with a detailed claim denial letter. This letter should clearly state:
· Their reason for denying the claim. Common reasons include insufficient medical evidence, your condition not being covered by the policy, or not meeting the policy’s definition of disability.
· Appeal procedures and deadlines. In most ERISA cases, you have 180 days to appeal your claim denial. It’s important to start quickly to help make sure your long-term disability appeal is as bulletproof as possible (for reasons we’ll explain in a minute).
Contact a Long-Term Disability Lawyer
We strongly urge you to contact an attorney right away to review your claim denial letter and evaluate whether you have a good case for a disability appeal.
The denial letter and other communication from New York Life might make the disability appeals process seem simple and straightforward—just write a letter and tell them why you disagree. However, this is not the case.
ERISA appeals limit both the amount of appeal time and your opportunities to add evidence to your claims file. You might only get one shot at gathering and presenting the evidence you need. An attorney will help ensure you don’t miss any critical deadlines and that your disability appeal is as strong and thorough as possible before you file it.
Gather Evidence
Request a copy of your claim file from New York Life if it hasn’t already been provided to you. This should include all the records, evidence, and information they have regarding your case.
Ask yourself: what’s missing from this picture? Gather and organize as much relevant additional evidence as you can to support your disability determination. This might include:
· Additional medical records supporting your diagnosis, severity of your symptoms, related restrictions and limitations, and side effects of medications or other treatments
· Medical opinions and letters of support from your medical team
· Functional evaluations supporting your physical and/or cognitive limitations
· Vocational evaluations that assess your earning capacity and ability to perform job duties
· Personal testimony from colleagues and acquaintances
· Photos and videos
· Journal entries about your daily experiences
Again, we urge you to work with an attorney on this process. An experienced long-term disability lawyer will know what kind of evidence you need to obtain—including items you might not have thought of on your own.
File Your Appeal with New York Life
Once you’ve assembled all the evidence you need, you must submit it to New York Life. Your submissions should be accompanied by an appeal letter that provides a concise summary of the new evidence, the specific rulings you’re contesting, and a persuasive argument for why your benefits should be approved.
Understand that a few paragraphs in an online form will not nearly be enough to change the insurance company’s mind. A qualified ERISA attorney who knows the law and has experience working with New York Life directly will be invaluable for most claimants.
And again, we can’t stress this enough: this single administrative appeal will be your last and only chance to add evidence to your claim file. No new records can be added, even if your case ends up in court. The court can only review the evidence you add during the administrative appeals process.
Wait For a Response
Under ERISA, New York Life has 45 days to either approve or deny your appeal after they receive it—under normal circumstances, that is. The true wait can be as long as 90 days, since ERISA allows New York Life to request a 45-day extension if there is “good cause.”
Hopefully, New York Life will reverse its decision. But if it does not, you will have the option of filing a lawsuit.
