Top Reasons For New York Life Disability Denials
There are many reasons why New York Life Insurance Company may have denied your long-term disability claim. You or your legal team can review your denial letter to determine New York Lifes specific reason for denying your claim for disability benefits.
In this video, Nick Ortiz will discuss the most common reasons for a New York Life disability claim denial.
If You Become Disabled While You Are Employed
- There is a seven day waiting period for which no benefits are paid. Benefits begin on the eighth consecutive day of disability . If you have been disabled more than seven days, your employer must give you a Statement of Rights under the Disability Benefits Law within five days of learning that you are disabled .
- A “day of disability” is a day on which you were prevented from performing work because of disability and for which you have not received regular wages or remuneration. You are ineligible for disability benefits if you perform any type of work for which you receive wages or profit, even if performed at home.
What Is New York Lifes Experience With Long Term Disability Benefit Claims
New York Life insurance company became one of the largest group disability insurance companies when they purchased Cignas disability income and life insurance division in December 2019 for $6.3 billion. New York Life is not a stranger to the insurance business as they have been around since 1845 and are the largest mutual insurer in the U.S. with over $300 billion in assets under management. Prior to the purchase of Cigna, New York Life handled long term disability insurance claims but it was almost exclusively individual disability policies and not employer provided disability coverage.
Employer provided disability policies are governed by ERISA, which is a horribly unfair pro-insurance company federal law governing all employer provided benefits. New York Life had very little experience with ERISA prior to buying Cigna, but with Cigna employees joining New York Life through the merger, we anticipate that the same unreasonable claim denials that took place at Cigna will continue at New York Life.
What If An Employee Becomes Disabled While Unemployed
An employee who becomes disabled while they are unemployed may still be eligible for disability benefits. An employee may not collect unemployment benefits and disability benefits for the same period of time.
The length of time an employee has been unemployed determines who pays the disability benefits:
- If an employee has been unemployed for less than four weeks:
- Disability insurance benefits are provided by last employer’s disability insurance carrier.
- The seven day waiting period applies.
When Will My Benefits Start
Benefits may begin after you have met an elimination period a plan-defined period of time, starting with the date you are disabled from work and the number of days you must continue to be disabled until benefits may begin. Most group long-term disability plans have an elimination period of 90 days or 180 days. Under most group plans, generally the employer selects the elimination period.
When you choose disability coverage, consider how long you can manage without a paycheck. If you have significant savings, you may be willing to choose a longer elimination period. Typically, the longer the elimination period, the lower the premium.
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You Can Initiate Contact With The Claim Manager To:
Learn whether the disability claim has been approved or denied
Ask questions about the status of an employee on a disability leave
What to do while waiting for a claim decision to be made
The period of time during which a claim is being reviewed and investigated before a determination is made is called the “claim pending” stage. During this stage, there is nothing for you as the manager to do except continue weekly “check-ins” with the employee.
Process for when a disability claim is approved, but additional medical information is needed
In this case, the disability claim has been approved, but no firm return-to-work date or length of disability has been established. In many cases, the approval letter has an “approved through” date, which is the duration for which the disability has been approved. It is usually based on the employee’s medical treatment.
The “approved through” date does not necessarily mean that the employee will return to work on that date. If the disability is extended, another approval letter will be sent updating the next “approved through” date.
- The claim manager will send an approval letter to the employee with the “approved through” date.
- You should continue communication with the employee and discuss potentialRTWoptions.
- If you have any questions or status requests, you can call or email the claim manager.
Process for when a disability claim is denied
Process to appeal a disability claim denial
562-8421 7a.m. – 7p.m. CST
Group New York Life Disability Insurance Claims
If you have a New York Life disability policy that was obtained as part of a group benefits plan then your policy is likely governed by ERISA. ERISA disability claims have strict appeal procedures and deadlines. ERISA requires that you file an internal or administrative appeal if your claim for disability benefits is denied or terminated.
The time limit to appeal the denial of your long-term disability claim is very limited, usually only 180 days. Under some policies, you may have a second, voluntary appeal. If you do not file the required appeal within the required amount of time, then you will not be able to take legal action against the insurer.
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Support For The Journey Ahead
New York Life is partnering with Empathy to help you through your next steps.*
From time-saving tools to personalized care, Empathy gives beneficiaries the resources to handle the practical and emotional challenges that follow the loss of a loved one.
Personalized guidanceChecklists tailored to your specific needs give you step-by-step guidance for every challenge brought by loss. Whether its helping you understand the will or navigate the probate process, youll get the care you deserve.
Tools for copingEveryone experiences grief differently. No matter what you are going through, Empathy offers emotional support resources to get you through your hardest days.
Human supportA dedicated member of Empathys Care Team is there to help you every step of the way. They can take tasks off your hands, handle complicated paperwork, and give you tailored care and guidance.
* Empathy is not affiliated with New York Life and provides this service at no cost to you.
Additional ResourcesIf you need help understanding your role as an executor or beneficiary, finding bereavement resources, or accessing your benefits in any way, we can help guide you through the links below.
New York Life Acquired Cigna Group Insurance
New York Life Insurance Company has acquired Cigna Group Insurance, which is now known as New York Life Group Benefit Solutions. Prior to this merger, New York Life focused primarily on individual disability insurance, but now they are one of the largest carriers of group disability insurance.
We are already receiving correspondence from New York Life Group Benefit Solutions on behalf of our clients, which states that we should not notice any changes other than the new company name, which will appear in place of Cigna Group Insurance moving forward.
Contact information for existing claims, such as phone numbers and mycigna.com remain the same at this time .
New York Life Insurance Companys acquisition of Cigna Group Insurance will not impact our ability to help policyholders with their long-term disability claims. We have experience representing both New York Life and Cigna Group Insurance policyholders, and we will put that experience to use representing New York Life Group Benefit Solutions policyholders as well. Call us today for a free disability claim consultation with an experienced disability lawyer.
Your Disability Benefits Have Been Denied Or Terminated By Cigna/new York Life What Can You Do The Erisa Law Center Can Help You
Most disability benefit claims are governed by ERISA. Some disability benefit claims, those based on government plans and some church plans, are not governed by ERISA. Either way, the ERISA Law Center can help you. We regularly represent persons who have been denied both and ERISA and non-ERISA disability benefits by Life Insurance Company of North America/New York LIfe.
Disability benefit claims denied by Life Insurance Company of North America/New York Life often follow a common pattern. Sometimes Life Insurance Company of North America/New York Life denies disability benefits because you or your doctors did not complete and submit to Life Insurance Company of North America/New York Life forms or medical records it requested. You can often fix that problem yourself by completing the forms, seeing your doctor, and getting your doctor to complete forms, and provide medical records.
Often Life Insurance Company of North America/New York Life will deny or terminate disability benefits during the own occupation definition of disabled not because it claims you can do your own job but because Life Insurance Company of North America/New York Life claims you can do a similar job. Most Life Insurance Company of North America/New York Life policies define your occupation not as what you actually do for your employer but what people doing similar jobs generally.
New York Life Says I Need To Apply For Social Security Disability Benefits
It is not unusual for a disability insurance company to require disabled individuals to file a claim for SSDI benefits. Under the terms of most insurance policies, the insurer can reduce the amount they pay you each month by the amount of the SSDI benefits you receive.
If your claim is denied, you will be encouraged to proceed with the appeal process. The SSA does not pay any short-term disability benefits, so for your claim to be successful you must prove that your medical conditions will prevent you from working for a period of 12 continuous months.
We also handle disability claims with the Social Security Administration . If New York Life is requesting that you file for SSDI benefits then we can assist you with that claim as well. Much of the medical evidence used to support your disability insurance claim can also be used to support a claim with the SSA, so it often makes sense to hire one disability attorney that can handle both claims.
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What If I Need To File A Claim
You may need written proof of your disability from your treatment provider to be approved for a claim. You may also need to provide additional medical records concerning the details of your disability. Your insurer may also want you examined at their cost and/or may require financial information from you. Please see your companys benefits administrator for details.
MetLife offers various ways to submit your claim based on your plan, including online, mail, phone, and fax options. Plus, you can count on MetLife to provide caring, compassionate, and accurate claims service if and when you experience a disability.
Get A Free Consultation With A New York Life Disability Lawyer
Ortiz Law Firm specializes in disability claims with insurance carriers like New York Life and helping the disabled receive the pay they deserve. If your disability case has been denied by New York Life, the attorneys at our firm can help. We will review your claim to determine your next step in the process, and we will not rest until we have recovered the disability insurance benefits you deserve.
Let us help you get your claim approved. Call our office today at or fill out our contact form to request a free consultation with a New York Life disability lawyer. We will evaluate the specific details of your New York Life disability insurance claim and the disability law that applies to your situation to determine how a disability attorney at our firm can help you get the disability benefits you deserve.
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What To Do If New York Life Insurance Delays Your Disability Claim
If you feel as though your disability claim is being delayed, you should first reach out to the insurance company to try and get a status update. Your employer should be able to help you get in touch with the company or you can call the customer service line to speak to a representative. If you feel as though you arent getting any answers regarding the status of your claim, you may want to consider speaking to an experienced disability lawyer to help move the process along. Our experienced lawyers at Osterhout Berger Disability Law have dealt with many insurance companies regarding disability claims and spot the tactics these companies use to delay paying benefits. Your lawyer can work on your behalf to try to get your benefits paid to you in a timely manner.
Individual New York Life Disability Insurance Claims
Individual disability policies and government employee disability policies are not governed by ERISA. If you have an individual policy or are a government employee and your long-term disability insurance claim has been denied or cut off, you may not have to file an administrative appeal to enforce your rights.
In fact, you may be able to skip the appeal process altogether and proceed directly to filing a lawsuit against New York Life Insurance Company. You should consult with an experienced disability lawyer to determine your legal rights and the best way to obtain your long-term disability benefits.
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If You Become Disabled While You Are Unemployed
- If you have been unemployed for less than four weeks
- your disability benefits are provided by your last employer’s disability benefits insurance carrier, and
- the seven-day waiting period applies.
First Steps In Starting A New York Life Disability Claim
CESAR GAVIDIA: Well, look, I could tell you that, as soon as I hear something in terms of Im on claim with New York Life, my first question is going to be, well, how long has that been? Because I could tell you, particularly with group disability policies, they could be in the first 24 months of payments, and you could see a shift from own occupation to any occupation happening, you know, very, very soon. And a review going on at the claim handling level where theyre trying to assess now whether you meet this totally different standard compared to what you basically have to have been meeting for the past 20 something months in order to continue qualifying.
So thats going to be one of my first questions is, where are you in terms of your benefit payments? And what kind of activity has there been? Have they been asking you anything about your medical treatment? Have they said theyre pulling your medical records? Or are they saying theyre having any trouble pulling medical records for you?
Another thing is are they asking you certain specific questions because that could be keying into whether theyve done any certain surveillance on you. And maybe been watching you, watching your activities to see if maybe youre engaged in something that isnt exactly consistent with what youve been reporting to them.
GREGORY DELL: Well, theres not going to be a shift unless they change some management. But basically, theyre keeping all of the same people as far as weve seen.
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Appealing A Denial Of Disability Benefits From New York Life Insurance
Disability insurance from New York Life Insurance can help to protect your finances if you are ever disabled and unable to work. If you have become disabled and have submitted your claim, you might be disheartened if the company denies it. The experienced team of lawyers at Osterhout Berger Disability Law is proud to help people with appealing their denials from New York Life Insurance.
In This Article
Appealing A Denial From New York Life Insurance
When you come in to speak with the experienced disability team at Osterhout Berger Disability Law, the attorneys will want to see your file and your letter. After they review the information, they will then determine the best strategy to use for your appeal. You should listen to your lawyer and follow his or her advice. Everything that your attorney will recommend to you will be meant to help your appeal.
If you are forced to file a lawsuit, you will only be able to use the evidence that is contained in your claim file. Your lawyer will want you to help to add as much additional evidence to your file as possible that is favorable to you. He or she may recommend that you keep all of your medical appointments, submit to more medical tests and exams and get written statements from your doctor and others about the functional limitations that your condition causes.
Throughout your claim and appeal, it is vital for you to be honest at all times. Some people mistakenly believe that if they exaggerate their symptoms, they will help their claims. Companies like New York Life are practiced with uncovering evidence of deception. If you are dishonest, the company may use it as evidence of malingering. It is much more difficult to win your appeal if you are believed to be a malingerer. To learn more about the options that you have, contact the experienced disability lawyers at Osterhout Berger Disability Law today.
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