Denied Long-Term Disability Claims with New York Life: Why Professionals Should Seek Legal Counsel

Long-term disability (LTD) claims are a crucial lifeline for professionals who find themselves unable to work due to injury or illness. These claims provide financial support that helps individuals maintain their standard of living during extended periods of incapacity. Unfortunately, the process of filing an LTD claim—and ensuring its approval—is not always straightforward. Insurance companies, including industry giant New York Life, can deny these claims, leaving professionals in a precarious situation. When faced with such a denial, seeking legal counsel from Robinson & Warncke is not only advisable, but often essential for a favorable outcome. This article delves into why professionals should prioritize legal assistance when handling a denied LTD claim from New York Life. Our Atlanta, GA Law firm specializes in helping professionals with denied claims and provides boutique-style services to a select client base.

Understanding Long-Term Disability Claims

Long-term disability insurance is designed to replace a portion of an individual’s income if they are unable to work due to a serious medical condition. Professionals across industries—whether in finance, law, healthcare, or technology—frequently invest in LTD policies to protect their financial future. However, the process of claiming LTD benefits is notoriously complicated, with stringent documentation requirements and potential disputes over policy interpretation. Insurance companies are businesses, and as such, they have a vested interest in minimizing payouts. This can lead to claim denials, even when the policyholder’s case is valid.

Why New York Life LTD Claims Are Denied

Before exploring why legal counsel is essential in these cases, it’s important to understand why an LTD claim might be denied. Common reasons for denial by New York Life and other insurers include:

• Insufficient Medical Evidence: The insurance company may argue that the medical records provided do not sufficiently prove the disability’s severity or that the condition is not as debilitating as claimed.
• Pre-existing Conditions: If the insurer believes that the disability stems from a pre-existing condition not covered by the policy, they may deny the claim outright.
• Disputed Medical Opinions: The insurance company may dispute the diagnosis or prognosis offered by the claimant’s medical provider, relying on their own medical examiners or consultants who assert that the individual is fit to work.
• Noncompliance with Treatment: If the claimant has not followed the prescribed treatment plan or attended follow-up appointments, the insurance company could argue that the individual is not taking the necessary steps to recover, leading to a denial.
• Policy Limitations and Exclusions: Many LTD policies have intricate language outlining specific conditions, exclusions, and limitations that can be leveraged to deny a claim.

Given these challenges, professionals—especially those who are used to managing high-stakes decisions in their careers—may feel blindsided when their LTD claim is denied. This is where legal representation becomes indispensable.

New York Life, one of the largest and most established insurers in the U.S., offers a variety of LTD policies, each with its own specific terms and conditions. These policies can be dense and difficult to navigate for individuals unfamiliar with insurance law. Moreover, New York Life, like many insurers, often employs teams of lawyers and adjusters trained to interpret policies in ways that minimize payouts. The language of LTD policies is often opaque, with key terms like “disability,” “substantial gainful activity,” and “own occupation” requiring precise legal interpretation. For instance, some policies define “disability” as the inability to perform the duties of one’s own occupation, while others use a broader definition that considers whether the individual can perform any occupation. Legal counsel can help professionals understand these nuances and build a case that aligns with the policy’s language.

For professionals grappling with a denied LTD claim, the decision to engage a lawyer can mean the difference between financial hardship and securing the benefits they are rightfully entitled to. Here’s why legal counsel is essential:

1. Navigating the Appeals Process

When a long-term disability claim is denied, the claimant typically has the right to appeal. However, the appeals process is governed by strict deadlines and procedural rules that can be daunting for someone unfamiliar with them. Legal counsel can help professionals adhere to these deadlines, gather the necessary documentation, and craft a compelling appeal that addresses the insurer’s reasons for denial.

Moreover, the appeals process often involves multiple layers of review. Lawyers experienced in LTD cases understand the strategies that insurers like New York Life may use to avoid paying benefits. They can anticipate these tactics and counter them effectively, ensuring that the appeal is grounded in solid legal arguments.

2. Ensuring Proper Medical Documentation

One of the primary reasons for denied LTD claims is insufficient or incomplete medical documentation. A legal professional with expertise in disability claims knows exactly what type of medical evidence is required to substantiate the claim. This includes obtaining detailed reports from physicians, specialists, and other healthcare providers that clearly outline the nature and severity of the condition.

Additionally, lawyers can work with medical experts to ensure that the documentation provided aligns with the specific language of the insurance policy. This is critical because insurance companies often seize upon ambiguous or vague language in medical records as grounds for denial.

3. Challenging Biased Medical Examinations

It is not uncommon for insurance companies like New York Life to request that claimants undergo an independent medical examination (IME) as part of the claims process. However, these IMEs are often conducted by doctors chosen and paid for by the insurance company, raising concerns about bias. Legal counsel can scrutinize the results of an IME, challenge the objectivity of the examiner, and present alternative medical evidence that more accurately reflects the claimant’s condition.

4. Negotiating a Fair Settlement

In some cases, the insurer may offer a settlement to avoid paying full long-term disability benefits. While a settlement might seem like a quick and easy solution, it’s often far less than what the policyholder is entitled to. An experienced LTD attorney can negotiate on behalf of the professional to secure a settlement that is fair and reflective of the claimant’s actual financial needs.

5. Taking Legal Action if Necessary

If the appeal process does not yield a favorable outcome, legal counsel can take the next step by filing a lawsuit against the insurance company. This is especially important in cases where the insurer has acted in bad faith—engaging in practices like unreasonably delaying the claims process, misrepresenting policy terms, or failing to conduct a thorough investigation.

Litigation can be a complex and lengthy process, requiring a deep understanding of both insurance law and courtroom procedures. Professionals should not attempt to navigate this process on their own. A lawyer experienced in LTD claims can dramatically improve the chances of success in court.

6. Reducing Stress for the Claimant

Professionals who are dealing with a disability are often already under significant physical, emotional, and financial stress. Trying to manage a denied LTD claim on their own only adds to that burden. By engaging legal counsel, professionals can offload much of the procedural and legal work, allowing them to focus on their health and recovery while their lawyer handles the intricacies of the claim.

A denied long-term disability claim from New York Life can be a devastating blow for professionals who rely on this financial support. However, it’s important to remember that a denial is not the end of the road. With the right legal counsel, professionals can navigate the complex appeals process, gather the necessary evidence, and fight for the benefits they deserve.

Whether it’s negotiating a fair settlement, challenging biased medical examinations, or litigating the case in court, a lawyer with experience in LTD claims will have the knowledge and resources to ensure that New York Life upholds its obligations under the policy. For professionals facing a denial, seeking legal counsel is not just a wise move—it’s a critical step toward securing a more stable future. Call Jeff and Doug today to discuss your options when dealing with a denied claim from New York Life.