A 61-year-old former general manager for Chuck E. Cheese’s life was turned upside down when he suffered a serious stroke. The stroke left him with right-sided weakness (hemiparesis), clumsiness, sensory loss, balance problems, memory issues, near-syncopal episodes, and fatigue. These impairments made it impossible for him to continue working.
At first, New York Life acknowledged the severity of his condition and approved his long-term disability (LTD) claim. However, after some time, the insurance company terminated his benefits. They based their decision on a “peer review” conducted by a doctor hired by the insurance company who never met or examined our client in person. Based solely on the medical records, the peer review doctor claimed that our client could return to work in a sedentary role.
That’s when our client turned to the Ortiz Law Firm for help.
We prepared a detailed appeal, pointing out that New York Life had focused on only one aspect of the claim – the physical demands of a sedentary occupation. However, that was only one piece of the puzzle.
Our client was dealing with more than just physical symptoms; he had cognitive impairments, balance issues, and fatigue that impacted his ability to function consistently in any job. We argued that the insurance company had failed to assess the claim as a whole, and that it ignored the combined effects of his physical and mental limitations.
We also challenged the fairness of the peer review process itself. The insurer’s doctor dismissed the opinions of our client’s treating physicians without providing a meaningful explanation. Despite clear medical documentation, New York Life refused to acknowledge the severity of our client’s condition.
Ultimately, our appeal was successful!
New York Life overturned the denial and reinstated benefits, ensuring that our client could continue to receive the financial support he had earned.
Don’t Let the Insurance Company Have the Final Word
If your long-term disability claim has been denied or terminated unfairly, know that you’re not alone. You also don’t have to accept the insurance company’s decision. At Ortiz Law Firm, we represent clients nationwide in disability appeals and lawsuits. We know how to hold insurance companies accountable and fight back when they wrongly deny claims. Call us today at (888) 321-8131 for a free case evaluation. Let us help you get the benefits you deserve.
