Living with chronic illness is hard enough, but it is even more stressful when disability benefits are taken away. That’s what happened to one of our clients, who hasn’t been able to work because of several mental and physical health conditions. What started as a hopeful application for LTD benefits turned into a difficult fight, and we are proud to have helped our client win.
New York Life Insurance Company (the parent company of Life Insurance Company of North America) initially approved our client’s LTD benefits based on their mental health diagnoses. The expectation was that this support would allow them to focus on their health and recovery. But that support was short lived.
New York Life later claimed that a medical file review showed no severe psychiatric symptoms that would justify continued disability. This decision ignored the medical opinions of our client’s treating doctors and the clear reality of their conditions. Based on this flawed review, NYL closed the claim.
Peer review reports like this are a common tactic used by LTD insurers to deny or terminate claims. These doctors are hired by the insurance company to review medical records without ever seeing the patient. Unfortunately, they often favor the insurer and minimize or ignore critical evidence. In our client’s case, the peer review failed to reflect the severity of their daily limitations and ongoing struggles.
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This denial was a serious setback. Our client’s medical records clearly showed how their conditions affected every part of their life. PTSD, depression, and anxiety disrupted their ability to focus, communicate, and interact with others. Chronic pain and fatigue made even simple tasks overwhelming. They couldn’t manage a regular work schedule, let alone handle the demands of a job.
The claimant reached out to us, and we immediately got to work preparing an administrative appeal. We reviewed their entire claim file, gathered updated medical records, and prepared a detailed appeal package. We challenged the peer review and made sure New York Life saw the full picture of our client’s condition.
Thanks to our efforts, New York Life reversed its decision and reinstated our client’s benefits. This victory gave our client much needed financial stability. If your LTD claim has been denied, especially after a questionable peer review, we’re here to help. Call the Ortiz Law Firm today at (888) 321-8131 to find out how we can fight for you.
