Getting (and keeping) long-term disability (LTD) benefits isn’t always easy. Recently, New York Life Insurance Company (the parent company of the underwriting company Life Insurance Company of North America) unfairly denied a claimant’s LTD benefits. Thankfully, we were able to turn things around on appeal.
Our client has Central Sensitization Syndrome (CSS), a serious condition that causes constant pain, brain fog, memory issues, and difficulty processing information. At first, New York Life was paying his benefits. But then they stopped and terminated the claim, saying his condition was mental and fell under a 24-month limit for mental health claims.
New York Life hired a neurologist for a peer review report to support and justify their denial. In a peer review, the insurance company pays a doctor to review medical records without ever examining the patient in person. These reports often favor the insurer and can downplay or overlook key medical issues.
In this case, the reviewer ignored important findings from the client’s own doctors. The reviewing provider claimed there were no physical impairments. This is a common tactic used by insurance companies to terminate LTD claims.
That’s when the claimant called the Ortiz Law Firm. The client strongly disagreed with New York Life’s denial, explaining that the claimant’s disability was primarily physical.
We appealed the insurer’s claim that the claimant’s condition was only mental. We provided proof of his physical and cognitive limitations to challenge the biased medical review. In the end, New York Life overturned its decision and paid our client their rightful LTD benefits.
But we didn’t stop there. We also took on his SSDI case and stood by the claimant through that separate Social Security disability claim. Mr. Ortiz represented him all the way to a hearing before an Administrative Law Judge and won, getting the claimant’s SSDI benefits approved.
This case shows just how tough these fights can be—but also how important it is to have the right team on your side. If your LTD claim has been denied, don’t give up. Call the Ortiz Law Firm today to see how we can help secure your LTD benefits.
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