New York Life Disability Denials

What to Do If Your Benefits Were Denied or Terminated

Disability insurance benefits are meant to replace lost income when an illness or injury prevents you from working. New York Life Insurance Company offers both individual disability insurance policies and group long-term disability (LTD) plans through employers. New York Life also administers many group disability claims under the name New York Life Group Benefit Solutions (NYL GBS), which was formerly Cigna’s group disability and life insurance division.

Unfortunately, many legitimate New York Life disability claims are delayed, denied, or terminated prematurely. If your New York Life disability claim has been denied, understanding why the decision was made—and what steps to take next—is critical to protecting your right to benefits.

Why New York Life Denies Disability Claims

Most New York Life denials follow predictable patterns. Understanding the stated reason for denial is the first step toward challenging it.

Top Reasons for New York Life Disability Claim Denials

Reasons for denial may include, but are not limited to:

• Insufficient medical documentation
• Alleged lack of objective medical evidence
• Self-reported or non-verifiable conditions
• Treating physicians failing to return forms
• Disagreement from a peer review physician
• Allegations of exaggerated symptoms
• Video surveillance or social media activity
• Missed claim or appeal deadlines
• Pre-existing condition exclusions
• Policy-specific exclusions
• Failure to meet the policy’s definition of disability
• Changes in the definition of disability
• Findings of partial disability

Many of these reasons are tied directly to policy language that insurers rely on—often aggressively and sometimes improperly.

Policy Provisions New York Life Commonly Uses to Deny Claims

You Do Not Meet the Definition of Disability

New York Life may deny benefits if it determines you do not meet the policy’s definition of disability. For example, a New York Life policy may define disability as follows:

“Covered Total Disability – A Covered Total Disability is an incapacity from the following which an Insured Person suffers while he or she is insured under the Policy:

1. an Illness, but only if such incapacity completely and continuously prevents the Insured Person from doing the material and substantial duties of his or her occupation, provided he or she is not engaged in any occupation for pay or profit; and

2. an organ donation by an Insured Person, if he or she has been continuously insured under the Policy for at least 6 consecutive months on the day of such donation.”

Insurers often interpret these definitions narrowly, focusing on whether they believe you can perform any work-related activity rather than whether you can sustain full-time employment in your own occupation.

Denials Based on Alleged Pre-Existing Condition

Most New York Life policies contain pre-existing condition limitations. These provisions are frequently used to deny claims even when symptoms worsen well after coverage begins.

Here is an example from a recent New York Life policy:

“Preexisting Condition means an Illness or any condition related to such Illness for which a person consults a doctor, receives medical services or supplies or takes any medication during the 12 month period immediately before the Insured Person’s Certificate Effective Date, if such Illness or condition is not fully disclosed when a request for initial insurance is made under the Policy.”

Insurers often stretch these limitations beyond their intended scope. If your claim was denied based on a pre-existing condition, legal review is critical to determine whether the limitation was properly applied.

“You Haven’t Met the Standard of Proof”

Another common denial tactic is claiming that the evidence does not sufficiently prove that your disability prevents you from performing the duties of your occupation—or, in some cases, any job at all.

If the documentation submitted does not convincingly demonstrate how your medical condition impacts your ability to work, New York Life may argue that medical records fail to show how your condition prevents you from working.

This is why successful claims often require more than basic medical records. Detailed physician opinions, functional capacity assessments, and vocational evidence are frequently necessary to link medical impairments to real-world work limitations.

Mental Health and Chemical Dependency Limitations

Many policies limit benefits for disabilities related to mental disorders or chemical dependency, often to 24 or 36 months.

Here is an example from a New York Life policy:

“The Maximum Benefit Period for all Covered Disabilities of an Insured Person which are due to or related to Mental Disorders and/or Chemical Dependency while such person is insured under the Policy, whether insurance has been continuous or interrupted, cannot exceed the lesser of: (a) 36 months; or (b) the Maximum Benefit Period for a Covered Total Disability.”

Insurers sometimes apply these limitations even when physical conditions are the primary cause of disability. When mental health limitations are misapplied, benefits may be wrongfully terminated.

How the New York Life Disability Claim Process Works

Understanding how the claim process works—and where insurers look for weaknesses—can help prevent unnecessary delays or denials.

Filing a Disability Claim with New York Life

Disability claims require multiple forms, including claimant statements, employer statements, and attending physician statements. All sections must be completed accurately and thoroughly. Missing or vague information often leads to delays or denials.

How Pending Medical Procedures Can Affect Your Claim

If surgery or treatment is recommended but not yet completed, New York Life may delay or deny benefits by arguing your condition could improve.

It is important to document how your symptoms currently affect your ability to work, regardless of future treatment plans. Physician statements explaining why treatment is pending and how limitations exist now can help protect your claim.

Why New York Life May Delay a Decision

Delays are common. Insurers may request repeated updates, additional forms, or clarification from physicians. While some delays are procedural, others are strategic.

If delays persist, seeking legal assistance may help move the process forward and prevent missed deadlines.

What to Do After a New York Life Disability Denial

A denial letter is not the end of your claim—but what you do next is critical.

After receiving a denial, you should:

• Review the denial letter carefully
• Request a complete copy of your claim file
• Obtain a copy of your disability insurance policy
• Identify and calendar all appeal deadlines

The claim file contains the evidence New York Life relied on, including medical reviews and internal notes. Reviewing it is essential to building an effective appeal.

RELATED POST: What Evidence Can Help Overturn a Denial from New York Life?

Appealing a New York Life Claim Denial

The appeal process depends on whether your policy is governed by federal ERISA law or state insurance law.

Group Disability Policies (ERISA Claims)

Most employer-sponsored New York Life disability plans are governed by ERISA. ERISA requires claimants to complete the administrative appeal process before filing a lawsuit.

You typically have 180 days to file an appeal. Failing to submit a complete appeal within this deadline may permanently bar your claim.

Individual Disability Policies (Non-ERISA Claims)

Individual disability policies are not governed by ERISA. In some cases, claimants may be able to proceed directly to litigation. However, filing an appeal is often still beneficial and should be evaluated carefully.

What If New York Life Requires You to Apply for Social Security Disability Benefits?

It is not uncommon for long-term disability insurance companies, including New York Life, to require claimants to apply for Social Security Disability Insurance (SSDI) benefits. Most disability policies allow the insurer to reduce the amount it pays each month by any SSDI benefits you receive, which is why insurers often insist on an SSDI application.

If New York Life requires you to apply for SSDI, this does not mean your long-term disability claim is weak. In many cases, much of the same medical evidence used to support your New York Life disability claim can also support an SSDI application. Coordinating both claims properly is important, as inconsistent information or unsupported statements can create problems later.

In some situations, it makes sense to work with one attorney who understands how long-term disability claims and SSDI claims interact, helping ensure both claims are handled consistently and strategically.

Why Insurance Companies Hope You’ll Walk Away

The appeals process is complex by design. Short deadlines, dense paperwork, and repeated evidence requests discourage many claimants from continuing.

Insurance companies know that the longer the process drags on, the more likely claimants are to give up—saving the insurer money.

FREE RESOURCE: Whether you have a group or individual policy, we encourage you to check out our free step-by-step guide to appealing a disability insurance claim denial for appeal templates and residual functional capacity forms.

Who Is Actually Handling Your Claim?

New York Life, NYL Group Benefit Solutions, Cigna, and LINA Explained

Many claimants are confused by the names appearing on their policy or denial letter.

New York Life Group Benefit Solutions (NYL GBS) administers many group disability claims. This division was formerly part of Cigna, and many claims still reference Cigna or LINA.

As a result:

• Your policy may have originated with Cigna or LINA
• Your claim may now be handled by NYL GBS
• The same claim-handling practices often continue

Regardless of branding, these claims are typically governed by ERISA, and the same appeal strategies apply.

Who Handles Old New York Life Individual Disability Policies?

If you have an older individual disability insurance policy that was originally issued by New York Life, you might be wondering who manages these claims today. In 2000, New York Life transferred this block of business to Unum Group through a reinsurance agreement. That means any claims filed on those legacy individual disability policies are now administered and handled by Unum Group, not New York Life.

How an Experienced New York Life Disability Lawyer Can Help

Successfully challenging a New York Life disability denial requires strategy, evidence, and timing.

An experienced disability attorney can help by:

• Gathering medical and vocational evidence
• Responding to peer reviews and IMEs
• Preparing ERISA-compliant appeals
• Protecting your rights at every stage

A single mistake early in the process can permanently damage a claim.

Real New York Life Disability Claim Results

We have successfully handled numerous New York Life and NYL GBS disability claims, including:

• Claims approved despite independent medical examinations
• Terminated “any occupation” claims reinstated
• Denials overturned after peer review disputes

Names are withheld to protect client privacy.

What Happens If Your Claim Is Approved?

Even after approval, New York Life may continue to monitor your claim. Requests for updated medical records or new forms are common, and benefits may still be terminated later.

We continue representing clients after approval to help protect ongoing benefits.

Request a Free Case Evaluation with a New York Life Disability Lawyer

If your New York Life disability claim was denied, delayed, or terminated, you do not have to face the insurance company alone.

We offer a free consultation to review your claim, explain your rights, and help you determine the best path forward.

Call (888) 321-8131 or request your free case evaluation today.