How New York Life Denied a BAE Systems Engineer’s Disability Claim — And How Ortiz Law Firm Overturned It

A Manager at BAE Systems, Inc. became disabled following a traumatic brain injury that left him with seizures, migraines, and debilitating neurological impairments. Despite more than 1,000 pages of medical records supporting his claim, New York Life denied his long-term disability (LTD) benefits — relying on a paper review riddled with factual errors and selective reading of the evidence. After Ortiz Law Firm filed a comprehensive ERISA appeal, New York Life reversed its decision and approved the claim.

Who Was This Claimant, and What Conditions Prevented Him from Working?

The claimant worked as a Manager for BAE Systems, Inc., a defense and aerospace contractor. Following a traumatic brain injury (TBI), he developed a constellation of severe, overlapping conditions that made sustained full-time employment impossible.

His documented impairments included:

• Seizures
• Migraines
• Vertigo with fall risk
• Right-sided weakness
• Profound fatigue and excessive sleepiness
• Cognitive dysfunction
• Memory and concentration deficits
• Significant medication side effects

Any one of these conditions can seriously limit a person’s ability to work. Together, they paint a picture of profound disability — one that his treating physicians thoroughly documented in the medical record.

How Did New York Life Justify Denying the Claim?

New York Life denied the claim based primarily on a paper review conducted by a physician who never examined the claimant in person. That physician acknowledged the claimant’s diagnoses and abnormal findings — then concluded he had “no restrictions.” That conclusion was not supported by a legitimate analysis of the evidence.

The denial was built on two fundamentally flawed practices: cherry-picking isolated data points and ignoring the context that surrounded them.

What Errors Did New York Life’s Reviewing Physician Make?

The reviewing physician made at least one glaring factual error: he cited the claimant’s participation in sports as evidence of preserved functioning — but misstated the number of hours the claimant participated in sports. This misreading of a simple number was not a minor clerical mistake — it dramatically overstated the claimant’s activity level and was used to support a denial of benefits.

The reviewing physician also cited routine activities of daily living – such as exercise, yard work and driving – as proof that the claimant could work full time, while failing to account for the severity and unpredictability of seizures, the cognitive effects of the claimant’s TBI, or the disabling side effects of his medications.

How Did New York Life Misuse the Activities of Daily Living Form?

However, the claimant’s Activities of Daily Living form explicitly stated that activities like cooking, shopping, gardening, and household chores were performed prior to the incident — meaning before the claimant’s traumatic brain injury. Both the reviewing physician and New York Life ignored that qualifying language entirely.

Instead of reading what the form actually said, they treated those pre-injury activities as evidence that the claimant remained capable of full-time work after his injury. This was not an ambiguous interpretation — the form said “prior to the incident” in plain language. Using that information to support a denial of benefits was a misrepresentation of the claimant’s own reported limitations.

What Is a “Paper Review,” and Why Does It Matter in LTD Claims?

A paper review is when an insurance company’s physician evaluates a disability claim by reviewing medical records only — without ever examining the claimant, speaking with treating physicians, or ordering independent testing. Insurers use paper reviews because they are faster and cheaper than independent medical examinations.

The problem is that paper reviews are particularly susceptible to cherry-picking. A reviewer who never meets the claimant has no obligation to reconcile their conclusions with the claimant’s actual functional presentation. In this case, the reviewing physician acknowledged abnormal findings and confirmed the claimant’s diagnoses — but still concluded there were “no restrictions.” That outcome is difficult to defend on the merits and is precisely the kind of biased review process that ERISA appeals are designed to challenge.

What Did Ortiz Law Firm Argue in the ERISA Appeal?

After reviewing more than 1,000 pages of medical records and claim materials, Ortiz Law Firm filed a comprehensive administrative ERISA appeal on the claimant’s behalf. The appeal argued that New York Life failed to conduct the “full and fair review” required under ERISA — the federal law that governs most employer-sponsored disability plans.

Specifically, the appeal addressed:

• The reviewing physician’s misreading of the number of hours participating in sporting activites
• The improper use of pre-injury activities as evidence of post-injury capability
• The failure to account for the opinions of the claimant’s treating physicians
• The selective citation of isolated evidence while disregarding the totality of the medical record
• The documented effects of seizures, vertigo, cognitive impairment, fatigue, and medication side effects on the claimant’s ability to work

ERISA requires plan administrators to conduct a genuine, impartial review of all relevant evidence. Ignoring the qualifying language on a claimant’s own forms — and misreading documented numbers by an order of magnitude — falls far short of that standard.

What Was the Outcome of the Appeal?

Following our appeal, New York Life overturned its prior denial and approved the claim for long-term disability benefits. The claimant — a skilled manager whose career was cut short by a traumatic brain injury — received the financial protection his policy was designed to provide.

This outcome required a thorough, evidence-based appeal that confronted every flaw in the insurer’s reasoning directly and on the record.

Were You Denied Long-Term Disability Benefits After a Brain Injury or Neurological Condition?

If a disability insurer has denied your LTD claim — or approved it for a limited time and then cut off your benefits — you may have strong grounds for an appeal. Insurance companies routinely rely on paper reviews, ignore treating physician opinions, and misrepresent claimant-reported information to justify denials.

Ortiz Law Firm handles ERISA long-term disability appeals nationwide. Call us at (888) 321-8131 to discuss your claim with our team.