Our client was forced to stop working due to a combination of disabling conditions, including essential tremor, chronic pain and neuropathy, and complications from right shoulder surgery. New York Life initially approved her long-term disability (LTD) claim and paid benefits during the 24-month “own occupation” period.
However, after that period ended, the definition of disability under her policy changed. To remain eligible for benefits, she now had to prove that she was unable to perform the duties of any occupation and unable to earn at least 60% of her pre-disability income.
Despite this clear language, New York Life misapplied the standard—conveniently omitting the 60% earnings requirement from its vocational analysis and using a Transferable Skills Analysis (TSA) form that instructed reviewers to exclude wage data unless the policy had an “or” definition. Ours did not—it had an “and.”
To make matters worse, New York Life relied on a paper review of the file by an orthopedic surgeon who claimed that our client—whose hand tremors were so severe that she could barely sign her name—could somehow work in a sedentary job. Based on this flawed review and wage-deficient TSA, the company terminated her benefits without ever giving her a chance to respond to the new evidence.
Our firm stepped in and prepared a compelling appeal. We included:
- A sworn affidavit from the client;
- A corroborating letter from her husband;
- Medical source statements from treating physicians;
- And a detailed legal argument dismantling New York Life’s misinterpretation of the policy and flawed vocational conclusions.
Less than a month after filing the appeal, New York Life reversed its denial, and our client’s benefits were fully reinstated.
Was Your Disability Claim Unfairly Denied?
Insurance companies don’t always play fair—but we know how to fight back. If your long-term disability benefits have been denied or terminated, contact the Ortiz Law Firm today for a free case evaluation. Call (888) 321-8131 or contact us online to learn how we can help you get the benefits you deserve.
