Hi, I'm Nick Ortiz. I'm a board certified disability insurance attorney. Today I'm here to talk to you about New York Life Insurance Company and the top reasons why New York Life denies long-term disability claims. Please note that these are not presented in any particular order of importance.
Number one, New York Life says that there are insufficient medical records. For example, they may have requested your medical records from your doctors and your doctors did not provide the medical records to the insurance company.
Number two, New York Life may argue that there is insufficient objective medical evidence. The type of evidence the insurance company is looking for includes: X-rays, MRI's, CT scans, and the like.
Number three, New York Life may argue that your medical condition is, "Non-verifiable," or based primarily on self-reported symptoms.
Number four, your doctors did not return forms or questionnaires, also known as attending physician statements, to the insurance company.
Number five, New York Life may have hired a peer review physician, and that doctor issues a report that does not agree with the reports of your doctors.
Number six, New York Life may be arguing that you are exaggerating your symptoms based on the evidence that it sees.
Number seven, New York Life may hire a private investigator to conduct covert video surveillance, and the footage from that surveillance is inconsistent with your limitations.
Number eight, you better believe that New York Life is following your social media presence. For example, they may be tracking you on Facebook, Twitter, Instagram, LinkedIn, and the like, and they're going to argue that your postings show that your limitations aren't as severe as you're alleging.
Number nine, missed deadlines. You have certain time limits to file things like your initial application, your proof of loss, and your appeal, and if you do not file those within the required time limits then you may be denied benefits.
Number 10, the preexisting condition exclusion, wherein you're denied because your condition was already preexisting to your coverage.
Number 11, a specifically excluded condition. Your disability may be specifically excluded as a condition that qualifies for benefits under the plan or policy.
Number 12, you have not established that you meet or satisfy the definition of disability under the plan or policy.
Number 13, change in the definition of the term, "Disability." For example, from own occupation to any occupation.
Number 14, you may be partially disabled, but not totally disabled under the long-term disability plan or policy.
Number 15, you are not working due to your own choice and not due to your medical impairment.
And finally, number 16, ERISA. ERISA is the law that applies to most group plan policies, and ERISA very heavily favors insurance companies.
If you've been denied due to one or a combination of these reasons, then we encourage you to give our office a call. We have experience in handling all of these reasons why insurance companies like New York Life denies claims. You can call our office at 850-308-7833 for a free phone consultation.
Or, if you want to download additional written information, I wrote a book called The Top Ten Mistakes That Will Destroy Your Long-Term Disability Claim. You can claim a free copy of that book at www.FreeLTDBook.com. Thanks for listening.