Why New York Life Denies Disability Claims (and How to Fight Back)

When New York Life denies long-term disability (LTD) benefits, the reasons usually fall into predictable patterns. Understanding those patterns helps you respond strategically, focusing your appeal on evidence that matters most and avoiding dead-end arguments. Below are the most common denial reasons we see, with practical ways to overcome each one.

1. “No Objective Medical Evidence”

New York Life often claims your file lacks measurable proof of impairment. Pain, fatigue, dizziness, cognitive fog, and migraine frequency are common targets.

First, review your policy to verify whether you must submit “objective” medical evidence. Some insurance companies reference such records when they may not actually be required.

Assuming such “objective” evidence is indeed required, here are some additional tips.

How to respond:

• Submit condition-specific testing: MRI for spine disorders, EMG/nerve conduction for neuropathy, CPET for exertional intolerance, or neuropsychological evaluations for cognitive issues.
• Ask your treating providers to connect medical findings to work functions—how long you can sit, stand, or concentrate, your need for breaks, and expected absences.

2. Paper Review Overrules Your Treating Doctor

Insurers often rely on in-house doctors who never examine you. These reviewers may cherry-pick normal findings or misinterpret imaging as “mild.”

How to respond:

• Submit a detailed Residual Functional Capacity (RFC) assessment that focuses on pace, reliability, and attendance—not just physical restrictions.
• Prepare a point-by-point rebuttal addressing errors, missing context, or selective citations from the reviewer’s report.

3. “You Can Perform Other Work”

Transferable skills analyses (TSAs) are a favorite tool for denial. New York Life may:

• Misclassify your job under the wrong occupational code
• Ignore your actual production requirements or quotas
• Assume full-time stamina despite medical limits
• List outdated or unrealistic “sedentary” jobs

Your best defense:
A vocational expert can expose these errors and explain why the listed jobs don’t exist or don’t fit your medical restrictions.

4. Pre-Existing Condition Exclusions

Group LTD policies often exclude disabilities tied to conditions treated or investigated during a “look-back” period before coverage.

How to counter this:

• Create a clear timeline of symptom onset, medical visits, and when the disabling condition was diagnosed.
• Have your provider explain what was being evaluated before versus what ultimately caused disability.

5. Change from “Own Occupation” to “Any Occupation”

Many policies redefine disability after 24 months:

• Own Occupation: You’re disabled if you can’t perform the duties of your regular job.
• Any Occupation: You’re disabled only if you can’t perform any job for which you’re qualified by education, training, or experience.

Even subtle differences—like “any gainful occupation” or “any occupation paying 60% of pre-disability income”—can affect eligibility.

Prepare before this change:

• Update RFCs to address stamina, reliability, and absences in any work setting.
• Use vocational evidence to show that no sustainable full-time work is possible given your limitations.

6. “Not Under Regular Care” or “Non-Compliance”

New York Life may allege you skipped appointments, declined treatment, or failed to follow medical advice.

What to do:

• Document your good-faith efforts, including side effects or legitimate reasons for declining certain treatments.
• Keep consistent appointments and ensure your chart notes reflect ongoing symptoms and limitations.

7. Mental Health or Self-Reported Symptom Limits

Policies often limit benefits for mental health conditions or those deemed “self-reported” to 24 months.

How to respond:

Clarify whether your physical condition drives your disability and how it interacts with mental health symptoms.

Provide objective anchors like neuropsychological testing, sleep studies, or standardized scales when available.

8. Inconsistencies and Surveillance

New York Life regularly reviews social media and may use short videos or photos to question your credibility.

Protect yourself:

• Make accounts private and avoid posting photos or activity updates.
• Don’t discuss your claim online or let others tag you in physical-activity posts.
• If you’re filmed in public, note how long the activity lasted and how you felt afterward.

9. Missing Records or “We Didn’t Receive It”

Files go missing, faxes fail, and portals glitch. Lost records or technical errors can derail a claim.

Best practices:

• Keep a document log noting what you sent, when, and how.
• Use delivery confirmations or upload portals with receipts.
• Always confirm the full packet has been received and scanned into your claim file.

RELATED POST: Communicating with Long-Term Disability Insurance Adjusters

10. Procedural and Timing Issues

Late submissions or incomplete forms can result in a denial before medical evidence is even reviewed.

Fix it fast:

• Submit missing forms or corrections immediately and include a short cover letter explaining any delay.
• Keep copies of all correspondence to prove timely compliance.

How to Use These Reasons in Your Appeal

Start by reviewing New York Life’s denial letter line by line. Make a two-column chart: the reason stated on the left and exact evidence you will submit on the right. Then you should:

• Request your complete claim file and policy in writing.
• Fill any “objective” gaps with targeted testing and detailed RFCs.
• Address vocational issues with updated job descriptions or a vocational report.
• Assemble a single, complete appeal submission that walks reason-by-reason through your supporting evidence.

RELATED POST: How to Prepare for an Appeal After a New York Life Denial

Know Your ERISA Appeal Deadlines

Under federal ERISA law, you generally have 180 days from the date of New York Life’s denial letter to submit your appeal. But you should still always verify the number of days you have to appeal. Missing that window almost always ends your right to challenge the decision in court.

Once New York Life receives your appeal, the insurer typically has 45 days to decide. It may extend once for an additional 45 days if it gives written notice explaining why more time is needed.

Mark these dates on your calendar and aim to file your appeal by day 150 to allow time for confirmation and corrections.

When to Get Professional Help

Your ERISA appeal is often the last opportunity to add evidence that a court can later review. If the denial involves a paper review, pre-existing condition, or “any occupation” issue, it’s wise to involve an experienced attorney before filing an appeal.

How Ortiz Law Firm Handles New York Life Denials

At Ortiz Law Firm, we focus exclusively on LTD appeals and lawsuits. Our team:

• Works with your doctors to obtain quantified RFCs
• Gathers medical records and condition-specific test results
• Prepares vocational evidence addressing reliability, attendance, and pace
• Ensures the administrative record is complete and litigation-ready

We handle LTD appeals on a contingency fee basis—you pay nothing unless we recover benefits. The initial file review and consultation are free, and all fees are clearly explained before you hire us.

Take the Next Step

If New York Life denied or terminated your benefits, we can review your denial letter, identify key issues, and outline the exact evidence needed to strengthen your appeal. We represent claimants nationwide, and in most cases, you do not have to hire an attorney in your state. Call (888) 321-8131 today for a free case review.