If your disability insurance company is questioning whether you can continue working, the issue is rarely just your diagnosis. The real question is whether you can perform your job reliably, day after day, on a full-time basis.
That is where many claims break down.
Most people we speak with are not confused about their condition. They are frustrated by how it is being evaluated. They know what they are dealing with. What they are struggling with is an insurance company that focuses on isolated notes, one-time evaluations, or generalized assumptions about their job.
A long term disability claim is not simply about showing that something is wrong. It is about showing, clearly and consistently, how your condition affects your ability to function in a real work environment.
People tend to reach out at a few key points. Sometimes it is after a denial that does not make sense based on the medical record. Sometimes benefits are terminated after months or years, often with little warning. In other cases, the insurance company begins requesting additional evaluations, such as an IME or a Functional Capacity Evaluation, and the process starts to feel more adversarial. And sometimes the concern is more subtle—delays, repeated requests for information, or a growing sense that the claim is being viewed with skepticism.
We also work with people earlier in the process, before a claim is filed or before they stop working. That can be especially important where the condition is complex or the job requires a high level of cognitive or physical performance.
What we do is not just gather records. Most claim files already contain records. The issue is how those records are interpreted.
Medical notes do not always explain work limitations in a way that translates to a disability claim. A chart may say “stable” or “improving,” while the person still cannot sustain a full workday. A provider may document symptoms but not connect them to functional restrictions. That gap is often where claims are lost.
Our role is to make sure the record reflects what is actually happening. That means working with treating providers to clarify limitations, focusing on whether work can be sustained over time, and addressing the specific reasons an insurer is likely to rely on.
A recurring issue in these cases is the difference between being able to do something once and being able to do it consistently. Many people can push through a task on a given day. That does not mean they can repeat that performance five days a week, under normal work expectations. Disability insurers often blur that distinction.
We see patterns in how claims are evaluated.
It is common for insurers to conclude that a person can perform sedentary work without fully considering whether they can sit upright for extended periods, maintain concentration, or function at a reasonable pace throughout the day. It is common for isolated medical notes to be taken out of context. It is common for symptoms like fatigue, pain, or cognitive issues to be discounted because they are not easily measured.
None of this is surprising once you have seen enough of these claims. But it can be difficult to navigate from the outside.
The strength of a claim ultimately comes down to one issue: whether the evidence shows that you can function reliably in a work setting.
Not occasionally. Not on a good day. But in a way that meets the demands of your occupation.
That requires consistency across the record. It requires clarity from treating providers. In some cases, it requires additional evidence, such as functional testing or a vocational assessment. Just as important, it requires presenting that information in a way that aligns with how these claims are actually evaluated.
There are also important differences depending on the type of policy involved.
Many employer-sponsored plans are governed by ERISA, a federal law that affects how claims are handled. For individuals working in New York and nationwide, this distinction can be critical. In ERISA claims, the appeal stage is often the most important opportunity to strengthen the record, because courts typically review only the evidence that has already been submitted.
Individual disability policies allow for a different approach, but they come with their own challenges.
Understanding which type of policy applies changes how a claim should be handled from the outset.
We approach these cases with a focus on getting the details right.
That includes making sure the medical record accurately reflects what a client is experiencing, identifying where an insurer may misinterpret the evidence, and addressing those issues directly. It also means being mindful of the broader situation clients are in. By the time someone is dealing with a disability claim, they are often managing a significant amount—medically, professionally, and financially.
Our clients are often professionals and executives who are used to performing at a high level. Many have tried to continue working longer than they should have. When they reach out, they are not looking for general guidance. They want to understand what is happening with their claim and what can be done about it.
If your ability to work is being questioned, it can help to step back and look at how your claim is likely to be viewed by the insurance company, and where it may need to be strengthened.
We represent clients in New York and across the country in long term disability claims, appeals, and litigation. If you are dealing with a denied claim, a termination of benefits, or an insurer that is questioning your limitations, we are available to talk through your situation and help you determine the next steps.