Riemer Hess has helped many clients secure disability benefits with New York Life. If you have a disability insurance policy with New York Life, you may expect to receive benefits in the event that you become unable to work due to a physical or cognitive impairment. However, as many policyholders have discovered, filing a claim with New York Life is not always a straightforward process. A number of clients come to us after having encountered various obstacles and challenges in obtaining their rightful benefits from New York Life.
Below we will discuss some of the common tactics that New York Life uses to deny disability claims and how you can protect your rights as a policyholder.
Did New York Life buy out Cigna’s long term disability claims?
Yes, New York Life did acquire Cigna’s group life, accident, and disability insurance business. This acquisition, which was completed in December 2020, was a significant transaction valued at $6.3 billion. It resulted in New York Life becoming one of the top five insurers across group life, accident, and disability insurance. This deal included the transfer of over nine million customers to New York Life. Additionally, the acquisition was part of New York Life’s strategic move to enhance its portfolio of strategic businesses and contribute to its financial strength.
As a consequence of this acquisition, there might be increased scrutiny of existing long term disability claims originally held by Cigna. Claimants with approved or pending claims might experience heightened investigation of their claims, including increased claim forms and more frequent communication from their representatives. This increased scrutiny could be due to the insurer’s responsibility for claims that originated under Cigna, for which New York Life did not receive the initial premiums.
What common tactics does New York Life use to deny disability claims?
New York Life uses a variety of tactics to deny disability claims that can result in unfair and unjustified denials of benefits for policyholders who are genuinely disabled and unable to work. A few of these tactics may include:
- Dependence on the opinions of non-treating physicians: Insurers, including New York Life, may rely on evaluations by non-treating physicians, which often undermine the more informed assessments of the claimant’s treating physicians. This approach disregards the comprehensive insights that treating physicians offer regarding their patients’ conditions.
- Selective interpretation of ERISA and policy terms: New York Life may choose to construe the policy terms in ways that favor claim denial. For example, let’s suppose the New York Life long term disability policy states that a claimant must be “unable to perform any occupation” to qualify for benefits. New York Life might interpret this phrase in an extremely narrow sense, arguing that if the claimant is capable of performing any job, however unrelated or low-paying compared to their previous employment, they are not disabled. For instance, if a highly skilled surgeon develops a hand tremor and can no longer perform surgery but can still teach, the insurer might deny their claim, stating that teaching is an occupation they can perform, despite the significant difference in skill and compensation levels. This interpretation could be seen as self-serving, focusing on denying claims rather than providing fair coverage based on the claimant’s actual vocational impairment.
- Ignoring the approval of other disability benefits, such as Short Term Disability and SSDI: New York Life may deny a long term disability claim, even though short term disability (“STD”) and Social Security Disability (“SSD”) were approved for the same claimant. New York Life, as a private company, does have a financial incentive to deny LTD benefits, since they are more costly and require a longer commitment than short-term benefits. By ignoring the approval of other disability benefits, New York Life may be violating the duty of good faith and fair dealing that it owes to its policyholders.
Have courts criticized New York Life’s disability claim handling practices?
Yes, courts have criticized New York Life for their disability claims handling practices in denying disability benefits. These cases illustrate instances where courts have questioned or criticized New York Life’s methodologies in handling disability claims.
- Bruce v New York Life Ins. Co., 2003 WL 21005313, (ND Cal Apr. 28, 2003): The plaintiff, Mary Bruce, sued New York Life for denying her claim for long term disability benefits. The lawsuit centered around the dispute over whether Bruce was truly disabled as defined under her ERISA-governed insurance policy, with a focus on the insurer's evaluation methods and the credibility of medical opinions regarding her disability. The court sided with Bruce, criticizing New York Life for relying too heavily on evaluations by non-treating physicians and a vocational expert, and thereby overlooking the more informed assessments of Bruce’s treating physician.
- Bess v New York Life Ins. Co., 36 Fed Appx 599, (9th Cir June 10, 2002): Dr. Ludmila Bess sued New York Life, challenging the denial of her claim for long term disability benefits. The lawsuit focused on whether Bess’s disability policy, purchased for her sole benefit as a business owner, was governed by ERISA, affecting the handling and outcome of her claim. The Ninth Circuit Court of Appeals ruled for Bess, finding fault with the district court’s reliance on ERISA preemption and its interpretation of total disability provisions in Bess’s policies, implying that New York Life’s interpretation was overly restrictive.
- Reynolds v Life Ins. Co. of N. Am., 2023 WL 6541328, (WD Wash Oct. 6, 2023): Lucy Reynolds sued Life Insurance Company of North America, a subsidiary of New York Life, for denying her long term disability benefits. The case revolved around the evaluation of her medical condition and the insurer’s decision-making process, questioning whether the denial was consistent with the terms of her disability insurance policy. Reynolds prevailed in this case, as the court found that LINA’s denial of her long term disability benefits contradicted their approval of short term disability benefits and other medical evidence, including Social Security disability findings.
What strategies work best against New York Life?
To help effectively counteract the tactics insurers like New York Life use in denying long term disability claims, you can adopt the following strategies:
- Gather comprehensive medical evidence: Ensure thorough documentation of your condition by your treating physician, whose ongoing assessments are critical. Their detailed reports can counterbalance the evaluations by New York Life’s non-treating physicians. Additionally, any objective medical testing, evaluations, or other reports you can provide are key. This may include a Functional Capacity Evaluation, a neuropsychological evaluation, or a vocational assessment. These experts can offer valuable insights into how your disability affects your ability to work.
- Obtain rebuttals to Independent Medical Examinations (“IME”s): If New York Life sends you for an Independent Medical Examination, and the IME concludes that your condition is not as severe as claimed, request a rebuttal from your treating physicians. Their detailed response can address specific points raised in the IME and reinforce the validity of your claim based on their long-term knowledge of your condition.
- Understand your policy terms and protections ERISA: Familiarize yourself with the specific terms of your insurance policy and how ERISA impacts these terms. This knowledge can help in challenging New York Life’s interpretations that may be restrictive or self-serving.
- Prepare for surveillance: New York Life will sometimes conduct surveillance on claimants. Be aware that your activities might be monitored and should reflect the limitations you claim.
- Seek legal guidance: Consider consulting an attorney experienced in New York Life disability insurance claims and ERISA. Legal expertise can be invaluable in navigating complex policy interpretations and legal arguments.
How can Riemer Hess help with my New York Life long term disability claim?
Riemer Hess has helped many clients successfully secure their disability benefits from New York Life. With our extensive experience, we’ve developed a deep understanding of New York Life’s tactics in administering claims. This familiarity positions Riemer Hess well to anticipate and counter New York Life’s approaches, leveraging our insights and experience to effectively advocate for your rights under ERISA.
Here’s one example of how we’ve helped a client defeat New York Life’s denial tactics:
“Travis,” a facilities manager for a large corporation, suffered a work-related accident when he fell while performing his job duties. This accident seriously injured his knee and back. Despite treatment, his injuries worsened over time, leading him to file for long term disability with his provider, New York Life. New York initially approved the LTD claim, until out of nowhere sent Travis for an independent medical examination with one of their doctors. The IME lasted all of fifteen minutes and focused exclusively on his knee, ignoring his back injury altogether. Travis was shocked when New York Life used this cursory and incomplete IME as justification to abruptly terminate his benefits. New York life also alleged that his job duties only involved “light” physical activity, greatly underestimating the physical functions needed to perform his role.
In response, Travis retained Riemer Hess to help with his appeal. Riemer Hess meticulously coordinated for Travis to undergo a Functional Capacity Evaluation (“FCE”), procured his official job description to challenge the misclassification of his job duties by New York Life, and collaborated with his doctors to effectively rebut the IME findings. Riemer Hess’s strategic approach led to a triumphant win on appeal, restoring Travis’s benefits with New York Life.
Relieved and grateful, Travis chose to continue his partnership with Riemer Hess to ensure ongoing oversight of his claim, securing peace of mind for his future.
Dealing with New York Life’s claims process involves various strategies that need careful attention and expertise. While this process can be complex, remember that you don’t need to handle it by yourself. Riemer Hess can simplify these challenges, ensuring that you’re not alone in this process.