How to Appeal Your New York Life Long-Term Disability Claim Denial

You're likely shocked when you get New York Life's denial letter in the mail denying your long-term disability claim. You have the struggle already of dealing with a disabling medical condition. You've tried to hold on to your job as long as you could and finally had to surrender to your medical condition. Your own doctors agree that you're disabled from working. You know that you're disabled from working. Your family knows that you were struggling and are disabled from working. But New York Life's letter says that it has hired doctors who looked only at your medical records, who have never met you in their lives, and they basically say that you're treating doctors don't know what they're talking about and you're basically exaggerating your symptoms to try to cop some free money on a disability claim. Well, it's maddening and New York Life does this every day across the country. But know this, you're not alone and you can win by appealing the claim in the right way using the right evidence. And we today are going to go through five critical steps to file your best appeal of a New York Life long-term disability benefit denial to have the best chances of winning on appeal. And if the appeal is denied as well, the work you put into that appeal is going to go a long way to your best chances of winning in court before a federal judge if they deny your claim on administrative appeal. Hi, I'm Price McNamara and I spent years representing insurance companies before quitting that to now use that knowledge I learned representing them to now represent people who are wrongly denied long-term disability insurance claims. This is 100% all we do in our office. This is our specialty. It's what we do every day. And I can tell you this, first of all, don't give up. You can overturn a claim denial. And secondly, don't file an appeal that simply argues why you think the insurance company was wrong in their denial. What you need to do instead is systematically build an appeal. Build an appeal by gathering existing evidence that the insurance company didn't consider in the first place and by creating and presenting to the insurance company new evidence that's going to support your claim on appeal. And if they deny it on appeal, that also sets up a much better chance of you winning in federal court because you have the right, after they deny the appeal, if they deny it, to bring that case to federal court and ask a federal judge to overturn that denial. So we'll go through the five steps that we use. We call our win my benefits process to file your best and strongest appeal with best chances of winning. Step one, we call gather. And what I mean by that is you have to gather the existing documents that we already know exist that are going to be highly relevant to your claim. This is going to include obviously the denial letter. It's going to include the insurance policy. It's going to include the insurance company's claim file. The insurance company has to give you their entire claim file. So to gather it, you simply look at your denial letter. It tells you where to send a request for the claim file. Send that request in writing. Send it certified mail so they can't deny receiving it because they will. And when you get the claim file back from them, it's going to be somewhere between 500 and 5,000 pages. They can be really big. Well, the claim file is going to include all of the medical records that they considered, your medical records. It's going to include the full reports of any doctors that they hired to look at your medical records. It's going to include the full reports of any vocational rehabilitation expert who looked at your records to determine what jobs you might be capable of functioning. And it's going to include a lot more than the insurance company has listed in their own denial letter. So it's critical to get all of these documents in one place so that you can begin the next step of the process. Step two of the Win My Benefits process is to organize. And what I mean by that is, like I said before, these files are generally big, from 500 pages to up to 5,000 pages, even more sometimes. And what you have to do is organize it in a way that you can see the big picture and not get lost in the weeds, so to speak. What we do is we bait stamp page numbers on that entire file from beginning to end so that we can easily reference exactly where in that huge file certain documents are that we are citing in our appeal or later to the court. Those page numbers are going to come in very handy later. We also index that claim file and we do a summary chronology where we actually create a summary on a word processing document that's chronological order rather than the order in which it's in the claim file. This comes in very handy because as you look at things chronologically, problems and weaknesses and missing evidence tends to stand out more obviously. It can bring into focus sometimes evidence that's obviously missing, but also evidence that may have been withheld by the insurance company that might be favorable to your claim. And if that's the case, then we re-request specifically the evidence that we think is missing. It also can bring to light certain procedural violations that ERISA outlaws that you can use to help support your claim and help support the idea that this insurance company is not even following the rules of procedure that ERISA imposes on the insurance companies. The claim file will include all of your medical records. It's going to include all of the reports by any expert physicians that the insurance company hired to review your records and their opinions that they give end up being much longer than the little snippets that the insurance company references in the claim denial. And sometimes it brings to light that the insurance company didn't even give their reviewing physician critical records that might have changed that reviewing physician's opinion. It'll also include typically reporting by the insurance company's vocational rehabilitation expert who gives opinion on what your capabilities are in terms of what jobs you might be capable of performing given your medical restrictions from your given medical condition. So getting all of this in a chronological order is extremely helpful. You really have to have this organized part down and completed before you can see it clearly to now engage in the next step of the win my benefits process. So the next step in the process we call analyze. And what I mean by that is now that you have a nice organized picture of what's in the claim file, what does exist, and a chronological summary of really the entire claim file with page references, you're going to notice that there are certain medical visits you may have had that are simply not in the claim file. There might be diagnostic testing that you've had regarding your medical condition that's just not in the claim file. And it will also become clear things like the insurance company claiming that your symptoms are only self-reported are subjective symptoms only and not objective or not something that your physician objectively determined in a physical examination. Well when you see things like that in the chronology you can go to your physician and say the insurance company says that my symptoms are only self-reported there's nothing objective supporting my claim. That's often what the insurance companies claim. Well your doctor can then specifically state and point in the record to things that are indeed objective support for your claim or your physician can order diagnostic or other testing that can prove objectively what the insurance company is calling self-reported or subjective only symptoms. So that analysis the analyze step is to look at the claim file and all the documents you have as a whole and decide what evidence you think you might be able to gather that are going to that is going to refute specifically some of the things the insurance company is claiming to support the denial of your claim and things that will just strengthen the overall picture of exactly why your medical condition is disabling and how your medical records and other records that we might be able to introduce into the record that weren't there before or even create to introduce into the record to support your appeal. Now the creation of the new evidence or the addition of new evidence to present to the insurance company that was not in the claim file before gets into our next step of the win my benefits process. Step four of the win my benefit process is to build. Now we've touched on that before but now we'll get specific. What do you do to build new evidence into the claim file that wasn't there before so it can be considered by the insurance company or potentially later considered by the court if the insurance company continues to deny the claim? Well one would be probably a much more detailed explanation a sworn statement by you stating exactly what you feel exactly how your symptoms disable you from doing your job and disable you from doing particular functions of the job that you found difficult that caused you to have to go out on disability. It's going to include your own statement of job description and exactly how physical or cognitive components of that job description or something you just can't do. This will include one of the things we want to include in new evidence if it's not already in the administrative record is your actual written job description from your employer. It's going to list the essential duties of your occupation but it's probably not going to be complete so you have to kind of fill in the gaps with things that you know and realize you have to do every day on the Next in the build part of the five-step process you can get other people close members of your family a spouse somebody else who lives with you co-workers perhaps or really good friends who can read the statement you have created in detail to state why your disabling condition really disables you from working and they can read that statement and do their own sworn statement that simply says that they've read your statement and that based on their observations everything you say in your statement is consistent with what they have observed and that they observe and speak with you on a daily basis or close to it. Next you're going to want to include any medical records that simply weren't in the record. These may be medical records that were in existence when the insurance company reviewed your claim or they may be medical records that were created or from visits that came after the last records that the insurance company had so you want to make sure that any medical visit you've had to a doctor or for a diagnostic study or for a procedure that claim file with your appeal becomes fully up to date with all relevant medical records. Another way to build your claim is to take the denial letter to your treating physician and ask your treating physician to review it and ask if he or she can issue a much more detailed report of why your condition is disabling specifically refuting things that the insurance company claims are not present in the medical record or things that they claim are present in the medical record but that support their denial of the claim. Your physician is going to be in the best position to say exactly why they are wrong in what they're saying and give details as to why they're wrong. The other thing your own physician can do to help you build your claim is perhaps order diagnostic studies to prove things that your insurance company is saying are only self-reported or objective. Your doctor can see what they claim are self-reported or only subjective and will know if there are objective ways to determine that and prove it that the things you are saying are not just subjective or self-reported but are proven objectively. The doctor's physical examinations can do that in some circumstances or it might be that the doctor has to order some diagnostic studies but that's always a possibility also to help build your claim. If a major component in your of your disability is cognitive dysfunction then your physician can order a neuropsychological study where you spend a day or two with a neuropsychiatrist or psychologist who can do studies that will show objectively a cognitive decline or what cognitive level you're functioning at with different types of cognitive requirements. In some cases you might want to hire an independent physician of your own who's not even a treating physician to review all of the records as a whole. The whole claim file, the denial, the medical records, the insurance companies reviewing physicians, their vocational rehabilitation experts' reports and opinions and an independent doctor can do a comprehensive case review and issue an opinion on whether it agrees or disagrees with the insurance company's denial and with the insurance company's doctors and can state exactly why the record supports your disability. Now your own physician or an independently hired physician can also provide you with journal articles or articles out of other authoritative medical literature that completely supports what you are saying and what your own treating doctor is saying about this medical condition causing you to be disabled from working. Another thing you can include that might not have been in the original claim determination might not have been a factor for their consideration is if you have medication side effects that might not have been mentioned earlier, might not even be mentioned in your doctor's records but if you have certain medications you have to take and they are causing you drowsiness or falling asleep or brain fog, inability to concentrate, dizziness, things like that, that can be a large component and a disabling feature in and of itself and you can describe those reactions to in your sworn statement and also get your doctor to comment on that as well. Sometimes in some cases we actually want to hire an independent vocational rehabilitation expert to look at the job market, look at the true requirements of jobs that the insurance company is saying you can do to determine if your medical restrictions and limitations that your doctor says you have would even allow you to perform the jobs that the insurance company is saying that you can perform, that its vocational rehabilitation expert is saying that you can perform. So in some cases many of these additional points that I've covered on possible avenues of building your claim stronger, creating new evidence to support your claim on appeal, sometimes many of those components can be added and are needed, sometimes just a few are needed but that's kind of a comprehensive list of things you can be thinking about that you might use as a grab bag for building and strengthening your claim with new evidence for appeal. Okay and finally step five of our win my benefits process is execute and by that I mean first we look at the federal case law across the country and try to find cases where courts have ruled against the insurance company and in favor of benefits under fact scenarios and medical conditions that are similar to your case and hopefully with addressing occupations that are similar to what is being addressed in your case and we can use that to show the insurance company that in prior cases judges have ruled in your favor and they might want to consider that when they are reviewing your appeal and reconsidering their claim denial and with that we basically take all of the new evidence we've built we take all of the evidence that existed in the claim file before and we weave that into a comprehensive argument along with the legal case law we found that supports your case and create the strongest most compelling argument we can as to why your disability in your particular case is true and how why you are truly unable to perform the material and substantial duties of your occupation or any occupation and remember you can include in your argument page sites to the specific page numbers where documents are in the claim file to support your argument and also attach all of the new evidence and that's got to be sent with your appeal as an exhibit so that becomes part of the administrative record as well and cite to it specifically and why it supports your claim now the important thing in getting all that new evidence into the administrative record is if they do deny your claim on appeal the federal court cannot consider any evidence that was not put into that administrative claim file on appeal so if they do deny your claim on appeal all the work you've done up to this point is still very very useful in your case in federal court so you haven't wasted your time but what we hope in the beginning is that they see the light and the insurance company sees that your claim your new appeal is so strong that they know a federal judge is going to rule in your favor and they do the right thing and they decide to award the benefits on administrative appeal and not force you to have to go through the court process as a final thought i would suggest that before you talk to any insurance adjuster again before you begin trying to handle the appeal process by yourself download our free book it's called how to win your appeal of a long-term disability claim you can find it right here on the website or if you're not on the website go to winmybenefits.com it's a free download it's full of useful information it tells you useful tips and tricks and also traps that the insurance company tries to lay for you the way they hope you appeal the claim things you can avoid to weaken your chances on appeal and some important considerations of some kind of technical issues and deadlines that ERISA law imposes with these claims so download the free book we hope it's helpful to you we hope this video has been helpful to you better yet give us a call anytime we're happy to talk to anybody about these claims we love helping people with these claims we'll review your claim denial letter for free if you'd like us to do that and we're always happy to help any way that we can we hope you have a great day