Long Term Disability Law Blog
If you’re applying for long term disability insurance benefits from New York Life, you may be concerned about having your claim denied—and then having to go through the lengthy appeal process in order to secure your disability insurance benefits. there’s no one-size-fits-all application that will guarantee that a particular claimant’s benefits will be approved, but at Dell & Schaefer we’ve helped thousands of people access their benefits and know just what New York Life will be looking for when evaluating your disability insurance claim. Below are some time-tested tips that can help you avoid denial of your disability insurance claim.
GREGORY DELL: Hi, I’m attorney Gregory Dell. I’m here today with attorney Cesar Gavidia. And we’re going to discuss New York Life Insurance Company and the handling of a long-term disability insurance claim. And the goal of this video is to provide you with some tips that can put you in the best position to protect your long-term disability benefits from being denied.
And Cesar, New York Life last year purchased Cigna’s Group Disability Insurance Division and kind of overnight became probably one of the top three largest group disability insurance carriers in the country behind Unum, which is the biggest, and Prudential’s, and MetLife–
CESAR GAVIDIA: Hartford and Aetna.
GREGORY DELL: –so they’re all– Hartford, Aetna, there’s been a lot of consolidation. But they’re clearly in the top three size wise. And everyone’s trying to take over this group disability insurance world, which is a probably an $18 or $20 billion industry. So it’s a really big business.
But New York Life is relatively new to the group world, because they were doing some individual disability policies before. So they’re not strangers to disability insurance world. But in this video, I want to give some tips for how people can protect their benefits and provide them the benefit of our experience from having dealt with Cigna so much, thousands of claims with Cigna, as well as hundreds of claims with New York Life.
But really, we know there was a transition where the Cigna people are basically now just wearing New York Life hats. And they’re New York Life employees. But it’s going to be a lot of the same type of stuff, but just under a different name.
And then, obviously, we offer this monthly claim handling service where a lot of the tips we’re going to provide we help people by providing them with a service where we manage the whole claim for them. And they don’t have to worry about anything. And they kind of get it like an insurance on an insurance. And it’s a unique thing that we offer. And we’ll talk about how we help people when we’re actually representing them.
But right off the bat, when someone calls you and says, look, I’m on claim with New York Life. What do you think about New York Life versus another type of disability insurance company that’s out there?
First Steps in Starting a New York Life Disability Claim
CESAR GAVIDIA: Well, look, I could tell you that, as soon as I hear something in terms of I’m on claim with New York Life, my first question is going to be, well, how long has that been? Because I could tell you, particularly with group disability policies, they could be in the first 24 months of payments, and you could see a shift from own occupation to any occupation happening, you know, very, very soon. And a review going on at the claim handling level where they’re trying to assess now whether you meet this totally different standard compared to what you basically have to have been meeting for the past 20 something months in order to continue qualifying.
So that’s going to be one of my first questions is, where are you in terms of your benefit payments? And what kind of activity has there been? Have they been asking you anything about your medical treatment? Have they said they’re pulling your medical records? Or are they saying they’re having any trouble pulling medical records for you?
Another thing is are they asking you certain specific questions because that could be keying into whether they’ve done any certain surveillance on you. And maybe been watching you, watching your activities to see if maybe you’re engaged in something that isn’t exactly consistent with what you’ve been reporting to them.
GREGORY DELL: But what about the demeanor of companies? There’s some companies that are like they’re looking for a reason to deny the claim. And there’s other companies that are looking for a reason to pay the claim. Where’s New York Life in that scenario?
CESAR GAVIDIA: Well, New York Life, I think, is probably, at least traditionally, I would say that their demeanor was we’re going to review the claim. We’re going to do an extensive review of everything. And if there’s evidence there to support the disability claim, we’re going to pay it.
But now, you’re bringing Cigna in. OK? And you know, depending on the kind of personnel and the kind of culture that was kind of built around that company, I mean, you got to remember Cigna’s a large, large disability insurer. They have a big, big bulk of the group disability work.
Sometimes I swear I’m dealing with a kind of these automatronics where they’re just pushing the paper along. And you know, they’re just checking off boxes. And they’re not really doing an in-depth review. I don’t know if there’s going to be necessarily a culture change now because of the shift to New York Life. But if you’re dealing with the same culture, if you’re dealing with the same demeanor in Cigna that’s always been there, I think that there’s a little bit of a cause for concern.
GREGORY DELL: Well, there’s not going to be a shift unless they change some management. But basically, they’re keeping all of the same people as far as we’ve seen.
CESAR GAVIDIA: Right.
GREGORY DELL: Haven’t seen any change. And when it comes to, if it was Cigna, which is now New York Life, because that’s basically what it is, if there was any excuse to deny a claim, it was being jumped on. And it was being jumped on in a superficial, unsupported, minimal type evidence of a reason deny a claim. They take it and run with it because the denial letters we’d get would be a page, maybe two.
And half of the page was the title, the claim number, and just basic information about the claim. So there was basically nothing there, other than we looked at your file. We sent it to a nurse. We sent it to a doctor. They don’t think you have restrictions. You’re denied.
CESAR GAVIDIA: Yeah.
GREGORY DELL: And the person, like you said, where you were calling it like automated, is basically just like a paper pusher who has absolutely no say whatsoever in the claim, other than to say, OK, you gave me your claim forms. You gave me the medical records. You gave me the attending physician statement. I’m giving it to the medical team. Whatever they say, that’s what I’m going to do. I don’t care about the four or five doctors who said you’re disabled. If the medical team says you’re not, you’re not. And I’m just here in the middle just pushing paper.
CESAR GAVIDIA: Yeah.
GREGORY DELL: And that’s the problem. That’s what you’re dealing with at Cigna. And that’s where, I believe, that we get involved. We make sure– we know the game. We know how the system is. And then that’s where I want to start talking about now is what is that information that’s going to have to be submitted. And how do you put all that information together?
And the first thing that I always think about is the importance of the medical records. And how important are those medical records? And what do you make sure is in those records so that Cigna doesn’t have a reasonable basis– sorry, New York Life doesn’t have a reasonable basis to deny the claim?
What Your Medical Records Need to Show
CESAR GAVIDIA: Well, I can tell you that the medical records and the medical support is critical because it’s the foundation of your whole disability claim. You know, I see so often where a claim is just kind of, you were saying, it’s like pushing paper. Someone in their medical department said, yeah, I think that the claim should be paid. But I think that we should do a review in five or six months because I would expect some improvement.
And if in that gap, in that time frame, you haven’t had really frequent visits with your doctor that’s evidencing that there are limitations, that your complaints are being well documented, that your symptoms are being well documented, then you’re in trouble. Unfortunately, you’re in trouble. They’re going to look at the past six months or 12 months, and say, we really don’t see much here to continue supporting the limitations that your doctor say you have or that you say you have. So unfortunately, that’s probably going to lead to a termination of benefits. It’s absolutely critical that you have a strong medical foundation.
GREGORY DELL: OK. So the steps, though, for someone who’s on claim right now with New York Life and worried about it is how you communicate with your doctor. And that’s part of the education process we provide for the claimant. But the important thing is that you bring the doctor your symptoms, whether you keep a log, a pain diary of things that have gone on. You give the doctors examples of these are four or five things that happen. Please make sure it’s in my medical records. Please document it.
Please, in the automatic transcribed medical records, which everything is now, nothing’s handwritten anymore, make sure that you’re looking at all the options in there and changing things that may have changed and documenting that. You can’t go in to the doctor and be like everything’s OK. If you’re on a pain scale, you’re not a normal person when you go to a doctor. You learn to live on a long-term disability that’s because you’re disabled for more than six months with probably– and you don’t know if you’re ever going to get back to work.
You have to continue to document this condition of what’s going on. And you have to convey that, yeah, if you go to a doctor say, I’m OK. You’re OK living with a five out of 10 pain scale. You’re not OK in the sense of the person who has no pain. You’re not supposed to have pain. You’re not supposed to have limitations.
Most people who aren’t disabled don’t have those things. They get an occasional flare. They hurt their neck. They hurt their back. As we get older, we all get little things here and there, but not with the continuity that you as a claimant who’s on long-term disability have.
How important is it when you get involved with the claimant in completing the attending physician statement? And how do you work with the doctor and the claimant to make sure that everything is in that form the way it should be?
CESAR GAVIDIA: Well, the attending physician statements is a very, very important form because it’s basically the medical update they’re getting from your doctor. It’s going to be asking you about what restrictions and limitations you continue to have. Information about your frequency of treatment, any medications you’re on.
Of course, all that information has to be accurate. The problem sometimes that I’ve seen is that you have a lot of doctors that pass this form along to their medical assistant or to some nurse to complete. And that is usually when things really get– unfortunately, where problems come up. And things could be misrepresented. Or they may not complete it accurately. And then they send that off to New York Life. And you’re going to have your claim denied.
And I can’t tell you– I mean, if there’s a reason to get on the phone with a doctor, it’s when they at least show, or there may be some hesitation on your part that they’re going to be cooperative, that they’re going to fill this out the way they are, then you have to get on the phone with them. Then you have to go in and talk to them. And say, look, this is what’s been going on. This is how this needs to be completed.
Because if they complete it in any other way, once that bell is rung, it’s rung. You can’t go back and change it. You know? You try to say, oh, well, my doctor put this in by mistake. Or they had some medical assistant complete this. And she made a mistake here.
The opportunity to fix that is gone. They’re going to basically assume that what they’ve represented in that initial form that’s been submitted to them is accurate.
GREGORY DELL: And then the other thing, Cesar, that’s great about having a lawyer involved in handling your claim is that not only are you educated about how to communicate with your doctor, not only can we call the doctor and be like, doctor, can we discuss this form? But it’s the ability to go to the doctor and be like, look, I can’t work. This is my livelihood. I have a lawyer who’s guiding me because I’m going up against this multibillion dollar company. And there’s lawyers out there who do this every day. And they gave me guidance.
And they suggested the following things are going into my medical records. The doctors appreciate that because they know where you’re coming from. You’re not speaking necessarily in the first person. You’re speaking third person. My lawyer told me this, that if this isn’t in the records, I’m probably going to get my benefits denied.
If the doctor’s treating you and believes in you, they want to support you. If you have a professional who’s giving you this advice and telling you things that should be in there, and you’re basically referencing your lawyer, it’s very helpful and easier manner to open up that line of communications with the doctor. And also knowing where your doctor stands. Will your doctor cooperate with your attorney should you need it? Will your doctor be there to help you if your benefits get denied? Because at any given time, they could be denied. So it’s a great intermediary tool to be able to have your lawyer and say this is what’s going on.
In the claimant form, Cesar, people don’t know how much is enough information has to put in. They feel like if I don’t say this, then they’re going to think I’m better. And I’m disabled. But there is this balance of what needs to be in there. And how do you work with your clients? And what do you recommend for how you fill out the claimant statement? New York Life asks for it once a month or every three months, it just depends on the type of claim.
CESAR GAVIDIA: Right. And you know, these questions are often really general. I mean, what are your daily activities? You know? What’s preventing you from working? What is your sickness? What is your disability?
And I think it’s really important, especially on what you describe in terms of your activities to represent the truth and to be accurate in what you’re expressing to the disability insurer. Because they’re looking for inconsistencies. They’re looking for some way to trip you up.
Really, these forms serve two purposes. To update them, but then to also, they’re cross-checking this with everything you’ve submitted before, with everything that’s in your medical notes and medical records, with everything your doctors are completing to see what’s inconsistent. What’s not matching up? Because then that’s going to give them a cause to go to even a deeper review of your disability claim.
Answer All Questions Truthfully
So it’s really important to address each question truthfully, provide them just enough information. You don’t want to necessarily, like you said, it’s a balance. You don’t want to over-represent or over-express what is going on, or over-answer the question. And you also don’t want to give them vague statements that isn’t giving them enough information because then they’re going to come back and ask for more.
They’re going to say, listen, we want to have an interview with you. We want to talk to you. We’re not sure about these answers. And we really need to kind of expand on this. We don’t get what’s going on with you.
GREGORY DELL: And a lot of these forms, Cesar, they don’t really leave enough space to explain what’s going on. So very often, we’ll write a custom addendum for the claimant. And that will basically say see attached. And we’ll answer the questions with the appropriate level of detail that needs to be there, working that fine line between how much is too little or too much.
And then every time we get the claim forms, we go back and tweak that particular addendum so it becomes even an easier process to fill out that claimant statement every time. So these are just a few of the tips that we’ve suggested. Obviously, when we’re representing a claimant, there’s very specific things that we look for, in particular, depending upon what the medical condition, depending upon what the definition of disability is. Depending upon if the person’s total or residually disabled. More often than not, we find that they’re totally disabled with a New York Life type policy.
So we’re always there for the claimant. There’s no line of communication between the carrier and the claimant. Everything comes through our office, which is unique. People love that. They don’t get anything in the mail. They don’t get any random phone calls.
If anything’s going to happen, it comes through us. And that provides a lot of peace of mind. So if you have a claim with New York Life, I encourage you to contact either Cesar, myself, or any of our lawyers. We’ll provide you with initial free consultation and let you know right away if we think we can assist you.
I also encourage you to spend a little bit of time on our website, search up New York Life. Look at the past cases that we’ve handled. Look at the lawsuit summaries that we’ve written.
You can check out reviews from other people who have New York Life policies and see the experiences that they’ve been having. And hopefully, gain some information there that could help protect your benefits, as well as look up your medical condition, or the occupation that you have. Because there’s lots and lots of information there. And the reason we have it there is to educate you about this process. And hopefully, the more educated you are, the better position you’ll be in to protect your benefits from being denied by New York Life.
So no matter where you live in the country, we welcome the opportunity to speak with you. And we’ll be here should you need us in the future. Thank you.
As you’ve heard, it can be a challenge to complete a long term disability claim packet that straddles the line between providing too much information (that can be used against you) and too little information (that won’t support a claim for benefits). It’s always a good idea to have an experienced legal team on your side. The attorneys at Dell & Schaefer frequently deal with New York Life and can work with you to ensure your claim packet is as complete and correct as possible. Just give us a call today to schedule your FREE consultation with one of our experienced long term disability insurance attorneys.