New York Life Insurance coverage Firm is likely one of the largest long-term incapacity insurance coverage suppliers within the nation, with roughly $1.5 billion in in-force premiums. That features premiums from 9 million or so clients they added to their record in 2021 after buying Cigna’s group life and incapacity enterprise.
In case you’ve just lately had a long-term incapacity declare denied by New York Life (or its underwriter Life Insurance coverage Firm of America, previously a part of Cigna), hope isn’t misplaced—however you have to to behave rapidly. Virtually all group long-term incapacity insurance policies have very strict deadlines and procedures for those who want to attraction. Lacking a deadline or forgetting to incorporate all of the proof in your administrative attraction may completely bar you from the incapacity advantages you deserve.
We don’t need that to occur to you. The most effective factor you are able to do, proper now, is converse with an skilled long-term disability lawyer. You aren’t alone. An skilled lawyer can present the perfect likelihood at efficiently interesting and acquiring your denied incapacity advantages.
Breaking Down the New York Life Incapacity Attraction Course of
Decide Whether or not Your Plan Is Ruled by ERISA
For many of this text, we’ll assume you’ve got a gaggle long-term incapacity insurance coverage coverage ruled by a federal regulation often known as ERISA.
How have you learnt if in case you have an ERISA plan? In case you get your long-term incapacity insurance coverage via your employer, and your employer isn’t both a non secular or authorities entity, you’ve got an ERISA plan.
Then again, for those who bought particular person incapacity insurance coverage straight from New York Life (for instance, in case you are self-employed or bought supplemental protection on high of your employer-sponsored protection), your long-term incapacity insurance coverage isn’t topic to ERISA regulation.
We are going to talk about interesting non-ERISA claims later on this weblog. For now, let’s look particularly at interesting a New York Life group profit denial.
RELATED: ERISA Governed Benefits – Bryant Legal Group (bryantlg.com)
Evaluate Your Declare Denial Letter
When New York Life Insurance coverage denies an ERISA declare, they’re required to offer policyholders with an in depth declare denial letter. This letter ought to clearly state:
· Their motive for denying the declare. Frequent causes embody inadequate medical proof, your situation not being coated by the coverage, or not assembly the coverage’s definition of incapacity.
· Attraction procedures and deadlines. In most ERISA instances, you’ve got 180 days to attraction your declare denial. It’s essential to start out rapidly to assist ensure your long-term incapacity attraction is as bulletproof as potential (for causes we’ll clarify in a minute).
Contact a Lengthy-Time period Incapacity Lawyer
We strongly urge you to contact an legal professional immediately to evaluation your declare denial letter and consider whether or not you’ve got case for a incapacity attraction.
The denial letter and different communication from New York Life would possibly make the incapacity appeals course of appear easy and easy—simply write a letter and inform them why you disagree. Nevertheless, this isn’t the case.
ERISA appeals restrict each the quantity of attraction time and your alternatives so as to add proof to your claims file. You would possibly solely get one shot at gathering and presenting the proof you want. An legal professional will assist make sure you don’t miss any crucial deadlines and that your incapacity attraction is as robust and thorough as potential earlier than you file it.
Collect Proof
Request a duplicate of your declare file from New York Life if it hasn’t already been offered to you. This could embody all of the data, proof, and data they’ve relating to your case.
Ask your self: what’s lacking from this image? Collect and arrange as a lot related extra proof as you’ll be able to to help your incapacity willpower. This would possibly embody:
· Further medical data supporting your analysis, severity of your signs, associated restrictions and limitations, and negative effects of medicines or different remedies
· Medical opinions and letters of help out of your medical staff
· Practical evaluations supporting your bodily and/or cognitive limitations
· Vocational evaluations that assess your incomes capability and talent to carry out job duties
· Private testimony from colleagues and acquaintances
· Images and movies
· Journal entries about your every day experiences
Once more, we urge you to work with an legal professional on this course of. An skilled long-term incapacity lawyer will know what sort of proof it’s essential get hold of—together with objects you won’t have considered by yourself.
File Your Attraction with New York Life
When you’ve assembled all of the proof you want, you have to submit it to New York Life. Your submissions ought to be accompanied by an attraction letter that gives a concise abstract of the brand new proof, the precise rulings you’re contesting, and a persuasive argument for why your advantages ought to be authorized.
Perceive that a number of paragraphs in an internet kind is not going to practically be sufficient to vary the insurance coverage firm’s thoughts. A professional ERISA legal professional who is aware of the regulation and has expertise working with New York Life straight will probably be invaluable for many claimants.
And once more, we are able to’t stress this sufficient: this single administrative attraction will probably be your final and solely likelihood so as to add proof to your declare file. No new data will be added, even when your case leads to court docket. The court docket can solely evaluation the proof you add in the course of the administrative appeals course of.
Wait For a Response
Underneath ERISA, New York Life has 45 days to both approve or deny your attraction after they obtain it—below regular circumstances, that’s. The true wait will be so long as 90 days, since ERISA permits New York Life to request a 45-day extension if there may be “good trigger.”
Hopefully, New York Life will reverse its choice. But when it doesn’t, you’ll have the choice of submitting a lawsuit.
