Short & Long Term Disability Cases We’ve Won for Our Clients Against New York Life

A certified phlebotomist for a large health care provider was diagnosed with lumbar intervertebral disc disease with myelopathy, with associated radiating pain. She quit working because she was unable to keep up with her physically demanding and stressful job. New York Life agreed and paid the woman’s claim for several months. Out of nowhere and without explanation, the insurer requested the woman attend an independent medical examination. In turn, her benefits were denied based on the report, which far overestimated her physical abilities.

After hiring Fields Law Firm to assist with an appeal of the denial, our attorneys combed over the claim file and discovered that the independent doctor had failed to base his recommended work restrictions on examination findings. The Fields Law attorneys arranged for our client to attend a functional capacity evaluation to refute the findings of New York Life’s doctor and secured a substantial amount of medical records. Our attorneys submitted the medical records, functional capacity evaluation, and several legal arguments undermining the denial decision; which resulted in the decision being overturned our client’s benefits being reinstated.

A machine operator from Ohio experienced severe discomfort following back surgery. He could not sit or stand for more than a few minutes without serious pain. Work became impossible, so he applied for Long Term Disability benefits. His insurer initially approved his claim and paid him monthly benefits for about two years. Suddenly, they sent a letter telling him that he no longer fit their definition of disabled and that payments would stop.

Shocked and worried at his lost income, he called Fields Law for help. The attorneys at Fields Law scoured his claim file and found that they made their decision while our client was in between insurance providers and struggling to find good care providers in his network. Our attorneys contacted our client’s physicians to obtain updated medical records and sent a strong appeal to his insurance company with the updated medical records attached. His insurer overturned their original decision and our client received a lump-sum payment for back-pay and ongoing monthly benefits. He was relieved that his monthly income was restored and is happy to be able to use the money to continue treatment.

A Sales Representative for a cable provider became totally disabled due to chronic back pain, caused by bulging and herniated discs in his lumbar and cervical spines. After 24 months of paying benefits, his insurance company terminated his benefits because the policy’s definition of disability changed from whether one was disabled from performing his Own Occupation to disabled from performing the material duties of Any Occupation, claiming that he could perform sedentary work and specifically alleged he had transferable skills to perform the occupations of Dispatcher and Service Clerk. Confused by this logic, he approached Fields Law for help with less than 30 days remaining to submit an appeal. Our attorneys immediately reached out to New York Life to request a 45-day extension to submit his appeal, which was granted.

Based on our experience, we knew that New York Life had not performed a significant vocational analysis and had failed to appreciate how our client’s chronic pain and limited range of motion impaired him performing even sedentary work on a competitive basis. We sent our client’s file to a vocational expert who conducted a national and regional job outlook study and determined that the positions of Dispatcher and Service Clerk were not appropriate occupations for our client based on his age, education, work history, and experience. The Fields Law team quickly gathered the necessary evidence and drafted a strong appeal for our client. New York Life reversed its denial decision, issued the back-pay benefits our client was owed and resumed paying his monthly benefits.