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.
Should 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 will not be misplaced—however you have to to behave shortly. Virtually all group long-term incapacity insurance policies have very strict deadlines and procedures should you want to enchantment. Lacking a deadline or forgetting to incorporate all of the proof in your administrative enchantment 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 communicate with an skilled long-term incapacity lawyer. You aren’t alone. An skilled lawyer can present the most effective probability at efficiently interesting and acquiring your denied incapacity advantages.
Breaking Down the New York Life Incapacity Enchantment Course of
Decide Whether or not Your Plan Is Ruled by ERISA
For many of this text, we’ll assume you might have a gaggle long-term incapacity insurance coverage coverage ruled by a federal legislation often known as ERISA.
How have you learnt when you’ve got an ERISA plan? Should you get your long-term incapacity insurance coverage by your employer, and your employer will not be both a non secular or authorities entity, you might have an ERISA plan.
Alternatively, should you 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 will not be topic to ERISA regulation.
We’ll 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 Ruled Advantages – Bryant Authorized Group (bryantlg.com)
Evaluate Your Declare Denial Letter
When New York Life Insurance coverage denies an ERISA declare, they’re required to supply policyholders with an in depth declare denial letter. This letter ought to clearly state:
· Their cause for denying the declare. Widespread causes embody inadequate medical proof, your situation not being lined by the coverage, or not assembly the coverage’s definition of incapacity.
· Enchantment procedures and deadlines. In most ERISA circumstances, you might have 180 days to enchantment your declare denial. It’s necessary to start out shortly to assist ensure that your long-term incapacity enchantment 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 overview your declare denial letter and consider whether or not you might have a superb case for a incapacity enchantment.
The denial letter and different communication from New York Life may make the incapacity appeals course of appear easy and simple—simply write a letter and inform them why you disagree. Nevertheless, this isn’t the case.
ERISA appeals restrict each the quantity of enchantment time and your alternatives so as to add proof to your claims file. You may solely get one shot at gathering and presenting the proof you want. An legal professional will assist make sure you don’t miss any vital deadlines and that your incapacity enchantment is as sturdy and thorough as potential earlier than you file it.
Collect Proof
Request a replica of your declare file from New York Life if it hasn’t already been supplied 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 set up as a lot related further proof as you possibly can to assist your incapacity willpower. This may embody:
· Extra medical data supporting your analysis, severity of your signs, associated restrictions and limitations, and unwanted effects of medicines or different remedies
· Medical opinions and letters of assist out of your medical workforce
· Purposeful evaluations supporting your bodily and/or cognitive limitations
· Vocational evaluations that assess your incomes capability and skill to carry out job duties
· Private testimony from colleagues and acquaintances
· Photographs 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 is advisable to acquire—together with gadgets you won’t have considered by yourself.
File Your Enchantment with New York Life
When you’ve assembled all of the proof you want, you should submit it to New York Life. Your submissions needs to be accompanied by an enchantment 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 needs to be authorized.
Perceive that a number of paragraphs in an internet kind won’t almost be sufficient to alter the insurance coverage firm’s thoughts. A professional ERISA legal professional who is aware of the legislation and has expertise working with New York Life straight shall be invaluable for many claimants.
And once more, we are able to’t stress this sufficient: this single administrative enchantment shall be your final and solely probability so as to add proof to your declare file. No new data will be added, even when your case results in court docket. The court docket can solely overview the proof you add in the course of the administrative appeals course of.
Wait For a Response
Below ERISA, New York Life has 45 days to both approve or deny your enchantment 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’s “good trigger.”
Hopefully, New York Life will reverse its choice. But when it doesn’t, you should have the choice of submitting a lawsuit.
