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New York Life Disability Benefit Claim Tips to Avoid Denial - YouTube
Channel: Dell Disability Law
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[Music]
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hi i'm attorney gregory dell and i'm
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here today with attorney cesar gavidia
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and we're going to discuss new york life
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insurance company
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and the handling of a long-term
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disability insurance claim
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and the goal of this video is to provide
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you with some tips that can put you in
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the best position to protect your
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long-term disability benefits
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from being denied and caesar new york
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life
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last year purchased cigna's group
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disability insurance division and
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kind of overnight became probably one of
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the top three
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largest group disability insurance
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carriers in the country behind unum
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which is the biggest and prudentials and
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met life
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so they're all hartford and there's been
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a lot of consolidation but they're
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clearly in the
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top three size-wise and there's
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everyone's trying to take over this
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group disability insurance world which
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is a
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probably an 18 or 20 billion dollar
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industry so it's a really
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a big business but new york life is
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relatively new to the group world
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because they were doing some individual
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disability
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policies before so they're not strangers
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to the disability insurance world but in
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this video i want to give some tips for
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how people can protect their benefits
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and provide them the benefit of our
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experience from having dealt with
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cigna so much thousands of claims with
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cigna
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as well as hundreds of claims with new
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york life but really we know there was a
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transition where
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the cigna people are basically now just
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wearing new york life hats
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and their new york life employees but
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it's going to be a lot of the
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the same type of stuff but just under a
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different name
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and then obviously we we offer this
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monthly claim handling service where a
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lot of the tips we're going to provide
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we help
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people by providing them with a service
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where we manage the whole claim for them
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and they don't have to worry about
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anything and they kind of get like an
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insurance on an insurance and it's a
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unique thing that we offer and we'll
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talk about
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how we help people when we're actually
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representing them but right off the bat
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when someone calls you and says look
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i'm on claim with new york life what do
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you think about new york life versus
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another type of disability insurance
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company that's out there
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well look i could tell you that you know
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as soon as i hear
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something in terms of i'm on claim with
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new york life
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my first question is going to be well
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how long has has that been
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because i could tell you particularly
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with group disability policies
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they could be in the first 24 months of
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payments
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and you could see a shift from own
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occupation to any occupation happening
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you know very very soon and a review
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going on at at the claim handling level
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where they're trying to assess now
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whether
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you meet this totally different standard
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that you've compared to what you
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basically have to been meeting
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for the past you know 20 something
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months in order to continue qualifying
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so that's going to be one of my first
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questions
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is you know what where are you in terms
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of your benefit payments and
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and you know what kind of activity has
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there been have they been asking you
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anything about your medical treatment
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have they said that they're pulling your
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medical records or
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they saying they have they're having any
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trouble pulling medical records for you
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another thing is are they asking you
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certain specific
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questions because that could be keying
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into whether they've done any certain
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surveillance on you
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and maybe been watching you watching
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your activities to see if maybe
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you know you're engaged in something
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that isn't exactly consistent with what
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you've been reporting to them
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but what about the demeanor of companies
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there's some companies that are like
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they're looking for a reason to deny the
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claim and there's other companies are
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looking for a reason to pay the claim
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where's new york life in that in that
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scenario well
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new york life i think is probably in
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well at least traditionally i would say
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that they were
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their demeanor was you know we're going
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to review the claim we're going to do an
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extensive review of everything
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and if there's evidence there to support
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the disability claim we're going to pay
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it
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but now you're bringing cigna in okay
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and you know depending on the kind of
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personnel
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and the kind of culture that was kind of
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built around that company
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i mean you got to remember cygnus a
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large large disability insurer
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they have a big big bulk of the group
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disability work
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sometimes i swear i'm dealing with you
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know kind of
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you know these these uh
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animatronics where they're just you know
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pushing the paper along
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and you know they're just checking off
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boxes and they're not really doing an
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in-depth review i don't know if there's
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going to be necessarily a culture change
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now because of the shift
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to new york life but if you're dealing
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with the same culture if you're dealing
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with the same demeanor in cigna
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that's always been there i think that
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there's a little bit of a cause for
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concern
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well there's there's not going to be a
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shift unless they change some management
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but basically they're keeping all the
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same people as far as we've seen
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right um haven't seen any change and and
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when it comes to
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if it was cigna which is now new york
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life because that's basically what it is
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if there was any excuse to deny a claim
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it was being jumped on
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and it was being jumped on in a
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superficial
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unsupported minimal
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type you know evidence of of
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a reason to deny a claim they take it
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and and
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run with it because the denial letters
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we'd get would be a page
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maybe two and the half of the page was
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the title
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uh the claim number you know and and
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just basic information about the claim
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so there's basically nothing there
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other than we looked at your file we
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sent it to a nurse we sent it to a
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doctor they don't think you have your
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restrictions you're denied
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yeah and the person like you said where
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you were calling it like
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automated is basically just like a paper
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pusher who has absolutely no
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say whatsoever in the claim other than
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to say okay you gave me your claim forms
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you gave me the medical records you gave
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me the attending position statement
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i'm giving it to the medical team
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whatever they say that's what i'm going
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to do i don't care about the four or
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five doctors who said you're disabled
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if the medical team says you're not
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you're not and i'm just here in the
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middle just pushing paper
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yeah and that's the problem that's what
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you're dealing with
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at cigna and that's where i believe that
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we get involved
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we make sure we know the game we know
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how the system is and then that's where
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i want to start talking about now is
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what is that information that's going to
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have to be submitted
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and how do you put all that information
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together and the first thing that i
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always think about is the importance of
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the medical records
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and how important are those medical
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records and what do you make sure
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is in those records so that cigna
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doesn't have a reasonable basis
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sorry new york life doesn't have a
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reasonable basis to deny the claim well
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i can tell you that the medical records
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and and the medical support
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is critical because it's the foundation
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of your whole disability claim
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um you know i i see so often where
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you know claim is just kind of you know
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you were saying it's it's it's like
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pushing paper someone in their medical
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department said yeah i think that
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the claim should be paid uh but i think
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that we should
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do a review in you know five or six
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months because i would expect some
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improvement
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and if in that gap in that in that time
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frame
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you haven't had you know really frequent
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visits with your doctor that's that's
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evidencing
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that there are limitations that they're
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that your diet
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your complaints are being well
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documented that your symptoms are being
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well documented
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then you're in trouble unfortunately
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you're in trouble they're going to
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look at the past six months or 12 months
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and say
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we really don't see much here to
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continue uh supporting the limitations
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that
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your doctors say say you have or that
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you say you have so unfortunately
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they're probably
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that's probably going to lead to a
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termination of benefits it's absolutely
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critical that you have a strong medical
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foundation
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okay so the steps though for someone
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who's on claim right now in newark life
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and worried about it is how you
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communicate with your doctor
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and that's part of the education process
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we provide for the claimant but the
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important thing is is that you bring the
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doctor your symptoms whether you keep a
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log
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pain diary of things that have gone on
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you give the doctors examples of this
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these are four or five things that
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happen please make sure it's in my
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medical records please document it
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please in the automatic uh transcribed
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medical records which everything is now
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nothing's handwritten anymore
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make sure that you're looking at all the
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options in there and changing things
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that may have changed and documenting
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that
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you can't go in to the doctor and be
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like everything's okay
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you know if you're on a pain scale
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you're not a normal person when you go
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to the doctor you learn to live
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on a long-term disability that's because
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you're disabled for more than six months
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with probably and you don't know if
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you're ever going to get back to work
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you have to continue to document this
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condition
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of what's going on and you have to
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convey that yeah if you go to the doctor
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and say i'm okay you're okay living with
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a 5 out of 10 pain scale
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you're not okay in the sense of the
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person who has no pain you're not
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supposed to have pain
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you're not supposed to have limitations
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most people who aren't disabled don't
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have those things they get an occasional
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flare they hurt their neck they hurt
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their back
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you know as we get older we all get
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little things here and there
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but not with the continuity that you as
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a claimant who's on long-term disability
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have
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how important is it when you get
[542]
involved with the claimant on in
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completing the attendant physicians
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attending physician statement
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and how do you work with the doctor and
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the claimant to make sure
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that everything is in that form the way
[553]
it should be well the attending
[554]
physician statements
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is a very very important form because
[557]
it's it's basically
[559]
the medical update they're getting from
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your doctor it's going to be asking you
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about
[563]
you know what restrictions and
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limitations you you continue to have
[567]
you know information about your your
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frequency of treatment any medications
[571]
you're on
[572]
of course all that information has to be
[574]
has to be accurate
[576]
the problem sometimes that that i've
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seen is that
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you have a lot of doctors that pass this
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this form along to their medical
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assistant
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or to some nurse to complete and that is
[587]
usually when things
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really get unfortunately um where
[591]
problems come up and and
[592]
things can be misrepresented or or
[596]
they may not complete it uh you know
[598]
accurately and then
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they send that off to to new york life
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and
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you're going to have your claim denied
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and i can't tell you enough i mean if
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there's a reason to get on the phone
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with a doctor it's when they
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at least show or or there may be some
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hesitation on your part that they're
[614]
going to be cooperative that they're
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going to fill this out the way they are
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then you have to get on the phone with
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them then you have to go in and talk to
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them and say
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look this is what's been going on this
[623]
is how this needs to be completed
[625]
because if they complete it
[626]
in any other way once that bell is wrong
[628]
it's wrong you can't go back and change
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it
[630]
you know they're not you try to say oh
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well my doctor put this in by mistake or
[634]
they had some
[635]
some medical assistant complete this and
[637]
she and she made a mistake here
[639]
that's that the opportunity to fix that
[642]
is gone they're going to basically
[644]
assume that what they've represented in
[646]
that initial form that's been submitted
[648]
to them
[648]
is accurate and then the other thing
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seizure that's great about having a
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lawyer
[653]
involved in handling your claim is that
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not only are you educated about how to
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communicate with your doctor not only
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can we call the doctor and be like
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doctor can you know can we discuss this
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form
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but it's the ability to go to the doctor
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and be like look
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this disability benefit i can't work
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this is my livelihood
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i have a lawyer who's guiding me because
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i'm going up against this multi-billion
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dollar company
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and there's a lot there's a lawyers out
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there who do this every day
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and they gave me guidance and they
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suggested the following things or go
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into my medical records
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the doctors appreciate that because they
[687]
know where you're coming from you're not
[689]
speaking necessarily in the
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first person you're speaking third
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person my lawyer told me this
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that if this isn't in the records i'm
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probably going to get my benefits denied
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if the doctor's treating you and
[699]
believes in you they want to support you
[701]
if you have a professional who's giving
[703]
you this advice and telling you things
[704]
that should be in there
[706]
and you're basically referencing your
[708]
lawyer it's very helpful an easier
[710]
manner to open up that line of
[712]
communications with the doctor
[714]
and also knowing where your doctor
[715]
stands will your doctor cooperate
[717]
with your attorney should you need it
[719]
will your doctor be there to help you if
[721]
your benefits get denied
[722]
because at any given time they could be
[724]
denied so it's a great intermediary tool
[727]
to be able to have your lawyer and say
[729]
this is what's going on
[731]
in the claimant forum caesar people
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don't know
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how much is enough information has to be
[738]
put in they feel like if i don't say
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this then they're going to think i'm
[740]
better and i'm disabled
[742]
but there is this balance of what needs
[744]
to be in there and how do you
[745]
work with your clients and what do you
[747]
recommend for
[748]
how you fill out the claimant statement
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that's new york life lasts for once a
[752]
month or every three months it just
[753]
depends on the type of claim
[754]
right and you know these questions are
[757]
often you know
[758]
really general i mean they're they're
[759]
what are your daily activities
[761]
you know what's preventing you from from
[763]
working what is your sickness what is
[765]
your disability
[766]
and i think it's really important
[768]
especially on what you describe in terms
[770]
of
[770]
terms of your activities to to be you
[773]
know
[774]
to represent the truth um and to be
[777]
accurate in what you're you're
[778]
expressing to the
[779]
the disability insurer because they're
[781]
looking for inconsistencies they're
[782]
looking for some way to
[784]
to trip you up new york life is not just
[787]
really these forms are served two
[789]
purposes to update them but then to also
[791]
they're cross-checking this with
[793]
everything you've submitted before
[795]
with everything that's in your medical
[797]
notes and medical records with
[798]
everything your doctors are completing
[799]
to see what's
[801]
what's inconsistent what's not matching
[803]
up because then that's going to give
[804]
them a cause to go and do
[805]
even a deeper review of your disability
[808]
claim so
[809]
it's really important to address each
[811]
question
[812]
truthfully provide them just enough
[814]
information
[815]
you don't want it necessarily like you
[816]
said it's a it's a balance you don't
[818]
want to
[818]
over uh represent or over express what's
[822]
going on or answer over answer the
[824]
question
[825]
and you also don't want to give them um
[827]
you know
[828]
vague statements that isn't giving them
[830]
enough information because then they're
[831]
just going to come back and ask for more
[832]
they're going to say listen we want to
[834]
have an interview with you we want to
[835]
talk to you we're not sure about these
[837]
answers and we really need to
[839]
kind of expand on this we don't get
[840]
what's going on with you
[842]
and a lot of these pharmacies are you
[843]
know they don't really leave enough
[844]
space to explain what's going on so very
[846]
often we'll write a custom addendum
[848]
for the claimant and and that will
[851]
basically say
[851]
see attached and we'll answer the
[853]
questions with the appropriate level of
[855]
detail that needs to be there
[856]
working that fine line between how much
[858]
is too little or too much
[859]
and then every time we get the claim
[861]
forms we go back and tweak
[863]
that particular addendum so it becomes
[865]
even an easier process to fill out that
[868]
claimant statement every time so these
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are just a few of the t
[871]
the tips that we've suggested obviously
[873]
when we're representing a claimant
[874]
there's very specific things that we
[876]
look for in particular depending upon
[878]
what the medical condition is
[880]
depending upon what the definition a
[881]
disability is
[883]
depending upon if the person's total or
[885]
or residually disabled more often than
[887]
not we find they're totally disabled
[888]
with the new york life
[890]
type policy and so we're always there
[892]
for the claimant there's no line of
[894]
communication between the carrier and
[896]
the claimant everything comes through
[898]
our office which is unique people
[900]
love that they don't get anything in the
[901]
mail they don't get any random phone
[903]
calls
[903]
if anything's going to happen it comes
[905]
through us and that provides a lot of
[906]
peace of mind
[907]
so if you have a claim with new york
[910]
life i encourage you to contact either
[912]
caesar myself or any of our lawyers
[914]
we'll provide you with initial free
[915]
consultation and let you know
[918]
right away if we think we can assist you
[920]
i also encourage you to spend a little
[922]
bit of time on our website
[923]
search up new york life look at the past
[926]
cases that we've handled look at the
[927]
lawsuit summaries that we've written
[929]
you can check out reviews from other
[931]
people who have new york life policies
[933]
and see
[933]
the experiences that they've been having
[935]
and hopefully gain some
[936]
information there that could help
[938]
protect your benefits as well as look up
[940]
your medical condition
[941]
or the occupation that you have because
[943]
there's lots and lots of information
[944]
there and the reason we have it there is
[946]
to educate you
[947]
about this process and hopefully the
[949]
more educated you are
[950]
the better position you'll be in to
[952]
protect your benefits from being denied
[954]
by new york life
[955]
so no matter where you live in the
[956]
country we welcome the opportunity to
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speak with you
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and we'll be here should you need us in
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the future thank you
[983]
you
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