If you have received a letter from NYL during the appeal process that seems like it is denying your appeal, but also giving you an opportunity to respond to medical reviews, do not ignore it. We call this the pre-denial letter.
Keep in mind that if NYL’s medical reviews concluded you are disabled, then the insurance company would approve your claim for benefits. Therefore, because you are receiving a pre-denial letter, you know that an unfavorable review exists.
After obtaining the unfavorable reports from NYL, we will work with you, your treating doctors, and independent experts, when necessary, to respond.
Sometimes it is as simple as clarifying your restrictions and limitations, other times it requires an in-depth response with additional medical information. We will work together to determine the best way to respond.
Keep an eye on the deadlines
It is also important to keep all deadlines and timelines in mind. In cases governed by ERISA, once you have appealed the initial denial of your LTD benefits, the insurance company has 45 days to respond, unless they take an extension.
- Under ERISA, the insurance company may ask for one 45-day extension. Therefore, after at most 90-days, the insurance company must render a decision.
- Ifthe insurance company fails to decide your claim within the requisite time frame, your claim is “deemed exhausted” and our firm may help you file a complaint in court under ERISA § 502(a)(1)(B).
If your claim was submitted after April 2018, then NYL is required to give you an opportunity to respond to any adverse evidence generated during the appeal. This includes unfavorable medical reviews. Do not miss an opportunity to strengthen your case by responding to the pre-denial letter.
NYL will give a timeframe under which you have to respond. If additional time is needed, you may request it. However, do not just let the time pass without responding at all. That could be detrimental to your claim.
Get Help from a Lawyer with Expertise in Disability Insurance
Disability insurance law is complex. Hiring an experienced disability attorney is important. Because all disability lawyers at this law firm focus on disability insurance claims, we have expertise in disability insurance law.
That means we have:
- Experience with every major disability insurance company;
- A proven track record of success by winning major disability lawsuits;
- Recovered millions of dollars in disability benefits for clients;
And, we never charge fees or costs unless our clients get paid.
The firm can help at any stage of your disability insurance claim, including:
- Submitting a disability insurance claim,
- Appealing a long-term disability denial,
- Negotiating a lump-sum settlement, or
- Filing a lawsuit against your disability insurance company.
Because federal law applies to most disability insurance claims, our lawyers are able to represent clients across the country.