A technology professional had his long-term disability benefits abruptly terminated by New York Life after more than seven years of continuous, approved payments, despite a worsening psychiatric and physical condition that left him unable to perform even the most basic demands of daily life, let alone any form of employment. He turned to Dabdoub Law Firm, where Attorney Kevin Schaefer prepared a powerful supplemental appeal backed by unanimous support from three long-term treating providers, objective cognitive findings, and a documented medical picture that had only deteriorated since benefits were first approved. Faced with that record, New York Life reversed its termination decision and reinstated our client's benefits in full before we had to litigate.
What to Know About This Case:
- A technology professional with bipolar disorder, ADHD, PTSD with dissociation, and significant physical limitations and cognitive impairments had his long-term disability benefits terminated by New York Life after more than seven years of continuous payments, despite no evidence of improvement and a medical picture that had worsened over time.
- Attorney Kevin Schaefer prepared a supplemental appeal using unanimous conclusions from three long-term treating providers, objective examination findings, and a detailed challenge to New York Life's flawed termination rationale.
- Dabdoub Law Firm secured full reinstatement of our client's long-term disability benefits without the need for litigation.
Seven Years of Disability & An Abrupt Cancellation
Our client had been living with serious psychiatric conditions long before his disability began in February 2018. Over the years, New York Life reviewed his medical records repeatedly and reached the same conclusion each time: that his conditions prevented him from performing the duties of any occupation. For more than seven years, that assessment went unchallenged. Then, without any meaningful change in his medical picture, New York Life reversed course entirely.
His primary diagnoses included bipolar disorder, ADHD, PTSD with dissociation, and complex PTSD, the last of which had grown increasingly destabilizing over time as surfacing memories of childhood abuse added new layers of complexity to an already fragile psychiatric state. He experienced unpredictable dissociative episodes during which he lost all awareness and retained no memory of what had occurred. Active PTSD flashbacks, panic episodes, and severe depression with intermittent manic symptoms had brought him to the verge of rehospitalization on multiple occasions.
Despite taking Adderall at the maximum therapeutic dose, our client demonstrated significant deficits during clinical examinations, including an inability to spell a simple word correctly and serious errors on basic arithmetic tasks. His psychiatrist had tried numerous treatment approaches over more than seven years without achieving meaningful stabilization. In addition to his psychiatric impairments, our client also suffered from tardive dyskinesia, a permanent neurological condition causing involuntary movements, as well as obstructive sleep apnea and insomnia, confirmed by two separate overnight hospital sleep studies.
His physical conditions compounded everything further. Cervical spondylosis with radiculopathy and chronic lower back pain with degenerative disc disease left him unable to sit or stand for extended periods, interfered with his ability to manage basic daily activities, and required regular spinal injections that provided only short-lived relief. Three separate long-term treating providers, including his psychiatrist, his psychologist of more than a decade, and a third treating doctor, each independently concluded that he remained unable to work in any capacity. A federal administrative law judge evaluating his Social Security disability claim reached the same conclusion, too.
Attorney Schaefer Exposes Flaws in New York Life's Termination
New York Life's decision to terminate benefits after more than seven years of continuous payments was not supported by any evidence of improvement. The termination had been driven by the opinions of New York Life's own in-house medical director and nurse case manager, neither of whom had personally examined our client. Remarkably, New York Life's own termination letter had acknowledged that our client's treating providers confirmed he was unable to return to work, drive, perform basic personal hygiene, cook, shop, or manage his own finances, and yet the insurer terminated his benefits anyway. Attorney Schaefer placed that contradiction front and center in the appeal.
Compounding the situation was New York Life's conduct after the termination. When our client requested his claim file so he could understand and respond to the basis for the decision, New York Life withheld it. After Dabdoub Law Firm was retained and formally requested the file, it took New York Life nearly a month to produce a record that had grown to nearly 6,000 pages. The insurer also refused to grant any extension of time to complete the appeal despite those circumstances. The combination of delays and obstruction was identified by Attorney Schaefer as a clear failure of the fiduciary obligations New York Life owed to our client under ERISA.
Attorney Schaefer also challenged two specific arguments New York Life had raised in support of its termination. First, New York Life had attempted, for the first time in seven years, to invoke a Mental Illness Limitation clause in the policy to cap or cut off benefits. The firm countered this on two fronts: several of our client's conditions, including tardive dyskinesia, degenerative disc disease, and his sleep disorders, fall entirely outside the scope of that limitation; and New York Life's own seven-year silence on the provision made its sudden invocation unreasonable and unsupportable. Second, New York Life had pointed to our client's occasional attendance at baseball games and family visits as evidence that he retained meaningful functional capacity. One of his treating doctors addressed this directly, clarifying that those outings were therapeutically encouraged, required significant effort on our client's part, and were separated by many days during which he could not leave his home at all.
The supplemental appeal assembled by Attorney Schaefer presented New York Life with an overwhelming and consistent record consisting of seven years of accepted disability, three unanimous treating providers, objective cognitive findings, a worsening medical picture across every condition, and a Social Security disability determination that New York Life had acknowledged but never meaningfully addressed. Confronted with that record and the clear prospect of federal litigation, New York Life reversed its termination decision and reinstated our client's long-term disability benefits in full.
Lawyers with Expertise in Disability Insurance Claims & Appeals
At Dabdoub Law Firm, disability insurance is all we do. We represent clients nationwide and have successfully handled disability insurance claims involving:
- Long term disability denials and appeals
- Individual disability insurance claims
- Depression and anxiety disorders
- Cognitive impairment and memory loss
- Neurological conditions
- Medication side effects
We have taken on every major insurance company and have built a proven track record of success, including victories in federal court.
Because we specialize in long-term disability, our clients get the benefit of:
- Having an attorney who is an expert in long-term disability claims;
- Having an attorney who has experience with every major disability insurance company; and
- Being backed by a law firm that has a proven track record of winning tough disability lawsuits.
Need Help with a Disability Insurance Claim?
If your disability claim has been denied or you are struggling to navigate the claims process, we can help.
We help with:
- Filing a disability insurance claim
- Appealing denied or terminated long-term disability benefits
- Negotiating a lump-sum settlement
- Filing a lawsuit against your disability insurance company
We represent clients nationwide and charge no fees unless we win your case.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Pay no fees or costs unless you get paid.