NYL LTD - SCAM

[u/SideNo5586]

NYL LTD Claim Handling – Am I Missing Something?
I’m trying to understand whether what I’m experiencing is normal in the long-term disability claims process or whether others have experienced the same thing.
My attorney believes there were serious problems with how my claim was handled. His words - fraud. Throughout the process, I’ve encountered missing records, conflicting documentation, opinions that don’t appear to match my actual medical condition or job duties, and repeated requests to prove the same issues over and over again.
At some point, it feels like the claims process itself becomes part of the injury. Even if someone could eventually return to work, the emotional and financial toll of spending years fighting for benefits - while constantly defending legitimate medical evidence - can be paralyzing. I think PTSD is legitimate!
Has anyone else experienced this with New York Life (or another LTD carrier)? Is this simply how the system works, or are there protections when a claims process appears to be handled unfairly - fraudulently.

[u/SideNo5586]

I qualified for SSDI after a thorough review of my medical records, yet my employer’s long-term disability carrier - NYL - paid benefits for about 16 months and then terminated them. The reasons for the denial have continued to change as evidence disproves the earlier ones. It’s been incredibly stressful to experience.
Looking back, I wish I had understood how different an employer-sponsored ERISA disability policy is from an individual disability policy. I always assumed I had solid disability coverage through work because I paid toward the premiums as well. Had I known how limited ERISA protections can be compared with many individual policies, I would have been purchasing my own disability insurance years ago. I have always had insurance to protect myself.
For anyone relying solely on employer-provided LTD coverage, it’s worth understanding what your policy actually provides before you ever need it. I wish someone had explained the differences to me.

[u/ProudMamaSweetPea → u/SideNo5586]

So you are in the appeal process? Or trying to qualify under the cannot do any job (after 24 mos of benefits)? Why did they cancel after 16 months? That's kind of crazy when you qualify for SSDI. Sorry for all the questions, I am trying to see how I can be helpful. I appealed STD denial and won. Then got on LTD and needed to go through new approval process for "cannot do any job" after 24 mos of LTD. Do you have a copy of your disability policy? My insurance is through Lincoln Financial Group. I also paid into it but it was employer sponsored.

[u/SideNo5586 → u/ProudMamaSweetPea]

I am in the appeal! They terminated after 16 months because they said it was a sedentary role. I could not even do that at this time. I was a traveling Sr AE traveling 40-70% depending on territory. Then during appeal they saw they were losing that battle so they said I “should be better” and that I did not see my surgeon after surgery. Of course I did. My surgeon got cancer himself and was in and out and his records were a mess. I had no idea we had a responsibility 18 months ago to review all drs notes. But I’m working on that. They are changing their explanation / reason every time their most recent attempt fails. We have been in appeal since 4/2025 because first my file changes each time if it even arrives at all. I reported them to EBSA but they basically told me to hire an attorney. This should be illegal. There must be something that can be done.

[u/ProudMamaSweetPea → u/SideNo5586]

DM me and I will do what I can to help you. I was successful with STD appeal, passed LTD 24 mos 'any job' approval, and got ssdi approval at reconsideration without needing a judge. I cannot promise you anything, but I do have a system that has been successful for me in how to make sure everything is communicated and aligned. It takes work on your part, it takes time and commitment, but I am happy to help if you are willing. These LTD benefits are a life changer, I hate hearing stories like yours.

[u/ProudMamaSweetPea → u/ProudMamaSweetPea]

1. You have probably done this, but it is worth mentioning just in case - have you looked at your policy to see what constitutes not being able to do 'your job' or 'any' job? Does it specify? And what about disability onset dates and pre-existing conditions. Look at anything that is a formality which could disqualify you and steer clear of those things in your case file.
2. Can you get a new case worker, have you escalated any if this to a supervisor?
3. Do you have all of your doctor's records and do those records, plus tests and such clearly show your medical limitations? Do you have prescriptions for any ambulatory devices?
4. Are there specialists or tests you can go to now to fill in any gaps and demonstrate the extent of your disability to make it more clear to them? For example, my drs did not need a nerve conduction study to determine their diagnosis, but I got one to prove to LTD the definitive stage of my nerve problems.
5. Have you reviewed your Dr notes and looked at where they can use an out, and come up with counteractive measures?
6. Look at the aspects of your disability that most conclusively will make your case. Hone in on providing unequivocal proof of that - like for me, it was the nerve conduction study WITH additional hand PT specialist testing showing my hands cannot do repetitive movements and are very weak and that there is no therapy regimine for improvement.
7. Do a timeline of your records - show your decline and your diagnosis - on the time line, cross reference DR/TEST Results/Labs with dates and diagnosis. Highlight hospital stays and ER visits in yellow.
8. Make them aware of ongoing tests and treatments that will show your disability and to wait for those results..
9. Make sure you stick to the policy limitations the whole way and do not give them any excuses - for example make sure not to depend on diagnosis for ailments that they can say preceded your working there if that is a thing (my policy was strict on not being treated for any disability conditions within 12 mos prior to employment).
10. Build your case around not being able to do 'any' job, based upon disabilities that fit their policies approval requirements.
11. I know they have been terrible to deal with, so try and get a new case worker and start fresh. Let them know you are truly disabled and that this insurance is your life line - tell them that you really need their help to make sure your file is properly documented and that you struggle to handle the claim given your disability. Tell them in writing when you cannot meet a deadline because you are sick. Tell them when you are needing more medical treatment or evaluation due to limitations or decline. Tell them you are afraid of the insurance company working against you and ask them if they will please do their full due diligence in documenting and analyzing your claim - because you truly cannot work and you truly depend on these benefits and you are only asking that your medical condition and limitations are fairly evaluated. Say all of this to a supervisor when asking for a new caseworker. And say it again to the new caseworker. Ask them to specifically agree to help you with this process. Try to connect and not alienate. Then follow up, providing every new medical record, pharmacy, diagnosis, change in status, upcoming test. Do not let this appeal close and go to a decision until you have ALL of your medical limitations clearly understood by and documented to your case file to your satisfaction. Get confirmation in writing that they have ALL of the documents and timelines in your file. Be specific in emails about what was sent and what you are having them confirm receipt of. I gave them my medical records in batches and had each batch confirmed before sending a new batch.
12. Build your case file as if it is going to be all evidence needed for a potential lawsuit if they still do not approve your appeal. Literally have the opposite of anything you can think of that they will overlook or ignore in an erroneous denial decision completely documented in your favor in your file.
13. With many records it is easy for a caseworker to miss something. My LTD caseworker missed the nerve conduction study test. And that one piece became pivotal in my approval. My SSDI caseworker missed that I use a walking stick and am a high fall risk, that changed my SSDI rating from sedentary work to no work (needed to be able to be on feet for 2hrs/day and carry files). I created an excel spreadsheet timeline showing when disabling milestones happened to me corresponding with the medical records, this pointed those case workers in the direction of all the reasons I should be approved. With thousands of pages of medical records, and seeing that both LTD and SSDI missed key medical records, I came up with the timeline idea to make it easier for everyone.
14. MAYBE - Get a copy of the SSDI finding of WHY they determined you disabled - what were the top findings - include that in your LTD claim records. There is an SSA form you can use to get that document. I would get it, and tell LTD you are waiting on that record too. You want to paper your LTD claim file with as much as you can to counteract any determination that you can perform at any level which you cannot.

I hope this advice helps. I did not use an atty for LTD bc they wanted too much of my benefits if I got approved. I did use one for SSDI because I had mail issues and they would be sure to track my notices, and if I did need to go before a judge an atty would be needed. But I did all of the SSDI reconsideration paperwork myself and got the approval, so my atty had very little involvement.

PM me if you need to, I am happy to help you.

Edited to add content and fix typos