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Gregory Dell and Cesar Gavidia answer common questions about the New York Life disability appeal process. They begin by addressing whether claimants have a legitimate chance of getting a denial reversed, with Gavidia emphasizing that success is absolutely possible but depends entirely on how the appeal is built. The first step is always requesting the full administrative claim file to understand exactly why the denial occurred — what reports were used, which medical consultants were involved, and whether a treating provider may have inadvertently given the insurer ammunition by downplaying restrictions.
The attorneys also address whether someone can return to work and still appeal a denial. Gavidia explains that claimants can go back to work out of financial necessity while still pursuing their appeal, though the situation is complicated and fluid. Many people feel bullied into returning because the insurer has cut off their income, but going back doesn’t automatically forfeit the right to challenge the denial. He advises claimants to have honest conversations with their doctors before making that decision. On timing, New York Life has 45 days to decide an appeal, with the option to extend another 45 days — extensions that are often caused by the insurer’s own delays in getting reviews completed, not by anything the claimant did.
A central theme of the discussion is the flawed appeal review structure itself. Dell and Gavidia point out that New York Life’s appeal specialists almost invariably defer to the opinion of whatever doctor the company hires, regardless of how much supporting evidence the claimant submits. These specialists typically lack the medical training to independently weigh competing opinions, effectively making them file clerks rather than true decision-makers. Because of this reality, the attorneys explain that they build every appeal with litigation in mind — anticipating the denial will be upheld and ensuring the record is strong enough that a judge reviewing the file will find the claimant’s evidence more persuasive.
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📰 This article is sourced from a trusted insurance industry publication. Legacy Life Insurance Group shares this for informational purposes only. Always consult a licensed advisor for personalized guidance.