New York Life Disability Insurance Denial is Reversed

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Disability insurance attorney Rachel Alters discusses the importance of ensuring that claimants have strong medical support from their treating physicians.

In a recent California case against New York Life Insurance Company, the court held that New York Life failed to give a legitimate reason, supported by the record, why it rejected the opinions of the plaintiff's treating doctors.

Insurance companies will often hire physicians to review the medical records and render opinions as to why they believe the claimant is perfectly capable of working.

One would think that the doctors that have been treating a claimant for several years would have a greater understanding of the claimant's medical condition, and the restrictions and limitations which prevent them from working, and therefore, their opinions should be given greater weight over a doctor who has never met nor examined the claimant.

But sometimes this just is not the case. The Court held that if there is a disagreement between the treating physicians and the non-treating physicians, the court can disregard the opinions of the treating physicians only if there are "specific and legitimate reasons" for doing so and only if those reasons are supported by the administrative records. Because New York Life failed to provide a legitimate reason, the Court gave deference to Plaintiffs' treating physicians and held that the Plaintiff was disabled under the terms of the policy.

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