Long-Term Disability Claims Against LINA and New York Life Group Benefit Solutions
A long-term disability claim can become difficult when an insurer questions whether the medical evidence supports continued disability, interprets occupational duties differently, or terminates benefits after they have already been paid.
The Law Office of Kevin M. Zietz represents claimants in long-term disability disputes involving Life Insurance Company of North America (LINA) and New York Life Group Benefit Solutions.
LINA was formerly part of Cigna’s group insurance business. In 2020, New York Life acquired Cigna’s group life and disability insurance business, including LINA. Today, LINA is a subsidiary of New York Life Insurance Company and provides group disability coverage through New York Life Group Benefit Solutions.
Because of this history, older disability policies, claim files, correspondence, and other records may still contain references to Cigna. But LINA is no longer a Cigna company.
When LINA Denies Long-Term Disability Benefits
LINA may deny or terminate benefits based on its determination that a claimant no longer satisfies the policy’s definition of disability. Other disputes may involve the sufficiency of medical evidence, functional restrictions and limitations, occupational duties, pre-existing condition provisions, policy limitations, treatment history, or the claimant’s ability to perform an occupation.
A denial letter should identify the reasons for the decision and the policy provisions on which the insurer relied. It may also discuss medical reviews, vocational assessments, surveillance, or other evidence considered during the claim.
Kevin Zietz reviews the insurer’s reasoning together with the policy, medical records, occupational evidence, and available claim-file materials to determine what issues should be addressed in challenging the decision.
Employer-Sponsored LINA Claims and ERISA Appeals
Many employer-sponsored long-term disability plans insured by LINA are governed by the Employee Retirement Income Security Act (ERISA). When ERISA applies, claimants ordinarily must complete the plan’s administrative claim and appeal process before filing an action for benefits in federal court.
The administrative appeal is particularly important because the evidence and arguments submitted during the claim and appeal process generally form the record that will be reviewed if litigation becomes necessary.
An effective appeal may require more than simply asking LINA to reconsider its decision. Depending on the reasons for denial, the appeal may include additional medical evidence, treating-physician opinions, clarification of occupational duties, vocational evidence, responses to medical reviews, or other evidence addressing the stated reasons for denying or terminating benefits.
Our firm’s ERISA practice includes representing claimants in administrative appeals and federal litigation involving employer-sponsored disability benefits.
When LINA Terminates Benefits That Were Previously Approved
Long-term disability benefits may be paid for months or years before LINA determines that a claimant no longer satisfies the applicable definition of disability.
A termination may follow updated medical reviews, surveillance, vocational analysis, additional medical examinations, or a change in the policy’s definition of disability. For example, some policies initially determine disability based on whether the claimant can perform their own occupation, but later require the claimant to establish an inability to perform any occupation as defined by the policy.
The fact that benefits were previously approved does not necessarily prevent LINA from reviewing continued eligibility. However, the reasons for terminating benefits should be carefully compared with the policy language, medical evidence, occupational requirements, and the evidence on which the insurer previously relied in approving the claim.
Legal Help With LINA and New York Life Disability Claims
Kevin Zietz has represented individuals in disability insurance disputes for more than 25 years and handles both individual disability claims and employer-sponsored ERISA claims. Clients work directly with him throughout the claim or appeal rather than having their case passed to a case manager.
If LINA or New York Life Group Benefit Solutions has denied or terminated your long-term disability benefits, the policy language, denial letter, medical evidence, occupational requirements, and governing law can all affect how the decision should be challenged.
Contact the Law Office of Kevin M. Zietz for a free initial consultation. We can review the denial or termination of benefits and discuss the options that may be available for pursuing your long-term disability claim.
