This case involves a diesel fleet mechanic with severe degenerative disc disease and sciatica whose physically demanding, heavy-duty job became impossible due to chronic back pain supported by clear objective medical evidence (MRIs and imaging). He initially hired a non-specialized law firm that submitted a weak short-term disability insurance application with limited records, leading to a quick denial. They also handled the appeal and long-term disability claim poorly, both of which were denied, and then dropped him. By the time he sought new help, he was beyond the usual 180-day ERISA appeal deadline, but temporary COVID-related Department of Labor deadline extensions preserved his right to appeal.
We rebuilt the claim properly: obtaining full medical records, detailed support letters from treating doctors, a functional capacity evaluation showing he could perform only sedentary work (not his heavy mechanic job), and highlighting flaws in New York Life’s denial, which relied only on in-house nurse and doctor reviews with no independent specialists or functional testing. The comprehensive appeal led New York Life to overturn the denial, pay back long-term and even short-term benefits, and the same evidence supported a Social Security Disability approval. Going forward, the key issue will be the policy’s switch after 24 months from an “own occupation” to an “any occupation” standard, requiring continued strong medical proof to show he cannot perform other gainful work, even at a sedentary level.