When New York Life denied long-term disability benefits to an Ohio insurance claim specialist suffering from long COVID, lupus, and other disabling conditions, the insurance company overlooked the true demands of her occupation. Here’s how BenGlassLaw built a successful ERISA appeal that overturned the denial and restored her benefits.
Case Snapshot
Occupation: Auto Insurance Claim Specialist
State: Ohio
Insurance Company: New York Life
Medical Conditions:
- Long COVID
- Systemic Lupus Erythematosus (Lupus)
- Fibromyalgia
- Chronic Fatigue Syndrome
- Hashimoto’s Thyroiditis
- Vocal Cord Dysfunction
- Interstitial Cystitis
- Peripheral Neuropathy
Claim Type: ERISA Long-Term Disability Appeal
Result: New York Life reversed its denial and approved long-term disability benefits, including payment of past-due benefits.
An Ohio Insurance Claim Specialist Suddenly Couldn’t Do the Job She Loved
For more than ten years, “Rachel” worked as an insurance claim specialist for one of the nation’s largest auto insurance companies. From her home office in Ohio, she spent nearly every workday on the phone interviewing claimants, attorneys, and insured drivers, taking recorded statements, evaluating liability, documenting claim files, and making time-sensitive decisions involving motor vehicle accidents.
Although her position was performed from a desk, it was anything but “light work.” Success in her role required sustained concentration, complex decision-making, excellent memory, continuous verbal communication, and the ability to speak clearly for hours each day.
Rachel had long-term disability insurance through her employer, administered by New York Life Group Benefit Solutions. Like many employees, she never expected to rely on those benefits.
Long COVID and Lupus Made It Impossible to Perform Her Occupation
After contracting Influenza A followed by multiple COVID-19 infections, Rachel’s health deteriorated rapidly. What initially appeared to be a difficult winter developed into several serious medical conditions that affected nearly every aspect of her life.
Her physicians ultimately diagnosed her with:
- Long COVID
- Systemic Lupus Erythematosus (Lupus)
- Fibromyalgia
- Chronic Fatigue Syndrome
- Hashimoto’s Thyroiditis
- Vocal Cord Dysfunction
- Peripheral Neuropathy
- Interstitial Cystitis
One of her most disabling symptoms was the loss of her voice.
Speaking for extended periods caused severe coughing fits, shortness of breath, and vocal fatigue. An ENT specialist identified lesions on her larynx, while other specialists documented persistent fatigue, cognitive slowing, and reduced endurance.
For someone whose occupation depended almost entirely on speaking, listening carefully, processing information, and making accurate decisions throughout the day, these symptoms made performing her job impossible.
Rachel applied for long-term disability benefits under her employer’s ERISA-governed disability plan.
Why New York Life Denied Her Long-Term Disability Claim
On November 3, 2025, New York Life denied Rachel’s long-term disability claim.
The insurance company concluded that because her occupation fell within a “Light Physical Demand Level,” she remained capable of working.
That analysis focused almost exclusively on generic physical requirements such as lifting and sitting.
It ignored the actual duties of an insurance claim specialist, including:
- Continuous telephone communication
- Sustained cognitive focus
- Processing complex factual information
- Making liability determinations
- Maintaining clear speech throughout the workday
- Documenting legally significant conversations
New York Life also relied primarily on a paper review performed by a rheumatologist who never examined Rachel, never spoke with her treating physicians, and never addressed the documented evidence from her ENT, pulmonology, speech pathology, or neuropsychological providers.
Even more concerning, New York Life denied the claim before scheduled neuropsychological testing and a Functional Capacity Evaluation could be completed—despite knowing that both evaluations were imminent.
How BenGlassLaw Built the ERISA Appeal
Because Rachel’s claim was governed by ERISA, the administrative appeal represented the most important opportunity to submit the medical, vocational, and legal evidence needed to protect her right to long-term disability benefits.
BenGlassLaw immediately obtained the complete claim file and began building a comprehensive administrative record.
The legal team gathered records from every treating provider, including specialists at OSU Wexner Medical Center, Cleveland Clinic Arthritis & Rheumatology, Akron General, AndHealth Dermatology, and the Ohio State Long COVID Clinic.
The appeal focused on demonstrating that New York Life had evaluated the wrong occupation.
Rather than accepting the insurer’s generic “light duty” classification, the appeal documented the true cognitive and communication demands of Rachel’s position as an insurance claim specialist.
Additional evidence included:
- Neuropsychological testing documenting cognitive inefficiency and reduced mental endurance
- Detailed statements describing the actual duties of her occupation
- Lay witness statements from family members and friends documenting her functional decline
- A personal statement describing how her illnesses affected her daily life
- Medical evidence explaining the impact of vocal cord dysfunction, long COVID, lupus, and chronic fatigue on her ability to sustain full-time employment
The appeal also challenged New York Life’s attempt to extend the ERISA appeal deadline without satisfying the regulatory requirements for a valid extension.
By building a complete administrative record and preparing litigation simultaneously, BenGlassLaw positioned the case for success whether the insurer reversed its decision or the dispute proceeded to federal court.
The Result: New York Life Reversed Its Decision
Just minutes before a federal lawsuit was scheduled to be filed in the Southern District of Ohio, New York Life reversed its denial.
On May 19, 2026, the insurance company approved Rachel’s long-term disability appeal.
She received the back benefits that had been wrongfully withheld and her monthly long-term disability benefits resumed.
More importantly, she could shift her attention away from fighting the insurance company and back toward managing her health and continuing treatment.
What This Case Demonstrates
Many long-term disability denials involve occupations that insurance companies characterize as “sedentary” or “light duty.”
But an occupation is defined by much more than whether someone lifts ten pounds or sits at a desk.
For professionals whose jobs require sustained concentration, complex decision-making, continuous communication, or specialized cognitive abilities, conditions like long COVID, lupus, fibromyalgia, chronic fatigue syndrome, and vocal cord dysfunction can make it impossible to perform the material duties of their occupation—even if they appear physically capable of sitting at a workstation.
A successful ERISA appeal often depends on proving not only what medical conditions exist, but also how those conditions prevent someone from performing the actual duties of their own occupation.
Denied Long-Term Disability Benefits by New York Life?
If New York Life has denied your long-term disability claim, you may still have an opportunity to overturn that decision through the ERISA appeals process.
At BenGlassLaw, we represent clients nationwide in ERISA long-term disability appeals. We work with clients to develop comprehensive administrative records, obtain the right medical and vocational evidence, and challenge insurance companies that fail to fairly evaluate disability claims.
Because strict ERISA deadlines apply, it’s important to have your denial letter reviewed as soon as possible — something we offer for free. Our team can evaluate your claim, explain your options, and help determine the strongest path forward.