Long-Term Disability Benefits Terminated by New York Life
Long Term disability claims are often terminated after a limited record review, especially when the analysis focuses on whether a claimant can perform sedentary work.
In this case, New York Life reversed its decision after an ERISA appeal led by Erik Berger, Partner at Osterhout Berger Daley, demonstrated that the claimant could not sustain full-time employment.
Why New York Life Denied LTD Benefits for a Sedentary Occupation
The claimant, a User Support Analyst, had been receiving Long Term disability benefits due to spinal pathology, radiculopathy, chronic pain, and cognitive impairment.
In June 2025, benefits were terminated. The insurer concluded the claimant could perform sedentary work and transition to alternative occupations based on a transferable skills analysis.
This type of denial is common and often assumes sedentary work can be performed consistently.
Building the Record: Functional Capacity and Spinal Impairment Evidence
On appeal, the focus shifted to developing a record that accurately reflected the claimant’s functional limitations.
This included:
- A Functional Capacity Evaluation demonstrating limitations below sedentary work
- Updated treatment records confirming persistent pain and functional decline
- Treating physician opinions outlining work-preclusive restrictions
Key Functional Limitations That Prevented Sedentary Work
The developed record established that the claimant could not sustain the demands of full-time work, including:
- Limited sitting tolerance
- A need for frequent, unscheduled breaks
- Excessive absenteeism
- Reduced ability to maintain consistent productivity
These limitations directly contradicted the insurer’s conclusion that the claimant could perform sedentary work.
New York Life Reinstates LTD Benefits After ERISA Appeal
After reviewing the fully developed administrative record and legal briefing, New York Life reversed its termination and reinstated Long Term disability benefits.
What This Case Shows About Sedentary Work Denials
In ERISA cases, the issue is rarely whether a claimant can perform a task once. The question is whether they can sustain that activity over a full work schedule.
Assumptions about sedentary work often break down when the record clearly shows limitations in consistency, endurance, and attendance.
Key Takeaways: What Determines Whether a Disability Claim Is Approved or Denied
Osterhout Berger Daley works with attorneys nationwide on ERISA appeals, administrative record development, and federal disability litigation.
If you have a case involving a Long Term disability denial, we’re here to help.