New York Life Insurance Company: 2025 Long-Term Disability Guide

Dealing with long-term disability claims can be challenging, especially when navigating through the specific processes and rules of major insurance providers like New York Life Insurance Company (NYLIC).

This comprehensive guide covers everything Canadians need to know about NYLIC’s long-term disability (LTD) benefits, including how to apply, what happens after two years of receiving benefits, the payment schedule, and how to appeal a denied claim.

If you’re covered under NYLIC group benefits or hold an individual policy, this guide will provide essential insights to help you secure the financial support you deserve.

Complete guide to NYLIC long-term disability claims

About NYLIC and long-term disability

NYLIC is a major North American insurance provider — offering a broad range of services, including long-term disability (LTD) benefits.

Headquartered in New York City, New York, NYLIC supports millions of clients in Canada and the U.S.

NYLIC long-term disability benefits

NYLIC’s long-term disability insurance is designed to provide financial support to individuals who are unable to work due to a serious illness or injury. These benefits help replace a portion of your income while you focus on recovery.

The insurer offers two primary types of LTD policies:

• Group Insurance Plans: These plans are typically provided by employers as part of workplace benefits packages. Your long-term disability benefits in this plan will depend on the specific terms laid out in the group benefits booklet or certificate of insurance. It’s crucial to review this document, which should be available from your employer or union, to understand the details of your coverage.
• Individual Insurance Plans: This type of plan is tailored for self-employed professionals, business owners, or executives. Individual disability insurance provides customized benefits, and you are responsible for purchasing the policy through an insurance broker. These policies can offer higher coverage amounts and more flexible terms.

NYLIC’s long-term disability benefits typically kick in after short-term disability benefits or other forms of income support, such as Employment Insurance (EI), have been exhausted.

Whether you’re covered under a group or individual plan, understanding your policy is key to ensuring you receive the financial support you need during a disability.

• LEARN MORE: Going from short-term disability to long-term disability FAQ

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How to apply for NYLIC long-term disability benefits

Applying for LTD benefits is a critical step if you’re unable to work due to illness or injury.

NYLIC’s claims process requires specific documentation to demonstrate your medical condition and inability to perform your job.

Whether you are covered under a group benefits plan or an individual policy, understanding the process is essential to avoid delays or denials. Learn how to obtain your LTD policy here.

Step-by-step guide to applying for NYLIC LTD benefits

1. Gather the required forms

You will need to obtain several forms before submitting your LTD claim. These include:

• Employer statement: This form is completed by your plan administrator (typically your employer). It outlines the details of your employment and benefits coverage.
• Employee statement: You, the employee, must fill this form out. It provides information about your health, job responsibilities, and how your condition prevents you from working.
• Initial attending physician’s statement: Your doctor will need to complete this form, which details your diagnosis, treatment, and how your medical condition affects your ability to work.

2. Submit your claim

Once the necessary forms have been completed, you can submit them online or by mailing the physical documents.

Submitting online is faster and allows you to track the progress of your claim.

3. The waiting period (elimination period)

After submitting your LTD claim, you will typically have to wait through an elimination period (also referred to as the qualifying period), which can last between 90 to 180 days — depending on your policy.

During this time, you may continue to receive STD benefits, or other forms of financial assistance, until your LTD benefits kick in.

4. Approval or denial of your claim

It usually takes five to 20 days to process LTD claims, but it could take longer depending on the complexity of the case or if additional documentation is required.

If NYLIC denies your LTD claim, their rationale should be provided in writing. If you’re informed of the decision over the phone, request a denial letter before hanging up.

During this process, you may encounter challenges dealing with adjusters who handle your claim.

It’s important to understand how to communicate effectively and handle any difficulties that arise. Learn more about how to manage difficult adjusters here.

5. What to do if your claim is denied

If your LTD claim is denied, don’t lose hope. You have options to appeal the decision, which will be discussed in detail in the NYLIC appeal process section of this guide. You may need to submit additional medical evidence or clarify certain aspects of your condition to strengthen your case.

You can also get a free consultation with a disability lawyer at Samfiru Tumarkin LLP to understand your options.

Additionally, being on LTD can sometimes raise employment-related concerns, such as how your employer handles your position or benefits during your disability. Find out how employment issues interact with long-term disability claims.

Tips for a successful LTD application

• Ensure complete medical documentation: Incomplete or vague medical records are one of the main reasons LTD claims get denied. Make sure your doctor provides detailed documentation that clearly shows why you’re unable to work.
• Submit forms promptly: Delays in submitting required forms can prolong the approval process. Submit your documents as soon as they’re completed to avoid unnecessary waiting periods.
• Track your claim: If you submit your claim online, you should be able to monitor the status of your application and respond quickly to any requests for additional information.

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NYLIC long-term disability payment schedule

Understanding NYLIC’s LTD payment schedule is essential for financial planning while you’re unable to work due to illness or injury.

The insurer provides monthly payments to replace a portion of your income — helping you cover essential expenses like housing, medical bills, and daily living costs.

How much does NYLIC LTD pay?

Insurance companies typically provide Canadians with 60-80 per cent of their pre-disability gross income.

The exact percentage depends on your specific policy and factors such as your salary, the severity of your condition, as well as the terms outlined in your group or individual plan.

Important factors affecting payments:

• Policy maximums: Some policies have a maximum monthly benefit cap. This means that even if 60-80 per cent of your salary would result in a higher payment, your benefit amount won’t exceed the policy cap.
• Taxable vs. non-taxable benefits: The tax status of your benefits depends on who pays the premium. If your employer pays for your LTD premiums, your payments are likely taxable. However, if you cover the premiums yourself, your LTD payments are typically tax-free.
• Offsets and deductions: NYLIC may reduce your LTD payments if you receive other sources of income, such as Canada Pension Plan (CPP) disability benefits or severance pay. These are called “offsets” and they can lower the amount you receive from NYLIC.

When are payments made?

Canadians typically receive LTD payments on a monthly basis. The payment schedule typically aligns with the approval of your claim.

After your claim has been approved, you can confirm the exact payment date by contacting your NYLIC disability case manager.

Delayed or missed payments

There may be cases where your LTD payment is delayed. Common reasons for payment delays include:

• Incomplete documentation: If additional medical records or forms are required but not provided, this can cause delays.
• Policy review: In some cases, NYLIC may conduct a policy review after a certain period (such as two years on LTD), which could temporarily halt payments until the review is complete.

If your payment is delayed or you miss a scheduled payment, it’s important to:

• Contact your NYLIC disability case manager to inquire about the status.
• If you submitted your claim online, there might be a request for you to provide additional information.

LTD payment schedule after two years

After receiving LTD benefits for two years, insurance companies often reassess your eligibility — as the criteria for “total disability” changes.

The switch from an “own occupation” test to an “any occupation” test occurs at this point.

This reassessment can affect whether you continue receiving payments, which will be covered in more detail in the section about the two-year mark for LTD.

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Checking your NYLIC disability claim status

Keeping track of your LTD claim status is essential to ensure that there aren’t unnecessary delays or issues with your benefits.

Whether you’re waiting for an initial decision or are monitoring your ongoing benefits, there are several ways to check the status of your claim.

Regularly review your online submission

The fastest and most convenient way to check your disability claim status is online.

You can easily track the progress of your claim, view any correspondence from NYLIC, and ensure that your payment schedule remains consistent.

Contacting your disability case manager

If you prefer a more direct approach, or if you have specific questions about your claim, you can contact your disability case manager at NYLIC.

This person is responsible for overseeing your claim and can provide updates on its status.

How to contact your case manager:

1. Phone: You can reach your case manager by phone. Their contact information should be included in any mail or email communication you’ve received from NYLIC regarding your claim.

2. Email: Samfiru Tumarkin LLP recommends that you keep a record of your conversations with your insurer through email communication. Use the address provided by NYLIC to reach out to your case manager directly.

When contacting your case manager, be sure to have your claim number and plan details on hand for quicker service.

Can’t access your claim status? What you need to do

If you aren’t able to check your claim status online, or if you’re experiencing difficulties with your case manager, you can:

• Check your mail or email: NYLIC typically sends important updates about your claim by mail or email. Ensure that your contact information is up-to-date in their system.
• Contact customer service: Reach out to NYLIC’s general customer service department for assistance with account access or claim status inquiries.

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What happens after 2 years of LTD?

One of the most significant LTD milestones is the two-year mark.

At this point, the definition of disability changes — affecting your eligibility for continued benefits.

This is often referred to as the “change of definition” date and it’s a crucial factor in whether NYLIC continues your payments or terminates them.

Change from ‘own occupation’ to ‘any occupation’

For the first two years of receiving LTD benefits, NYLIC evaluates your ability to perform the duties of your own occupation.

However, the definition changes to “any occupation” after two years — checking if you’re reasonably suited for other jobs based on your education, training, or work experience.

This change makes it difficult to maintain continued benefits because NYLIC will no longer focus solely on your ability to perform your original job.

Instead, the insurer will look at your ability to do any role that matches your qualifications.

SEE MORE:
• Return to work and long-term disability FAQ
• 5 common terms you must know before applying for LTD
• List of disability insurance companies in Canada

The reassessment process

As you approach the two-year mark, it’s likely that NYLIC will conduct a thorough reassessment to determine if you’re still eligible for LTD benefits.

This may involve:

• Medical reassessments: NYLIC may request updated medical records from your doctor to evaluate whether your condition has improved or if you’re still unable to perform any occupation.
• Vocational rehabilitation programs: NYLIC may suggest or require participation in a vocational rehabilitation program designed to help you return to the workforce. These programs assess whether you can be trained or retrained for a new job.
• Surveillance or investigations: In some cases, NYLIC may conduct surveillance or other investigations to verify your condition and ensure you are unable to work.
• Independent medical examinations (IMEs): NYLIC may also require you to attend an IME to further assess your disability. Although these are presented as “independent” evaluations, they’re often used by insurers to dispute or deny claims. If you’re asked to participate in an IME, contact our team for a free LTD consultation.

What to expect if your LTD benefits are cut off

Unfortunately, many legitimate LTD claims are incorrectly denied or benefits are cut off after the two-year mark due to the stricter “any occupation” standard.

If NYLIC determines that you can work, your access to disability benefits may be terminated.

Common reasons LTD is cut off after two years:

• Claimants don’t meet the “any occupation” standard.
• Insufficient medical evidence.
• Surveillance or vocational assessments suggest an individual can work.
• Failure to participate in rehabilitation programs, if required.

What to do if your LTD benefits are cut off

If your access to LTD benefits are cut off after two years, don’t throw in the towel.

You have the right to challenge this through appeals or legal action. The appeal process will be discussed in detail in the next section, but key steps include:

• Gathering additional medical evidence to support your case.
• Seeking free legal advice from a disability lawyer at Samfiru Tumarkin LLP to ensure your rights are protected.

If NYLIC is wrongfully denying your benefits, you may still qualify for financial support. It’s crucial to act quickly, as waiting too long could affect your ability to appeal or pursue effective legal action.

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Appealing a long-term disability denial

If NYLIC denies your LTD claim or cuts off your benefits, it’s important to understand that you have the right to appeal their decision.

The appeal process can be complex, but with the right approach, you can increase your chances of securing the benefits you deserve.

Why was your LTD claim denied?

Before starting the appeal process, it’s crucial to understand why your claim was denied or cut off.

Common reasons for denial include:

• Insufficient medical evidence: NYLIC may claim that your medical documentation doesn’t clearly show that you’re “totally disabled.” Here’s what to know about health reports and how they affect your LTD claim.
• Definition change after two years: As discussed earlier, after two years, the definition of disability changes from your ability to perform your “own occupation” to “any occupation.” If NYLIC believes you can perform another job, they may stop your benefits.
• Surveillance or investigations: If NYLIC conducts surveillance and believes you’re capable of working, your benefits may be denied.
• Failure to comply: In some cases, NYLIC may claim that you didn’t follow their guidelines for rehabilitation programs or medical treatments.
• Pre-existing conditions: Your claim may be denied if NYLIC determines that your disability is related to a pre-existing condition. Learn more about how pre-existing conditions impact LTD claims.
• Policy age limit: Most LTD policies have an age limit (often 65). At this point, disability benefits typically stop — regardless of your situation.

The internal appeal process

When NYLIC denies your LTD claim, the first step is to file an internal appeal. This involves requesting a review of your claim by the insurance company.

While this may seem like a straightforward process, there are key points to keep in mind:

• Request a copy of your claim file: You should ask for a complete copy of your claim file from NYLIC. This file contains the evidence they used to deny your claim, including medical reports and any other relevant documentation.
• Submit additional medical evidence: If your claim was denied due to insufficient medical evidence, ask your doctor to provide more detailed information. Ensure all documentation clearly explains your condition and its impact on your ability to work.
• Clarify misunderstandings: In some cases, NYLIC’s internal review may have missed important details or misinterpreted information. You can use your appeal to clarify these misunderstandings.

While internal appeals can be successful in some cases, they’re often not the best long-term solution.

Since you’re asking the same company that denied your claim to change its decision, many claimants find that their appeal is denied again.

Should I appeal or file a legal claim?

Internal appeals are often a drawn-out process with limited success.

Instead, you may have better results by filing a legal claim against NYLIC.

Filing a legal appeal

If your internal appeal fails, or if you choose to bypass it, the next step is to file a claim.

This challenges NYLIC’s denial of your benefits. Here’s what the process looks like:

1. Hire a disability lawyer

Samfiru Tumarkin LLP specializes in long-term disability claims. We’ll handle communication with NYLIC and build a strong case based on medical evidence, legal precedents, and your unique circumstances.

2. NYLIC’s response

Once we file a claim, NYLIC must respond and may introduce a new claim manager to review your case. In some situations, they may reverse their decision (as in the case of our client, Sandra Bullock) and provide compensation.

3. Negotiations and resolution

In nearly all cases, these matters are settled before they ever go near a courtroom. This means you may receive your benefits without a lengthy trial. However, in the rare event the case does go to court, a judge will review all the evidence and make a final decision.

How to strengthen your appeal or lawsuit

• Comprehensive medical evidence: Detailed and updated reports from your healthcare provider are crucial to proving your disability. Be sure your doctors provide thorough documentation of your condition and explain why you’re unable to perform any occupation.
• Vocational assessments: If your claim was denied due to the “any occupation” clause, obtaining a vocational assessment that shows why you can’t work in any capacity can be valuable.
• Legal expertise: Disability claims can be legally complex — especially when dealing with large insurance companies like NYLIC. An experienced disability lawyer at Samfiru Tumarkin LLP can handle the complexities and advocate for your rights.

What NOT to do during an appeal

• Avoid delays: The longer you wait to file an appeal or legal claim, the more difficult it may become to win your case. Be aware of deadlines and start the process as soon as possible. You have two years from the time your claim is denied or cut off to file a claim against the insurance company.
• Don’t rely solely on an internal appeal: While it’s tempting to hope that an internal appeal will resolve the issue, insurers often stand by their initial decision. Get a free consultation with our team before relying entirely on this process.

If you’re denied or cut off LTD by NYLIC, it’s critical to take action quickly.

Whether through an internal appeal or by filing a legal claim, we can help you obtain the benefits you’re rightfully owed during this difficult time.

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LTD denial: Legal alternatives

If your LTD claim has been denied or your benefits have been cut off, you’re not out of options.

In fact, legal action is often the most effective way to secure compensation you’re entitled to when dealing with a large insurance company like NYLIC.

While an internal appeal may seem like the easiest route, a legal claim can provide you with stronger leverage and a more impartial review of your case.

Why consider legal action?

• Impartial judgment: A legal claim means your case is reviewed by an outside party — ensuring fairness and objectivity.
• Stronger leverage: Insurance companies like NYLIC are more willing to settle or approve your benefits once they realize Samfiru Tumarkin LLP is on your side.
• Potential for a larger settlement: In some cases, a legal claim can lead to compensation that goes beyond LTD benefits — especially if the denial was wrongful or in bad faith.

No win, no fee

At Samfiru Tumarkin LLP, we work on a contingency fee basis for LTD cases. This means you don’t pay unless we win.

Our goal is to make sure that pursuing legal action is accessible, with no upfront costs, allowing you to focus on your health while we focus on winning your case.

Negotiation or settlement

Most LTD legal claims are resolved through negotiation or settlement before they ever go to trial.

Our team will negotiate on your behalf to secure the best possible outcome. If a settlement is reached, you will typically receive your benefits or a lump-sum payment to resolve the dispute.

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FAQs about long-term disability claims

When dealing with LTD claims, there are often a lot of questions regarding the process, eligibility, and what to do if your claim is denied.

Below are some frequently asked questions to help guide you through your claim journey. Find more answers in our full LTD FAQ section.

1. Who qualifies for LTD benefits?

To qualify for long-term disability benefits at NYLIC, you must:

• Be covered under a group benefits plan provided by your employer or have an individual LTD insurance policy with NYLIC.
• Have a medical condition that prevents you from performing your own occupation for the first two years of your claim. Learn more about common medical conditions that qualify for LTD benefits.
• After two years, the eligibility changes, and you must be unable to perform any occupation for which you are reasonably suited by education, training, or experience.
• You must also meet any other requirements laid out in your specific policy, such as continuous disability for 90-180 days and proper medical documentation.

2. When should you apply for LTD benefits?

You should apply for LTD benefits as soon as it becomes clear that you will not be able to return to work due to illness or injury.

Typically, LTD benefits begin after the short-term disability (STD) or any other income support has been exhausted, which is usually around 17 weeks.

Make sure to gather all necessary documents, including the Employer Statement, Employee Statement, and Initial Attending Physician’s Statement.

You must wait for a particular period of time before you can switch to LTD. This is called the “elimination period.”

If you’re still disabled and unable to work after the elimination period, NYLIC should approve you for LTD benefits.

3. What happens if NYLIC doesn’t respond to new medical documentation?

After submitting additional medical documentation, it’s critical that NYLIC reviews your claim promptly.

However, if they fail to respond within a reasonable amount of time, this may be treated as an effective denial of your claim.

In such cases, you have the right to challenge their inaction and pursue your benefits.

Don’t wait too long. If you’re not hearing back, get a free consultation with Samfiru Tumarkin LLP to ensure your claim is properly handled.

4. Can NYLIC monitor or investigate my disability claim?

Yes. Insurance companies, including NYLIC, may conduct surveillance or investigate your claim to verify your disability.

This could involve monitoring your activities or reviewing your social media presence. If NYLIC believes you’re capable of working based on this evidence, they may deny your claim or cut off your benefits. It’s important to be honest and consistent in your claim.

For more detailed information on how surveillance works in long-term disability cases, you can explore our guide on LTD surveillance.

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Expert help is standing by

Don’t face an LTD issue alone. The experienced disability law team at Samfiru Tumarkin LLP has successfully represented thousands of Canadians — ensuring they receive the compensation they deserve when dealing with insurance companies like NYLIC.

We also assist clients with related claims, including life insurance, critical illness, and mortgage insurance.

Contact us today for a free consultation and find out how we can support you and protect your rights. Our services extend across all Canadian provinces, excluding Quebec.

Don’t wait – Explore how our experts can help secure your disability claim today.