Jessica Wyckoff J.
I NEVER imagined that I would have to…
I NEVER imagined that I would have to take my experience with New York Life Group Benefit Solutions to a public platform just to get someone to seriously review my short-term disability claim. Unfortunately, after weeks of phone calls, medical documentation, physician clarification letters, and an appeal, I feel like I have been left with very few options. I underwent major surgery in July and was initially approved for short-term disability benefits. At my 6-week postoperative appointment on August 27, my physician determined that I was NOT medically ready to return to work. One of my laparoscopic incision sites had opened, I continued to experience significant abdominal and pelvic pain and swelling, and my internal postoperative examination had NOT yet been completed. My physician continued restrictions on lifting, pulling, twisting, prolonged standing, and sitting upright for extended periods. I was also being treated with prescription narcotic pain medication, which created an additional safety concern. I AM A REGISTERED NURSE. I work in home health in a large city. My job is not sedentary. I spend a significant portion of my day driving from patient to patient and performing hands-on nursing duties that require bending, lifting, pulling, standing, walking, and other physical activity. Returning to those responsibilities while still under these restrictions and taking narcotic pain medication was simply not consistent with the restrictions my treating physician had placed me under. My physician did exactly what was requested. He submitted documentation. He sent MULTIPLE clarification letters explaining why my leave needed to be extended and why I was not yet released to return to my normal work duties. Yet I was informed that the medical review continued to focus heavily on the August 27 visit note despite the additional supporting documentation that was subsequently submitted. What makes this situation even more upsetting is the financial damage it has caused. I have spent approximately a MONTH without the short-term disability income I depended on while I was medically unable to work. Bills do not stop because an insurance company is reviewing a claim. My responsibilities to my family do not disappear. I should not have to choose between following my physician’s postoperative restrictions and being able to financially provide for my household. I have now appealed this decision. I am requesting that New York Life Group Benefit Solutions conduct a FULL and FAIR review of my claim using ALL of the medical evidence—not simply one office note. Review my physician’s clarification letters. Review my restrictions. Review my medications. Review the physical requirements of my occupation. Review the fact that my treating physician did not release me to resume normal activities until my subsequent postoperative examination. I am not asking New York Life for a favor. I am asking for my claim to be evaluated fairly based on the complete medical record and the actual demands of my occupation. I have tried to handle this privately and through the appropriate channels. Taking this publicly was NOT my first choice, but after weeks without benefits and repeated attempts to get this resolved, I feel that my concerns deserve to be heard. I am asking someone in New York Life Group Benefit Solutions leadership or the appropriate appeals/escalation department to review what has happened with my claim and address this matter. I WILL update this review publicly if New York Life steps in, thoroughly reviews the complete documentation, and resolves this matter appropriately. I sincerely hope I am given the opportunity to do exactly that.

