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Under ERISA, one of the rights you have as a part of your disability benefits claim is the right to a “full and fair review” by the insurance company. In providing a “full and fair review” the insurance company cannot cut corners or rely on generalizations to evaluate your claim.  Instead, the insurance company has…

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INJURED VICTIMS SUFFER TWICE UNDER McCUTCHEN RULING Congress needs to fix resulting unfair outcomes under ERISA subrogation claims (Yes, the tail finally does wag the dog!) On April 16, 2013, the United States Supreme Court issued its long awaited decision in the case of U.S. Airways v. McCutchen,  (No. 11-1285).  The case involved a subrogation…

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Long Term Disability Appeals in Ohio and 6 Nearby States At McDonald & McDonald, we practice ERISA / long-term disability insurance law in several states throughout the Midwest, Mid-Atlantic, & the South.  Our clients have come from a variety of locations and cities. Our law firm is headquartered in Centerville, Ohio, but . .  we have…

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Most individuals become familiar with the phrase 502(a) lawsuit by receiving a letter from an insurance company denying access to their long-term disability benefits. The traditional language often used by long-term disability insurers advises clients that they have “exhausted their administrative remedies”, and now have the ability to file a lawsuit under Section 502(a) of…

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Long Term Disability Insurance – “your job” vs. “your occupation” – understand the difference: THE VOCATIONAL SIDE OF LONG-TERM DISABILITY Frequently, long-term disability contracts provide us with definitions for disabling conditions.  These definitions embrace the idea that your illness or disability affects your ability to perform “your job.”  Occasionally, policies also refer to “your occupation.” …

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Reaching back into our history, I thought the following might be a good decision to share.  This case primarily deals with the often under-litigated issues of exhaustion of administrative remedies and timeliness of the Plaintiff’s Complaint under 502(a) of ERISA. In general, each Long Term Disability plan that issues a denial must have rules that…

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You are not obligated to accept the preferred Social Security representative recommended to you by your Long Term Disability carrier. When you apply for long-term disability benefits, many plans will require that you also apply for and pursue Social Security disability benefits.  The logic behind this request is simple.  They will take an offset for any…

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