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Insurance Denial

Long-Term Disability Denials of POTS Syndrome Claims

September 9, 2015 / By

Over the past few years we have represented many clients who have had Long Term Disability Insurance Denials of their POTS Syndrome claims. POTS or “Postural Orthostatic Tachycardia Syndrome” is an unusual condition that causes the Autonomic Nervous System to malfunction. POTS symptoms can include tachycardia, heart palpitations, chest pain, fainting, nausea, rapid gastric emptying, …

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Pulmonary Lung Disease Testing for Long Term Disability Claims

May 28, 2015 / By

Obstructive & Restrictive Lung Diseases:  The Importance of FEV¹ & FVC test results for Long Term Disability Insurance Claims If you have a pulmonary disorder, one of the most important tests that you will take is a PFT or Pulmonary Function Test. This test is somewhat complicated and measures many aspects of lung function. The …

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Missing Pieces of the Administrative Record – Full & Fair Review under ERISA?

July 14, 2014 / By

ERISA “Full & Fair Review” & the Missing Pieces of the ADMINISTRATIVE RECORD One of the most important pieces in a long-term disability case is the “administrative record.” The administrative record is defined as: everything that the insurance company considered in the denial of your claim. It also includes any appeal that you might submit, …

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Court Decides Liberty’s Denial of Our Client’s Waiver of Life Insurance Premium Did Not Meet “Full and Fair Review” Standard Under ERISA

August 20, 2013 / By

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 …

Court Decides Liberty’s Denial of Our Client’s Waiver of Life Insurance Premium Did Not Meet “Full and Fair Review” Standard Under ERISA Read More »

McDonald & McDonald – Long Term Disability Appeals in Ohio and 6 Nearby States

February 27, 2013 / By

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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Long Term Disability – Defining “your job” vs. “your occupation”

September 21, 2012 / By

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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Long Term Disability: “Exhaustion of Administrative Remedies”

May 24, 2012 / By

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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Long Term Disability Appeal Cancer Win

Long Term Disability Appeal For Cancer Denial – Client Wins!

March 8, 2012 / By

Long Term Disability Appeal For Cancer Denial – Client Wins! McDonald & McDonald Wins Long Term Disability case in Federal Court for Disabled Client! See Spina v. CVS Long Term Disability et al In 2011 the United States District Court for the Southern District of Ohio ruled in favor of our client, who suffers from …

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Surveillance and the Functional Capacity Evaluation

October 28, 2011 / By

This has been on my mind for some time and I have been trying to let my clients and perspective clients know about this so they can respond appropriately. Many insurance companies use vendors to conduct video surveillance while the disability claimant is at their home. There is simply no way to tell which files …

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