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claim denial

Long Term Disability & The Comorbidities Of EDS, POTS & MCAS

Over the years we have represented many clients in Long Term Disability Insurance claims for POTS (Postural orthostatic tachycardia syndrome)  or EDS (Ehlers-Danlos syndrome)or MCAS (Mast Cell Activation Syndrome). Then we started to notice a rise in cases where 2 or all 3 syndromes had been diagnosed. In 2016 Researchers found a genetic mutation that links Ehlers-Danlos …

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Stiff Person Syndrome

Stiff person syndrome (SPS) Stiff person syndrome (SPS) is a rare, progressive syndrome that affects the nervous system, specifically the brain and spinal cord.  Although very rare (Stiff Person Syndrome affects only 1 in a million people), McDonald & McDonald has represented several Long Term Disability Insurance clients who have suffered from SPS. The cause of stiff person syndrome is unknown, …

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experienced disability lawyers

HIRING AN EXPERIENCED LONG-TERM DISABILITY/ ERISA LAWYER

ERISA is a unique statute that applies to employee benefit disputes.   Under the ERISA statute, if your employer-sponsored disability plan denies your disability claim, the case will be litigated in Federal Court under a unique set of rules that often favor insurance companies and Long Term Disability Plan administrators.  So you need to make sure …

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Long-Term Disability Denials of POTS Syndrome Claims

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

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

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 »

Long Term Disability: “Exhaustion of Administrative Remedies”

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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“Physician Peer Reviews” Lead to Wrongful Denial of Disability Insurance Claims

“Physician Peer Reviews” Lead to Wrongful Denial of Disability Insurance Claims A Physician Peer Review is NOT the same as a second opinion or independent medical exam (IME). Essentially, a physician peer review is a tool used by the insurance company to review your Dr’s medical records. Physician Peer Reviews are problematic because the peer …

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Fibromyalgia Disability Advice: How to avoid Long Term Disability Claim Denial

Choosing the wrong type of Doctor to treat your fibromyalgia could cause insurance to deny your disability claim. What type of Doctor should I see for fibromyalgia? Fibromyalgia is a disease that does not offer any objective evidence or test results, therefore the clinical notes recorded by the treating physician become very important to diagnosing …

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