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disability benefits appeal

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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The difference between ‘Any Occupation’ and ‘Own Occupation’

Own Occupation & Any Occupation In Long Term Disability Insurance The Misunderstood ‘own occupation’ & ‘any occupation’ definitions in Long Term Disability Insurance policies. Own occupation is typically defined in most insurance contracts as your job as it appears in the national economy. So if your particular job has a feature in it that most …

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Most Long Term Disabilities Are Caused By Chronic Conditions

Chronic Conditions are the Root of Most Long Term Disability Cases Most Long Term Disability Insurance cases are the result of chronic conditions, rather than accidents or injuries. In our experience representing clients in Long Term Disability Insurance cases, very few disabilities are caused by injuries resulting from an accident. Most of our clients have …

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Proposed Changes to Rules Governing ERISA Long Term Disability Claims

Recently the Department of Labor (DOL) proposed some amendments to Section 503 of ERISA (Employee Retirement Income Security Act), to improve the current rules governing Long Term Disability claims and appeals.  Joe sent his comments and recommendations to the DOL with the hope of improving the disability claims process for all of our clients. Here are …

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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 & the Undiagnosed Condition

LONG TERM DISABILITY & THE UNDIAGNOSED CONDITION One of the most difficult cases in our long-term disability practice is the individual who does not have   a diagnosis. It is very common in medicine for claimants to go longer than a year without receiving a proper diagnosis. This is not the fault of physicians, but …

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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 …

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