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disability denial

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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How Can I Be Disabled Yet Still Denied My Disability Insurance Benefits?

How can I be disabled but still be denied my insurance disability benefits? This is really a good question and the person asking the question is typically the disabled person. You have a lot of scenarios where the individual literally, genuinely, feels like they’re not going to be able to work. If you wanted a …

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

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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Reinstating your Long Term Disability Benefit: The ERISA 502(a) Lawsuit

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: “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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Surveillance and the Functional Capacity Evaluation

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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“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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