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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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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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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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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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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 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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