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 …
The difference between ‘Any Occupation’ and ‘Own Occupation’ Read More »
If the insurance company sends you a denial, you have the legal right to an appeal in a long term disability case. The denial letter is really important because that denial letter is going to tell you that you have an ability to appeal. And the ability to appeal is not something that the insurance …
Do Not Appeal Your Long Term Disability Insurance Denial Without An ERISA Attorney Read More »
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, …
Missing Pieces of the Administrative Record – Full & Fair Review under ERISA? Read More »
Recently, a client asked me about my job. Those people who know me know I am bluntly honest. I told the client my job had two shifts: 1) the shift during the day, where I am in hearings, or meeting with clients, or on the phone handling problems. 2) the night and weekend shifts, where …
The Best Part of Being a Disability Insurance Attorney Read More »
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 …
McDonald & McDonald – Long Term Disability Appeals in Ohio and 6 Nearby States Read More »
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.” …
Long Term Disability – Defining “your job” vs. “your occupation” Read More »
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 …
Long Term Disability: “Exhaustion of Administrative Remedies” Read More »
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 …
Long Term Disability Appeal For Cancer Denial – Client Wins! Read More »
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 …
Surveillance and the Functional Capacity Evaluation Read More »
“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 …
“Physician Peer Reviews” Lead to Wrongful Denial of Disability Insurance Claims Read More »
