If your employer provides disability insurance, The Employee Retirement Income Security Act (ERISA) will play a huge role in helping a short or long-term disability claim succeed. You’ll want the help of a New Orleans, Louisiana, short and long-term disability insurance attorney who knows ERISA in and out and can also help you get the benefits you have coming.
J. Price McNamara is that attorney. He has more than 30 years of experience helping people who have heard the terrible news that an insurer has denied their legitimate claim. He won’t stop until he’s done everything possible to help achieve a successful outcome. Call our office at (504) 420-6962 for a free consultation.
New Orleans Short And Long-Term Disability Insurance Guide
- Why Choose Our New Orleans Short and Long-Term Disability Insurance Attorneys?
- How ERISA Protects Your Rights
- Why You Need a Skilled Attorney After a Claim Denial
- Pre-Existing Condition Exclusions in Disability Insurance Claims
- How an Independent Medical Examination Can Impact Your Disability Claim
- What to Expect if Your Disability Claim Goes to Court
- How Your Lawyer Will Help You Prepare
- Find Out More By Consulting J. Price McNamara
Why Choose Our New Orleans Short and Long-Term Disability Insurance Attorneys?
With 30 years of experience fighting insurance companies, J. Price McNamara is the trusted advocate you need on your side. Recovering denied insurance benefits is 100 percent of what we do. As a former insurance company attorney, our founder knows exactly what tactics the insurance company will use to deny your claim. But we're here to tell you what you should do instead.
Don't lose hope if your claim has been denied. We offer free consultations to answer any questions you may have. Our team of skilled attorneys understands ERISA and insurance law and will fight tirelessly to overturn your denial. We act as your mentor and guide, empowering you to make informed decisions and achieve the results you deserve.
Don't let the insurance company dictate your next move - choose J. Price McNamara and regain control of your claim.
How ERISA Protects Your Rights
President Gerald Ford signed ERISA into law in 1974 to protect the rights of employees and ensure the fair administration of employee benefit plans, including retirement plans, health insurance, and disability insurance. This law protects employees’ benefits and promotes transparency, accountability, and fairness in managing these plans.
Lawmakers created ERISA in response to widespread mismanagement and abuse in employee benefit plans. Its primary purpose is to protect the interests of employees by setting minimum standards for plan administration, ensuring administrators manage funds responsibly and that participants receive the benefits they’re entitled to. Here’s how ERISA protects a claimant’s rights:
Fiduciary Responsibilities
ERISA imposes strict fiduciary responsibilities on those who manage and control plan assets. Fiduciaries, including plan administrators and trustees, must act solely in the interest of plan participants and beneficiaries.
They must adhere to principles of prudence, diversification of plan investments, and compliance with plan documents. If fiduciaries fail to meet these obligations, they can be held personally liable for any losses incurred.
Your Right to Information
One key protection under ERISA is the right to receive detailed information about your benefit plan. Plan administrators must provide participants with essential documents, including summary plan descriptions (SPDs), annual reports, and statements of accrued benefits. This transparency ensures you’re fully informed about your rights, benefits, and the plan’s financial status.
Claims and Appeals Process
ERISA mandates that benefit plans establish a fair and transparent process for filing claims and appeals. If an insurer denies a claim, the plan must clearly explain the denial and outline the steps required to appeal the decision. This mandate ensures that participants have a fair opportunity to challenge adverse decisions and seek their rightful benefits.
Legal Recourse
ERISA also grants participants the right to sue for benefits and breaches of fiduciary duty. You can file a lawsuit in federal court if you believe the insurer wrongfully denied your benefits or a fiduciary has mismanaged plan assets. This legal recourse is a powerful tool for holding plan administrators accountable.
Protection from Retaliation
Companies that provide disability insurance can’t retaliate or discriminate against claimants for exercising their ERISA rights. The law prohibits employers and plan administrators from taking adverse actions against employees who file claims, appeals, or lawsuits.
Why You Need a Skilled Attorney After a Claim Denial
Experiencing a denial of your disability insurance claim can be incredibly disheartening, especially when you rely on those benefits to support yourself and your family.
Appealing a denied claim under ERISA is complex and requires a thorough understanding of the law and the intricacies of insurance policies. This is where our skilled New Orleans, Louisiana, short and long-term disability insurance attorney can be indispensable. Here are a few reasons you need legal help immediately.
Navigating Complex Regulations
ERISA regulations include specific procedures for filing claims, appealing denials, and litigating disputes.
A lawyer who thoroughly understands ERISA, such as J. Price McNamara, knows the rules. He’ll make sure your appeal complies with all legal requirements. This experience is crucial for avoiding procedural errors that can jeopardize your claim.
Developing a Strong Appeal
A significant part of overturning a denial involves presenting a compelling appeal that addresses the reasons for the initial denial. This often requires gathering additional medical evidence, obtaining expert opinions, and crafting detailed legal arguments.
Our New Orleans, Louisiana, short and long-term disability insurance attorney has the experience and resources to build a solid case, identify the weaknesses in the insurer’s decision, and reinforce your claim with substantial supporting documentation.
Ensuring Procedural Compliance
ERISA imposes strict deadlines for filing appeals and submitting additional evidence. Missing these deadlines can result in the permanent loss of your right to appeal.
- Price McNamara will keep track of all critical dates and file all documents on time. He’ll also ensure that the appeal letter and supporting evidence meet all procedural requirements.
Legal Advocacy and Representation
If the insurer denies your appeal, the next step may involve filing a lawsuit in federal court. ERISA litigation is highly complicated, requiring detailed knowledge of federal court procedures and ERISA case law.
Our experienced New Orleans, Louisiana, short and long-term disability insurance attorney can represent you in court, advocating to increase your chances of a favorable judgment. They can also negotiate settlements and handle all legal correspondence with the insurer.
Reducing Stress and Uncertainty
Dealing with a claim denial is stressful, especially when you’re already coping with a disability. Having a lawyer by your side can alleviate some of this burden, providing peace of mind and allowing you to focus on your health. Your attorney will handle the legal issues, keeping you informed and involved without overwhelming you with procedural details.
Pre-Existing Condition Exclusions in Disability Insurance Claims
Pre-existing condition exclusions in disability insurance policies limit or deny coverage for conditions that existed before the insurance policy was in effect. Insurers design these exclusions to avoid paying benefits for disabilities related to conditions the policyholder didn’t know or disclose before the policy was issued.
Insurers typically define a pre-existing condition as any illness or injury for which the claimant received medical treatment or advice within a specified period before the policy’s start date, usually six months to a year.
How Pre-Existing Condition Exclusions Work
When a claimant files a disability insurance claim, the insurer reviews the medical history to determine if the disability occurred due to a pre-existing condition. If the insurer finds that’s the case, they may deny the claim based on the pre-existing condition exclusion clause.
Strategies for Claimants With Pre-Existing Conditions
However, just because the insurer decides to deny your claim based on a pre-existing condition, that doesn’t mean you’re out of legal options. Our New Orleans, Louisiana, short and long-term disability insurance attorney can still help you get justice.
For example, we will work to ensure that your medical records clearly distinguish between your pre-existing condition and your current disability. Detailed and up-to-date medical documentation can help show that your current disability isn’t related to a pre-existing condition.
Our experienced New Orleans, Louisiana, short and long-term disability insurance attorney can help you compile evidence, interpret policy language, and present a strong case to the insurer that your disability isn’t related to a pre-existing condition.
Legal Precedents Can Help Your Case
Previous court decisions can also help you successfully overcome pre-existing condition exclusions. For example, in Glista v. Unum Life Insurance Company of America, the court found that the insurer had not provided sufficient evidence to link the disability to a pre-existing condition. J. Price McNamara can use this and other legal precedents to help show the insurer wrongly cited a pre-existing condition when denying your claim.
How an Independent Medical Examination Can Impact Your Disability Claim
An independent medical examination (IME) is often critical in the disability insurance claim process. Insurance companies typically require claimants to undergo an IME to obtain an unbiased evaluation of their medical condition. Here’s a detailed look at what an IME entails, why insurers require them, how to prepare, and the potential impact on your disability claim.
What an IME Entails
An IME involves a physical or mental examination conducted by a medical professional not involved in the claimant’s care. The insurer typically selects and pays for the physician.
The purpose of the IME is to objectively assess the claimant’s medical condition, focusing on whether the condition qualifies for disability benefits under the policy’s terms. The examiner reviews the claimant’s medical history, conducts a thorough physical or mental evaluation, and may perform additional tests as needed.
Insurance companies use IMEs to:
- Verify the severity and legitimacy of the claimant’s condition.
- Determine if the claimant meets the policy’s definition of disability.
- Assess whether the claimant’s condition has improved or deteriorated.
- Provide a basis for approving, denying, or continuing disability benefits.
How to Prepare for an IME
Our New Orleans, Louisiana, short and long-term disability insurance attorney will completely prepare you for your IME appointment and answer any questions regarding the process.
In most cases, if you do the following, you’ll prepare yourself should the insurer try to use the results of your IME to deny your claim.
- Know your medical history: Be familiar with your medical records and history. Bring copies of relevant medical documents, including previous doctor’s reports, test results, and treatment plans.
- Be honest and consistent: Answer questions truthfully and consistently. Exaggerating symptoms or providing inconsistent information can harm your credibility.
- Understand the process: Know what to expect during the examination. The examiner may ask about your medical history, symptoms, daily activities, and treatment. They’ll conduct a physical or mental assessment to evaluate your condition.
- Document the examination: After the IME, write down details of the examination, including the questions asked, tests performed, and the examiner’s behavior. This documentation can be helpful if you need to dispute the IME report later.
The Impact of IME Results on Your Disability Claim
The results of an IME can significantly influence your disability claim. A favorable IME report can support your claim, providing additional evidence of your disability. On the other hand, the insurer can use an unfavorable IME report to deny or terminate benefits. Insurance companies often give considerable weight to IME findings, so the report can be pivotal in decision-making.
Given the potential impact of an IME, having legal guidance is crucial. Our experienced disability insurance attorney can:
- Prepare for the IME by explaining what to expect and advising you on accurately presenting your condition.
- Review the IME report for accuracy and fairness.
- Challenge any discrepancies or inaccuracies in the IME findings.
- Advocate on your behalf if the insurer uses the IME report to deny or terminate your benefits unjustly.
What to Expect if Your Disability Claim Goes to Court
If the insurer denies your ERISA disability claim and you’ve exhausted all internal appeals, litigation may be the next step. Here’s an overview of what to expect during the ERISA litigation process, potential outcomes, and how your New Orleans, Louisiana, short and long-term disability insurance attorney will help you prepare.
The Litigation Process for ERISA Disability Claims
The process begins with your attorney filing a complaint in federal court against the insurance company. The complaint outlines your claim, the denial, and the legal grounds for your lawsuit.
Other steps include:
- Motions and briefs: Both parties may file motions and briefs. Common motions include motions for summary judgment, where one party seeks a judgment in their favor without a trial based on the administrative record.
- Discovery: Although limited in ERISA cases, discovery may include depositions, interrogatories, and requests for documents to clarify the administrative record.
- Court hearings: The judge may hold hearings to discuss motions and review the case. Judges, not juries, typically decide ERISA cases.
- Judgment: The judge will rule based on the administrative record and legal arguments presented. This ruling can uphold the denial, reverse it, or remand the claim back to the insurer for further review.
How Your Lawyer Will Help You Prepare
New Orleans, Louisiana, short and long-term disability insurance attorney J. Price McNamara will build the strongest possible case by:
- Including all relevant medical evidence and documentation in the administrative record
- Crafting compelling legal arguments and representing your interests effectively in court
- Guiding you through each step, keeping you informed and prepared for hearings and potential outcomes
Find Out More By Consulting J. Price McNamara
As you can see, ERISA litigation is a complex process requiring thorough preparation and trusted legal representation. New Orleans, Louisiana, short and long-term disability insurance attorney J. Price McNamara will handle all obstacles and improve your chances of a favorable outcome.
Use our online form or call (504) 420-6962 for a consultation.