If you are seeking benefits under an employer-sponsored insurance plan covered by ERISA, you can benefit from contacting a Baton Rouge ERISA lawyer to help you navigate the claims process.
If your claim for ERISA-covered benefits gets denied, you need to speak with a knowledgeable lawyer who can advocate for your rights when appealing the denial of your claim. At J. Price McNamara ERISA Insurance Claim Attorney, our dedicated and skilled team has decades of experience in handling legal cases arising from ERISA.
We understand the stress and frustration that follows after finding out that your insurer denied your ERISA claim. For this reason, we dedicate all of our resources, experience, and energy to protect those who need benefits in Baton Rouge.
Schedule a free case review with our Baton Rouge ERISA lawyers to discuss your particular situation. We can help you with a wide range of issues arising under the Employee Retirement Income Security Act, particularly the group long-term disability insurance benefits you may have through your employer, union, or trade association.
Since we work on contingency, you will owe us nothing if we cannot help you receive your benefits. Call to receive a Free Denial Review today.
What Does ERISA Mean?
Over 392,000 Baton Rouge residents have jobs, and many of them receive benefits covered by ERISA. ERISA, which stands for the Employee Retirement Income Security Act, covers many private sector employee benefit plans.
The Employee Retirement Income Security Act (ERISA) is a federal law enacted in 1974 that governs employer-sponsored insurance plans that provide health, disability, retirement, and other benefits to employees. ERISA only covers insurance plans provided by private employers.
ERISA aims to protect employee pensions, disability benefits, and other employer-provided benefits.
Many ERISA-based claims involve:
- Short-term and long-term disability insurance
- Life insurance
- Retirement benefits
- Accidental Death and Dismemberment (AD&D) insurance
While ERISA protects employees covered by ERISA, it also sets strict requirements for participants and beneficiaries who qualify for ERISA-covered benefits. ERISA does not require employers to purchase specific insurance plans to provide benefits to their employees. Instead, the Act sets minimum requirements for employer-funded policies.
ERISA does not cover all employer-provided plans, which is why it is advisable to consult with an attorney to determine if your coverage is under the Act. Even if your insurance plan is covered by ERISA, you may still have a hard time getting your claim approved. Your employer’s insurance company may deny your claim.
If you received a denial of ERISA-covered benefits from the insurer, contact a skilled lawyer right away. Our Baton Rouge ERISA lawyer, J. Price McNamara, aggressively advocates for your rights during the claims, administrative appeals, or litigation process.
Which Benefit Plans Are Under ERISA?
As mentioned earlier, ERISA does not apply to all benefit plans. Originally, ERISA covered only pensions. Today, various kinds of benefit plans are subject to the Employee Retirement Income Security Act (ERISA).
According to the U.S. Department of Labor, ERISA applies to more than 680,000 retirement plans, 2.4 million health plans, and 2.4 million welfare benefit plans.
The following benefit plans are subject to ERISA:
- Health plans
- Welfare benefit plans
- 401(k) plans
- Pension plans
- Cash balance pension plans
- Traditional pension plans
- Defined benefit pension plans
- Employee stock ownership plans
- Hospital and higher education plans
When seeking benefits under an ERISA-covered plan, it is critical to follow all applicable claim procedures and deadlines.
How to File an ERISA-Based Claim in Baton Rouge?
29 U.S.C. § 1024 provides that participants and beneficiaries of ERISA-covered benefit plans have a right to request copies of plan materials, including a copy of the Summary Plan Description (SPD). It is advisable to request a copy of the SPD before filing a claim for ERISA-covered benefits.
SPD can provide you with critical information such as:
- The benefits to which you are entitled
- The filing procedures
- The filing deadlines
- Information about your right to appeal if your claim gets denied
You must follow the specific claim procedures outlined in the SPD when filing a claim. Failure to comply with the requirements could result in the loss of your right to collect the benefits. If this happens, the plan administrator may deny your claim.
Hiring a Baton Rouge ERISA lawyer is of utmost importance when filing a claim. Your attorney will make sure that you follow all the applicable procedural requirements when pursuing your claim. A lawyer will help you gather the necessary information and evidence to strengthen your claim and help you obtain the benefits you deserve.
After submitting your ERISA-based claim, two things can happen:
- Your claim gets approved. If this happens, the plan administrator will send you written notice. You will begin receiving the benefits shortly after the notice.
- Your claim gets denied. You will receive a denial letter that includes a written explanation of the reasons behind your claim denial. The letter will also advise you on your next steps if you wish to appeal the plan administrator’s decision.
If your claim gets denied, do not hesitate to speak with a knowledgeable ERISA lawyer to discuss your options. Your attorney will help you pursue a successful administrative appeal within the deadline.
Under the Employee Retirement Income Security Act, there is the legal requirement to exhaust your administrative remedies before filing a lawsuit in federal court. Your attorney will protect your rights in ERISA litigation if the administrative appeal is unsuccessful.
Related Read: ERISA Claims and Appeal Process [Guide]
What Are the ERISA Fiduciary Responsibilities?
A fiduciary is any person using discretion in managing and administrating ERISA-covered plans or controlling the plan’s assets. It is vital to understand the fiduciary obligations of the plan administrator and other responsible parties when filing an ERISA-based claim.
Fiduciaries have a duty to process and handle claims in good faith and act in the best interests of participants of ERISA-covered plans.
According to the U.S. Department of Labor guidelines, ERISA fiduciaries have the following responsibilities:
- Making prudent decisions when managing the plan’s assets
- Avoiding conflict of interest
- Paying reasonable plan fees and expenses
- Followhttps://jpricemcnamara.com/overpayment-recovery-under-erisa-what-you-need-to-understand/ing plan requirements consistent with the rules imposed by ERISA
- Diversifying plan investments
If you believe that the plan’s administrator or another fiduciary failed to uphold their fiduciary duties, your attorney can hold the non-compliant party responsible for the breach.
What is the Statute of Limitations for ERISA-Related Claims?
While ERISA itself does not impose any time limits on filing claims under a covered benefits plan, it is essential to check if the plan itself has any statutes of limitations. Most ERISA-covered plans set a time limit for notifying the employer’s insurance company of the intention to pursue a claim.
When seeking short-term disability benefits, the time limit could be as short as seven days from the beginning of your disability. The statute of limitations for a claim seeking long-term disability benefits is often 30 days.
According to 29 CFR § 2560.503-1, an insurance company must decide on a long-term disability claim within 45 days of the claim filing date. If a claim denial happens, ERISA requires an insurance provider to give the claimant 180 days to appeal the long-term disability claim denial.
If the administrative appeal is unsuccessful, the claimant whose ERISA-covered claim got denied can file a lawsuit against the insurance company in federal court. ERISA rules do not specify the statute of limitations for filing lawsuits. For this reason, courts often use the state’s statute of limitations for contracts and judgments. In Louisiana, the statute of limitations for lawsuits involving written contracts is ten years (LA CIV CODE Tit. XXIV, Art. 3499).
Alternatively, each benefit plan governed by ERISA may set its own deadlines for filing lawsuits against the insurer. However, the plan must impose a reasonable deadline. If your claim for ERISA-based benefits got denied, you might want to speak with an attorney to find out how long you have to file a lawsuit in your particular case.
Your attorney will make sure that you follow all applicable procedural requirements and deadlines when appealing the denial of your claim and filing lawsuits in your ERISA-related case.
Why You Need a Baton Rouge ERISA Lawyer
If you are considering filing a claim under an ERISA-covered benefit plan, it is essential to work with a knowledgeable lawyer to gather the necessary documentation and evidence to strengthen your claim.
If the plan’s administrator denies your claim, your Baton Rouge ERISA lawyer will help you appeal directly to the insurance company. ERISA requires beneficiaries to file written appeals before they can file a lawsuit in federal court. For this reason, your lawyer will ensure that you adhere to all procedural requirements when appealing the denial of your claim.
Your appeal must cite and include strong and objective evidence to change the insurer’s decision. However, if your attempts to overturn the insurance company’s denial by filing an appeal are unsuccessful, you will be able to pursue a lawsuit against the insurer.
When the denial of your claim leads to ERISA litigation, your attorney will advocate for your rights and interests when presenting your arguments to the federal judge. Your ERISA lawyer will help you determine if the plan administrator or insurance company breached the fiduciary duties owed to you when handling your claim.
Consider the following reasons to hire an experienced lawyer to help you pursue benefits under an ERISA-covered plan:
- They will carefully review your situation to determine the right course of action
- They will help you understand your rights under your ERISA-based benefit plan
- They will gather the necessary documentation, including medical records, to strengthen your ERISA claim
- They will make sure that you follow the applicable procedural requirements and rules when pursuing benefits
- They will help you calculate the appropriate amount of benefits to which the law entitles you
- They will make sure that the plan administrator and insurance company uphold their fiduciary obligations
You need a Baton Rouge ERISA lawyer to effectively handle your claim and receive the benefits you deserve under your plan. You can schedule a free, no-obligation consultation with our attorney, J. Price McNamara. Mr. McNamara represents ERISA participants and beneficiaries in Baton Rouge, New Orleans, and throughout Louisiana. We also have offices in Houston, Texas.
How J. Price McNamara ERISA Insurance Claim Attorney Can Help You
No one should ever have to deal with the prospect of having their valid claim denied for no reason, especially when seeking short-term or long-term disability benefits. If you are in a situation where a plan administrator or insurance company denied your ERISA-based claim, you have no time to waste.
Our attorney, J. Price McNamara, has decades of experience in handling claims and lawsuits related to ERISA-covered benefit plans. Our law firm boasts enviable results in Baton Rouge and all across Louisiana.
At J. Price McNamara ERISA Insurance Claim Attorney, we:
- Assist ERISA beneficiaries and participants in all aspects of the claims and administrative appeals process;
- Help you understand your rights and obligations under your benefit plan;
- Explain all applicable requirements and procedural involved in the claims process;
- Ensure that you comply with all ERISA-mandated rules;
- Help you appeal the denial of your ERISA-based claim; and
- Represent your interests in ERISA litigation.
We have assisted numerous clients in ERISA-related matters in Baton Rouge. Our goal is to provide our clients with the highest quality legal services at the most affordable rate possible. We want to make sure that your insurance claim gets paid in full without any unreasonable or unnecessary delays.
Our knowledgeable ERISA lawyer has the dedication and skill to provide clients with trusted legal advice and ensure that his clients get proper compensation for their disability and other needs. We have a successful track record of handling all aspects of ERISA claims, including administrative appeals and litigation.
Do not delay a Free Denial Review with our Baton Rouge ERISA lawyer. It is in your best interests to discuss your particular situation with an attorney as soon as possible to ensure a favorable resolution of your claim. Get a free case review by calling (225) 425-7917. Do not risk losing your rightful insurance benefits by failing to seek the proper legal representation.
