You worked hard, completed your schooling, and paid your dues to get where you are as a medical professional, but one injury can take it all away. You’ve spent your career caring for other people, but now you are the one who can use a little help.
Your disability insurance, governed by ERISA, should kick in and help you get the benefits you need while you are sick or injured. Instead, your claim is denied, and you aren’t sure what to do next. Our physicians’ and medical professionals’ insurance lawyers in Baton Rouge can help.
Our ERISA Insurance Claim Attorneys have over 30 years of experience. Contact us today for a free case evaluation and find out how our Louisiana and Texas ERISA lawyer can help.
The Employee Retirement Income Security Act
Physicians and medical professionals often receive disability benefits through employer-sponsored plans regulated by the Employee Retirement Income Security Act (ERISA). While intended to help employees, it can also be overly complex.
ERISA is a federal law that establishes standards for the majority of employer-sponsored benefit plans, such as disability insurance. It aims to safeguard employees by requiring that plans offer clear information, follow fair claims processes, and prioritize the best interests of participants.
It also provides employees with the ability to appeal denied claims and, in some cases, take legal action in federal court if benefits are incorrectly denied. ERISA mainly covers private-sector employers, such as medical professionals employed by a hospital.
For a free legal consultation with a Insurance Claim lawyer serving Baton Rouge, call (225) 201-8311
How an Attorney Can Help
It can be frustrating and confusing when you’re injured and need to apply for benefits, or when your claim is denied for reasons that may be hard to understand. Our physicians’ and medical professionals’ insurance attorneys in Baton Rouge can help you get your claim back on track.
Some of the ways we may be able to assist include:
Help with Your Claim
We can review your policy and explain your rights. The ERISA claims procedure can be complicated, and sometimes a denial may be due to a misunderstanding of the process. Mistakes can mean a delay in your benefits or denial.
An experienced attorney can help ensure your claim is completed correctly with the necessary supporting documentation. We can answer your questions, help you avoid common mistakes, and communicate with insurance companies on your behalf.
Help with Your Appeal
If your claim has already been denied, it’s wise to have an experienced attorney on your side. ERISA requires a detailed administrative appeal before you can file a lawsuit. Once that appeal is completed, you typically cannot submit new evidence.
That means it is necessary to build a strong case from the start. If your disability claim is denied, our attorneys can review your denial letter, identify flaws in the insurer’s response, and collect medical evidence to support your appeal.
Ensure Compliance with ERISA Rules
Insurance companies often fail to meet ERISA’s strict requirements. They may not satisfy claim or appeal deadlines, neglect to supply plan documents, or use internal medical reviewers who have conflicts of interest.
These violations can seriously affect your ability to receive benefits. Our attorneys can make sure the insurance company complies with the law. If not, we can hold them accountable through appeals or litigation.
Represent You in Court
If your case goes to federal court, our attorneys will manage all aspects of litigation, including briefings, arguments, and any settlement negotiations.
For physicians, disability claims are especially complicated due to their incomes, specialized job duties, and own occupation definitions. Our Baton Rouge physicians’ and medical professionals’ insurance lawyers will fight for the benefits you need.
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What Happens if My ERISA Disability Claim is Denied?
If your ERISA disability claim is unsuccessful, you have 180 days to submit an administrative appeal to the insurance company. This is your sole chance to provide additional medical, vocational, and legal evidence.
If the appeal is denied, you can file a lawsuit in federal court, where a judge will review your case based only on the claim file. It is wise to hire an experienced attorney who understands ERISA benefit claims procedures and regulations.
Missing deadlines or failing to include important evidence during the appeal can damage your case. Don’t take a chance with your benefits; get the assistance you need from a skilled lawyer who understands ERISA denials.
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Common Reasons for ERISA Disability Denials for Medical Professionals
Medical professionals face many of the same challenges as others when it comes to disability claim denials, such as incomplete paperwork, missed deadlines, or insufficient supporting documentation. However, due to the specialized nature of your work, there is an additional hurdle.
Professions like physicians, surgeons, optometrists, and dentists often require exceptional manual dexterity, visual acuity, and cognitive function. An injury or illness that might be manageable in another occupation can be career-ending in yours.
Own Occupation vs. Any Occupation
A common issue in disability claims comes down to how your policy defines disability:
- Own Occupation: You are considered disabled if you cannot perform the duties of your specific job.
- Any Occupation: You are considered disabled only if you are unable to perform any job for which you are reasonably qualified based on your education, experience, or training.
If you’re unable to return to your current role but could potentially work in another capacity, your claim may be denied under the any occupation definition.
Some policies initially offer benefits under an own occupation definition but then transition to an any occupation standard after a set period, such as 24 months.
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Contact a Physician’s and Medical Professional’s Insurance Attorney in Baton Rouge
As a medical professional, your job requires a very specific skill set that takes years of education and training to attain. When an injury or illness means you can no longer perform your job, you should be able to rely on ERISA-backed disability insurance to help.
Unfortunately, the process is complex, and claims are often denied, especially for professionals like physicians, dentists, and surgeons. A physician’s and medical professionals’ insurance attorney in Baton Rouge can help you get the benefits you are entitled to.
Our ERISA Insurance Claim Attorneys are dedicated to helping people like you get the help they need when they are injured and can’t work. Contact us today to set up a free case evaluation and tell us your story.
Call or text (225) 201-8311 or complete a Free Case Evaluation form