If your short-term disability insurance claim was denied, you need an experienced lawyer on your side. J. Price McNamara is a Baton Rouge short-term disability lawyer who helps people get the benefits they deserve after a claim denial.
As an insurance company attorney early in his career, J. Price McNamara saw firsthand how insurance companies worked behind the scenes to deny valid claims.
He used this insider knowledge to start his own firm focused solely on helping disabled individuals recover wrongfully denied ERISA disability, life insurance, and accidental death & dismemberment benefits.
- Why You Need a Short-Term Disability Lawyer
- Price McNamara: Your Baton Rouge Short-Term Disability Lawyer
- Contingency Fees for Short-Term Disability Appeals
- Common Reasons for Short-Term Disability Denials
- Don't Give Up After an Initial Denial
- A Note From Our Attorney
- Frequently Asked Questions
- Contact Baton Rouge Short-Term Disability Attorney J. Price McNamara Today
Why You Need a Short-Term Disability Lawyer
Dealing with a disability is hard enough without having to fight your insurance company for benefits. Hiring an experienced short-term disability lawyer levels the playing field against big insurers who will use any loophole to avoid paying claims.
Insurance policies are complex legal contracts. They have fine print that most people cannot fully understand. J. Price McNamara is an experienced lawyer who knows exactly how to interpret these policies and identify when an insurer has wrongfully denied a legitimate claim.
J. Price McNamara will also handle the entire appeals process, including gathering strong medical evidence, filing paperwork properly and on time, negotiating with the insurance company, and representing you in court if needed. With J. Price McNamara managing your case, you can focus on your health and have peace of mind knowing your claim is in good hands.
Price McNamara: Your Baton Rouge Short-Term Disability Lawyer
J. Price McNamara has over 30 years of experience handling ERISA disability claims, including short-term and long-term disability, life insurance, and accidental death & dismemberment. As a sole practitioner, he provides personalized attention and works directly on every aspect of your case himself.
While J. Price McNamara is a single attorney, he has a team supporting his work behind the scenes. This allows him to provide excellent service and thorough representation while keeping costs low for clients.
His offices are located in the United States Court of Appeals for the Fifth Circuit in New Orleans. Since ERISA is a federal law, J. Price McNamara can take cases from individuals covered by group disability plans anywhere in the United States.
Contingency Fees for Short-Term Disability Appeals
J. Price McNamara takes short-term disability cases on a contingency basis. This means you pay no upfront costs or attorney fees. He only gets paid if he wins your case and recovers your short-term disability benefits, with his fees as a percentage of the amount recovered.
Contingency fee arrangements make hiring an experienced ERISA disability lawyer affordable for anyone, regardless of your current financial situation. You pay nothing out of pocket to get top-notch legal representation.
Common Reasons for Short-Term Disability Denials
Insurance companies are for-profit businesses, so they have a financial incentive to deny as many claims as possible. Some of the most common reasons given for denying short-term disability benefits include:
Lack of Objective Medical Evidence
Insurance companies often deny claims due to an alleged "lack of objective medical evidence" to support a person's disability. They may argue that diagnostic tests, imaging scans, lab results, etc., do not conclusively prove the person cannot work.
However, many disabling conditions like fibromyalgia, chronic fatigue, or mental health issues do not always show up clearly on tests.
J. Price McNamara can package all available evidence, including physician records documenting symptoms and limitations, to make a strong case.
Pre-Existing Condition Exclusions
Disability policies commonly include pre-existing condition exclusions that allow insurers to deny claims related to a condition you had before the coverage effective date, even if you were not treated for it previously.
J. Price McNamara can review your medical records, compare them to policy language, and fight back against improper use of the pre-existing condition exclusion.
Policy Limits on Mental Health/Subjective Disorders
Many disability policies limit how long they will pay benefits for mental health conditions or disorders without clearly observable symptoms, like chronic pain or fatigue.
An insurer may argue your condition falls under these limits to cut off benefits early. An attorney can argue for your full benefits by highlighting the physical aspects and providing evidence the condition is not simply mental or subjective.
Missed Deadlines for Filing or Appealing
Disability claims have strict deadlines for initial filing, as well as filing appeals after a denial. If you miss these deadlines, your claim can be barred entirely. J. Price McNamara will meet all time limits and file all appeal paperwork properly.
Procedural Errors or Omissions in Claim Forms
Even minor errors in completing claim forms can lead to denials by insurers looking for any reason to refuse to pay benefits. Having your case handled by an attorney greatly reduces procedural mistakes that can derail your claim from the start.
Disputes Over Disability Definitions or Doctor Opinions
There may be disagreements over whether your specific condition meets the policy's definition of a covered disability or your physician's opinion on your restrictions differs from the insurance company's consultants.
J. Price McNamara understands how to argue these issues effectively and will consult additional experts if needed.
Insurance Company Doctor Disagreeing With Your Doctors
Insurers routinely have their own doctors review claims and dispute findings from your treating physicians. However, courts often defer to opinions of doctors providing hands-on treatment versus an insurer's reviewing staff. J. Price McNamara can maximize this advantage.
No matter what reason your insurer gave for denial, J. Price McNamara has strategies for overcoming these obstacles and recovering the benefits you deserve.
Don't Give Up After an Initial Denial
One of the biggest mistakes people make is giving up after their initial short-term disability claim gets denied. In many cases, an appeal with the proper evidence and legal arguments can overturn the insurer's decision.
J. Price McNamara has experience getting short-term disability claim denials overturned on appeal and in lawsuits against major insurance companies. He often gets calls from people who were approved initially but then had their benefits terminated prematurely when the insurer decided they should return to work.
The complicated appeals process contains strict deadlines and procedures that you must follow precisely. An experienced disability lawyer like J. Price McNamara gives your appeal the best chance at a successful outcome.
A Note From Our Attorney
"Losing my own brother, then my father and sister after long, disabling illnesses just a few months apart drove a career change for me. Before that experience, I never truly understood the place you're in.
I never understood the dramatic impact that receiving (or not receiving) the disability and life insurance benefits you paid for and counted on can have on your life, especially when you need to focus on family and healing.
What I experienced with my own family now drives the way I view my clients and my work, and I will never forget it!"
—J. Price McNamara
Background and Qualifications
J. Price McNamara founded his law firm in 1995 after over five years as an insurance company defense attorney. This insider experience gives him a deeper understanding of how insurers operate and their tactics to deny claims.
He has over 30 years of experience handling personal injury cases, ERISA long-term disability appeals, life insurance denials, workers' compensation, business litigation, estates, and criminal defense work in both state and federal courts.
Awards and Recognition
- Holds highest Martindale-Hubbell rating of AV Preeminent
- 10/10 AVVO rating
- Named "Top Attorney for Burn, Brain, and Closed Head Injuries" by New Orleans Magazine
- A+ Better Business Bureau rating
Frequently Asked Questions
How long does a short-term disability appeal take?
The appeals process for short-term disability claims can take several months from the time the appeal is initially filed. Strict deadlines must be followed. The insurance company will conduct its own review.
An experienced lawyer like J. Price McNamara will work to move your appeal along as quickly as possible, but these cases do take time. The length can vary based on the specific circumstances and complexity of your case.
What medical records do I need for my appeal?
Your lawyer will need access to all relevant medical records from every physician treating you for your disabling condition(s).
This includes:
- Office visit notes
- Test results
- Imaging scans
- Physician correspondence
- Anything else pertaining to your impairments.
It's also helpful to track your symptoms and limitations in a daily log. More objective medical evidence gives your case a stronger foundation.
Do I have to be completely bedridden to qualify for benefits?
No. Total disability or confinement to bed is generally not required for short-term disability benefits. Qualifying policies define disability as being unable to perform the primary duties of your own occupation, or sometimes any occupation, due to sickness or injury. Your lawyer will look at your specific policy language and medical evidence.
Should I apply for social security disability, too?
Your disability lawyer can advise if applying for Social Security benefits is recommended for your particular situation.
Getting approved for SSD benefits can strengthen your case for private short-term disability by showing that an independent government agency deemed you disabled. However, the definition of disability differs, so an SSD approval or denial does not automatically impact your private policy claim.
What happens if my claim goes to court?
Most short-term disability appeals get resolved through the internal appeals process before going to federal court. However, if the insurance company still does not pay after an appeal, your attorney may need to file a lawsuit under ERISA.
Court cases follow a standard legal process of motions, discovery, settlement conferences, and potentially a trial before a judge to present evidence and arguments.
How much does it cost to hire a short-term disability lawyer?
Many disability lawyers, including J. Price McNamara, take cases on a contingency fee basis. This means you pay no upfront costs or hourly fees.
The lawyer only gets paid if they win your case, taking a percentage of the back and future benefits they recover. Contingency fees make excellent legal representation affordable for anyone.
Can my disability claim be denied for taking medication?
It depends on the specific language in your policy, but in general, no. Taking prescribed medication for your disabling condition should not alone allow the insurance company to deny your claim.
However, insurers may try to argue that if your condition is well-managed by medication, you should be working. Having medical evidence of your continued symptoms and limitations is important.
What if I am denied for having a "subjective" condition?
Many policies try to limit or deny coverage for conditions without objective test results, like chronic pain, fatigue, and mental health issues, by deeming them subjective.
An experienced lawyer knows how to counter this by combining all evidence - physician notes, opinion statements, description of symptoms, outside job descriptions, etc. to create an objective picture of your disability.
How far back will my benefits be paid if approved?
If your initial denial is overturned on appeal, you should receive disability benefits retroactive back to the date you were originally entitled to them. This can be a substantial lump sum payment, depending on how long your claim was improperly denied. Your lawyer will ensure you get all back benefits owed.
Does my employer have any role in an ERISA disability appeal?
No. The disability appeal is solely between you/your lawyer and the private insurance company.
Your employer does not get involved. The insurance company both funds and administers the disability plan. However, your lawyer may need some basic job description information from your employer to document you cannot perform your occupational duties due to disability.
Contact Baton Rouge Short-Term Disability Attorney J. Price McNamara Today
If you need assistance with a short-term or long-term disability claim in Baton Rouge or anywhere in the U.S., contact J. Price McNamara at (225) 201-8311 for a free consultation. His decades of experience and exclusive focus on ERISA disability law make him uniquely qualified to handle your appeal.
Don't take on the insurance company alone. Level the playing field with the help of an experienced Baton Rough ERISA disability lawyer. Contact our office today.
