Texas Short And Long-Term Disability Insurance Guide

Suffering a disabling injury is obviously horrible. But finding out the insurance company had denied your claim can be even more devastating. If this has happened to you, contact Texas short and long-term disability insurance attorney J. Price McNamara immediately.

McNamara has more than three decades of experience fighting legitimate insurance denials. He’ll use his extensive knowledge of the law and his substantial legal skills to help get back on solid financial footing. Let J. Price McNamara take care of the legal issues so you can focus on getting better as quickly as possible.

Call our Texas office today at (713) 300-0462 for a free consultation about how we can help.

For a free legal consultation, call (225) 201-8311

Why Choose Us to Represent Your Claim?

When recovering your denied insurance benefits, you need an experienced attorney who fully understands the process. At J. Price McNamara, we have fought insurance companies for over 30 years, and recovering denied claims is 100 percent of what we do.

As a former insurance company attorney, we know the tactics and strategies they use to deny claims. We have the insider knowledge to properly advocate for your rights. With us on your side, you don’t have to face the insurance company alone.

We answer any questions you have, free of charge, and provide you with the information you need to make informed decisions. Our experience and dedication ensure that you are not only heard but also empowered throughout the entire claims process.

ERISA Basics and How to Avoid Common Mistakes

If an insurance company denies your valid disability claim, Texas short and long-term disability insurance attorney J. Price McNamara can help fight for what’s right. His knowledge of the Employee Retirement Income Security Act (ERISA) can make the difference between obtaining full benefits and dealing with the financial fallout of a denial.

ERISA is a federal law enacted in 1974 designed to protect employees’ retirement and health benefits. It sets minimum standards for most voluntarily established pension and health plans to protect individuals enrolled.

Why ERISA is Important

One key area where ERISA plays a critical role is in short and long-term disability claims. For employees who can’t work due to illness or injury, ERISA governs the process of obtaining disability benefits from employer-sponsored plans.

ERISA helps protect claimants’ rights in the following ways:

• It mandates that company insurance plans provide participants with detailed information about plan features and funding. 
• The law sets standards for fiduciary responsibilities.
• It also establishes a grievance and appeals process for participants to get benefits from their plans and gives participants the right to sue for benefits and breaches of fiduciary duty.

Our Texas short and long-term disability insurance attorney can work to overturn a denial by closely looking at your policy to ensure it complies with these and other ERISA requirements. If it doesn’t, that can help you obtain the money you deserve.

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Common Pitfalls Unrepresented Claimant’s Face

Despite its protective intentions, the ERISA process can be filled with potential pitfalls for claimants. Here are some common mistakes made by unrepresented claimants and how an attorney can help avoid them:

Incomplete or Inadequate Documentation

Many claimants fail to provide sufficient medical evidence to support their disability claims. Insurance companies require comprehensive documentation that clearly demonstrates the claimant’s inability to work.

Our Texas short and long-term disability insurance attorney can guide claimants in gathering and presenting detailed medical records, doctor’s notes, and other necessary documentation to strengthen their case.

Missing Deadlines

Strict deadlines bind ERISA claims. From the initial filing to appealing a denied claim, missing a deadline can result in a forfeiture of benefits. An experienced attorney keeps track of these critical timelines and promptly submits all paperwork, safeguarding the claimant’s rights.

Not Understanding Policy Definitions

Terms like “own occupation” and “any occupation” can significantly impact the outcome of a disability claim. These terms refer to an insurer’s definition of disability. If your plan defines it as being incapable of performing your job, you might find it easier to obtain benefits.

However, if the plan defines disability as being unable to do any job, that can be a problem. Suppose you worked as an equipment repair specialist. You were always in the field fixing different types of machinery. The insurer can argue that while you can no longer handle your former job duties, you can still do another job, such as working from a desk. That can make getting what you deserve more difficult.

Many claimants don’t fully understand these definitions or how they apply to their situation. An attorney can interpret these terms and build a case that aligns with the specific policy language, increasing the likelihood of a successful claim.

Overlooking the Importance of the Administrative Record

The administrative record is crucial in ERISA disability claims. This record contains all the evidence and documentation submitted to the insurance company. If the insurer denies a claim and the matter moves to litigation, the court may only review this record.

1. Price McNamara can ensure the administrative record is comprehensive and complete, covering all aspects of your disability.

Handling Denials Without Professional Help

Many claimants attempt to handle appeals on their own after an initial denial, often with little success. Insurance companies have experienced legal teams, and claimants without professional legal assistance face enormous disadvantages.

Our Texas short and long-term disability insurance attorney with experience in ERISA law can navigate the appeals process effectively, improving the chances of overturning a denial.

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How to Maximize Your Chances of Approval for a Disability Claim

You need proper documentation for a successful disability claim. Here are some key tips:

Keep Consistent Medical Records

Ensure that you have comprehensive and consistent medical records from your healthcare providers. Regularly visit your doctor and maintain thorough records of all appointments, treatments, and prescribed medications. Detailed notes on symptoms, treatment plans, and progress are essential.

Work Limitations

Clearly document how your medical condition affects your ability to perform work-related tasks. This documentation includes physical limitations, cognitive impairments, and any restrictions your doctor has placed on your activities. A detailed job description from your employer can help illustrate how your condition prevents you from fulfilling your duties.

Daily Activity Logs

Keep a daily log of your symptoms and how they impact your daily life and work. Note any activities you struggle with or can’t perform and how your condition varies day-to-day. This personal account can be compelling evidence.

Medical Evidence is Critical

Producing medical evidence that proves the extent of your disability is crucial to a successful claim.

The most persuasive medical evidence to insurance companies includes:

• Objective medical tests: Whenever possible, provide objective medical tests such as X-rays, MRIs, CT scans, and lab results. These tests offer concrete evidence of your medical condition and its severity.
• Specialist reports: Reports and letters from medical specialists carry significant weight. These should include detailed assessments, diagnoses, treatment plans, and their professional opinion on your work limitations.
• Functional capacity evaluation (FCE): An FCE is a comprehensive assessment conducted by a physical therapist or other qualified professional to evaluate your physical capabilities and limitations. The FCE can provide objective evidence of your inability to work.
• Psychological evaluations: If your disability includes mental health issues, obtain evaluations and reports from licensed mental health professionals. Detailed documentation of your mental health condition and its impact on your work is critical.

How an Attorney Can Help

You can’t overstate the role of the right Texas short and long-term disability insurance attorney in helping you obtain and submit critical medical documentation correctly and on time.

Here are a few ways we can do so.

• Comprehensive documentation: Lawyers ensure that all necessary documentation is thorough and accurately reflects your condition. They can help gather medical records, specialist reports, and other critical evidence.
• Timely submissions: Disability claims have strict deadlines for filing and appeals. An attorney keeps track of these deadlines, submitting all paperwork promptly to avoid forfeiting your claim.

As you can see, maximizing your chances of approval for a disability claim requires meticulous documentation, persuasive medical evidence, and professional legal guidance. Following these steps can strengthen your claim and improve your chances of securing the benefits you need.

The Independent Medical Examination 

An independent medical examination (IME) is a medical evaluation conducted by a physician chosen by an insurance company to assess the validity and extent of a claimant’s disability. The IME will be critical to your claim, so you must prepare yourself as thoroughly as possible.

You might think the purpose of an IME is to provide an unbiased medical opinion on your condition and determine whether it aligns with the disability benefits being claimed. The reality is that bias is inherent. Again, the insurance company is paying the doctor who performs the examination.

The IME’s Impact on Your Claim

The IME results can significantly damage a legitimate disability claim. If the IME report supports the insurance company’s stance that you’re not as disabled as you say, that can lead to a denial or termination of benefits.

Again, because the IME doctor is selected and paid by the insurance company, there can be a bias toward minimizing your disability. If the IME results are unfavorable, You can challenge the findings by providing additional medical evidence or seeking another opinion.

How a Lawyer Can Make Sure You Prepare Correctly for Your IME 

Our Texas short and long-term disability insurance attorney can prepare you for your IME. We will explain the process and what to expect during the examination. Your lawyer will also review your medical history and ensure that all relevant information is communicated accurately to the IME doctor.

Your attorney will also advise you on what not to do during the IME. For example, don’t exaggerate your symptoms, which can discredit your claim. Avoid volunteering unnecessary information, as the insurer can misconstrue that information or use it against you. Only answer the questions asked, and do so directly and honestly.

Other types of information to avoid volunteering include the following:

• Personal opinions about your diagnosis or treatment.
• Statements about your pain levels that aren’t supported by medical evidence.
• Unverified details about your daily activities or lifestyle.
• Comments about unrelated health issues.

How to Handle Surveillance and Other Tactics Used by Insurance Companies

Insurance companies often use surveillance tactics to gather evidence to deny valid disability claims. Common methods include:

• Video surveillance: Private investigators may follow and record you in public places, hoping to capture footage that contradicts your reported disability.
• Social media monitoring: The insurer will likely scrutinize your social media profiles for posts and photos suggesting you’re more active or less impaired than claimed.
• Direct observation: Investigators may observe your home to document activities that suggest physical capability, such as gardening or lifting heavy objects.

Protecting Your Privacy

Thankfully, there are several steps you can take to protect your privacy and integrity.

These include:

• Be cautious in public: Assume you may be under surveillance anytime. Avoid activities an insurer can misinterpret.
• Manage social media: Set your profiles to private and be mindful of what you post. Avoid sharing details about your physical activities, vacations, or outings.
• Consistent behavior: Ensure that your actions align with your reported limitations. Any inconsistencies can be used against you, even if they’re isolated incidents.

Our Texas short and long-term disability insurance attorney can counteract insurance company tactics through:

• Guidance and preparation: An experienced lawyer will tell you about potential surveillance tactics and advise you on how to conduct yourself to avoid jeopardizing your claim.
• Challenging evidence: If the insurer uses surveillance footage or social media posts to deny your claim, an attorney can challenge the validity and context of their evidence. They can argue that isolated instances don’t accurately represent your overall condition.
• Ensuring fair practices: Attorneys hold insurance companies responsible for adhering to legal and ethical standards in their investigative practices. If there is evidence of harassment or invasion of privacy, your lawyer can file a complaint and stop that irresponsible behavior.

J. Price McNamara is Ready to Fight Your Disability Insurance Claim Denial

Texas short- and long-term disability insurance attorney J. Price McNamara has a long track record of successfully helping people in situations like yours. He clearly understands ERISA and disability claim laws and knows insurance companies’ tricks and tactics to deny claimants their rightful benefits. He’s ready to put his knowledge and experience to work for you.

Please don’t hesitate to contact J. Price McNamara for a case evaluation. You can use this online contact form or call (713) 300-0462 to get in touch.

Houston Office

2000 Crawford St Suite 1649,

Houston, TX 77002

Phone: (225)-201-8311

Call or text (225) 201-8311 or complete a Free Case Evaluation form