Are you having a hard time getting your insurance benefits under a plan that was provided for you by your employer?
Unfortunately, this can sometimes be the case even when you have a legitimate claim to those benefits.
Your employer most likely provided you with disability, life, accidental death, medical, surgical, or mental health care insurance benefits as part of the employment agreement you signed. You may have been eligible for long-term disability benefits under the plan through an insurance policy.
These benefits were made available to you in exchange for your hard work, and usually the payment of some or all of the insurance premiums for the benefits. However, sometimes when people actually need the benefits they’ve been paying for, the plan provider (insurance company) may not have properly fulfilled its obligation to you under the agreement. When this is the case, you may need to hire an ERISA attorney.
Being wrongfully denied insurance coverage can be frustrating. The laws regulating the behavior of insurance companies and employee benefit packages are often complex and difficult for the layperson to understand. However, there is help available.
If you feel you were wrongfully denied coverage under your employee benefits, contact an ERISA lawyer as soon as possible. The sooner you consult with an attorney, the more likely it is that your interests will be aggressively represented and that your case will be handled in the most efficient manner possible. J. Price McNamara ERISA Insurance Claim Attorney, offers Free Denial Reviews. We answer any questions you have free of charge. Give us a call at 225-201-8311.
Let’s discuss your case and see what we can do to help you get the compensation that you deserve.
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What is ERISA?
The Employee Retirement Income Security Act (commonly referred to as ERISA) is the federal law that governs employee benefit plans.
If you work for a company, your employer usually provides you with certain benefits as part of your employment agreement. These benefits will include items like medical coverage, short-term disability coverage, and long-term disability (LTD) insurance to protect your income in the event that a disability keeps you from being able to work.
ERISA was created in 1974 as a way to protect employees when they are in need of these employment benefits. The law sets minimum standards for the administration of employee benefit plans and gives employees the right to sue when their benefits are denied.
ERISA further regulates the following employer-sponsored benefits issues:
- The amount of time it takes to process claims and offer appeals
- Disclosure of important benefits information to employees
- What type of employees are offered benefits
- The claims appeal process and lawsuits against employers
- Addressing employee grievances
Under ERISA, insurance companies are required to act in good faith when denying or terminating a claim. They must also follow the terms of the plan as written.
In addition, ERISA also states employees have the right to first file an administrative appeal of a claim denial, then file a lawsuit against a plan carrier if they believe they have been unfairly or erroneously denied coverage after the appeal is concluded.
If you have been denied coverage for a benefit that you believe you are entitled to, an appeal and then filing a lawsuit against the insurance company are your next steps. This is where an ERISA lawyer can help.
For a free legal consultation, call (225) 201-8311
What does an ERISA attorney do?
An ERISA lawyer is someone who specializes in the laws governing employee benefits plans. An ERISA attorney can help you file a claim for benefits, and if your claim is denied, file an appeal of the denial, and if the appeal is denied, file a lawsuit against the insurance company that is denying your benefits. An ERISA lawyer will be able to review the plan’s terms, determine what coverage you are entitled to, and work on your behalf to secure that coverage for you.
An ERISA lawyer may also be able to help you if your employer is trying to terminate your benefits after paying them for some period of time.
If you have any questions about employee benefits, contact an ERISA lawyer to help guide you through the process and protect your rights.
We Fight Back & Appeal Insurance Claim Denials
There are numerous benefits of an ERISA lawyer, especially in the wake of a claim denial. Plan carriers (usually insurance companies) often attempt to make the claims submission and appeals process as complex as possible and it is normal for individuals to overlook one of the countless critical steps that must be followed in these processes. Even when a person does take the right steps and submits the proper administrative and medical forms, many plan carriers still find a way to deny them the benefits they deserve.
Fighting back against a plan carrier can be difficult without the right legal knowledge, especially because the claims process for most health, life, and disability insurance companies are intentionally difficult to follow. However with help from an attorney, disabled workers can obtain the benefits they need.
Our legal team is here to help you fight back against these claim denials. We have the knowledge and experience needed to secure your benefits for you or appeal a denied claim on your behalf. No one should have to deal with the stress of a denied claim alone, so please do not hesitate to contact us for help.
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What to Expect with ERISA Attorney Fees
Receiving a bill should never be the first step in getting help. Our firm knows that when dealing with an ERISA long term disability or insurance claim, what you need is answers, and we are here to provide them free of charge.
Our firm welcomes telephone calls at 225-201-8311 or the opportunity to visit with you in person to answer any questions you may have. We also provide Free Denial Review. There is no obligation to hire us as your ERISA attorney.
If you ultimately decide to hire us, we work on a contingency fee basis. This means that there are no fees or costs to you unless we recover benefits for you. Our clients owe us nothing, no fee, no cost, no expenses, unless we recover.
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Common Questions About ERISA Answered
When it comes to ERISA, it is not uncommon to have lots of questions. Below are some of the most common questions our clients ask us. If you have additional questions, please do not hesitate to contact us.
What is an ERISA Claim?
An ERISA claim is the legal term used when you are fighting back against an insurance carrier that has denied your employment based insurance benefits. This type of claim requires a number of steps, which can be overwhelming for someone facing this situation on their own. Our firm is here to help you through every step in filing your ERISA claim.
What Do I do If My Claim is Denied?
The first step in filing an ERISA claim is to request a review of your employer’s benefit plan from the human resources department. The benefit plan is often insured by an insurance carrier, and the actual plan in this case will be in the form of an insurance policy. You will also need to review the denial letter. Finally, you should request the entire claim file from the insurance carrier.
ERISA gives you the right to file an appeal of a benefit claim denial. We have the experience and knowledge necessary to build a strong appeal and increase your chances of having your benefits approved. You can learn step-by-step about the proper way to file an appeal by downloading our appeal guide book at winmybenefits.com
When Should I Hire an ERISA Attorney?
If you have been denied coverage for a benefit that you believe you are entitled to, you may want to consider hiring an ERISA lawyer. An ERISA attorney can help you file a claim against an insurance company that is denying your benefits. They will be able to review the plan’s terms, determine what coverage you are entitled to, and work on your behalf to secure that coverage for you.
An ERISA lawyer may also be able to help you if your employer is trying to terminate your benefits after paying them for some period of time.
What is the Difference Between Long-Term and Short Term Disability?
Short-term disability (STD) usually provides benefits for a short period of time after an illness or injury has prevented you from working. The length of time you can receive benefits depends on the terms of your policy, but it commonly covers a period of between three and six months.
Long-term disability (LTD) provides benefits for a longer period of time, often until retirement age, if you are unable to work due to an illness or injury.
What are the Most Common Reasons for Long-Term Disability Denial?
There are many reasons an insurance company may deny a claim for long-term disability benefits. Some common reasons include:
- The insurance company claims that the individual is not disabled from working even though their doctor claims that they are disabled from working.
- The insurance company claims that the individual had a pre-existing condition that caused the disability, which falls under a policy exclusion for pre-existing condition.
What are the Most Common Reasons for Accidental, Death, & Dismemberment Claim Denials?
There are many reasons an insurance company may deny a claim for accidental, death, or dismemberment benefits. Some common reasons include:
- The insurance company claims that the death of “natural” causes such as sickness, illness, or disease rather than by accident.
- The insurance company claims that the death was caused by intoxication, such as drunk driving, drunk boating, drunk swimming, a drunken fall, etc.
- The insurance company claims the death was caused by an overdose, whether by ingestion of illegal or prescribed drugs or narcotics, taken “other than as prescribed by a physician.”
- The insurance company claims the death was caused by a combination of alcohol and drugs.
- The insurance company claims that the death was caused by self inflicted injury or suicide.
- The insurance company claims that there was a non-disclosure or false statement on the insurance application.
In addition to the above, there can also be a dispute between two people, each of whom claim to be the beneficiary. This often occurs when there has been a divorce where the deceased spouse fails to change beneficiaries from the ex-spouse to a new spouse. Or, the deceased names a beneficiary that is someone other than his or her living current spouse. These disputes are known as “interpleader” because the insurance company deposits the insurance proceeds into court and lets those claiming to be beneficiaries fight it out in court.
What are the Most Common Reasons for Life Insurance Claim Denials?
Life Insurance Claims have very similar patterns for denial as AD&D claims. The insurance company will sometimes claim that the death was from suicide, intoxication or drug overdose, or that the insured failed to disclose health issues on the application. The insurance company may also allege that the policy was obtained by fraud.
Why Do I Need an ERISA Attorney?
It is not uncommon to have a lot of questions when it comes to ERISA benefits. In fact, there are multiple ways in which an individual can be denied the benefits they deserve. Many of these denials happen due to simple mistakes or missed paperwork, but others occur because an insurance carrier will fight tooth and nail against paying out claims.
An ERISA lawyer can help you navigate the often confusing and difficult claims process, as well as represent you in any appeals or lawsuits that may be necessary. They will have the knowledge and experience needed to get you the benefits that you are entitled to. If you have been denied benefits, contact an ERISA lawyer as soon as possible. The sooner you speak with an attorney, the sooner you can be sure that your interests are being pursued aggressively and that your case is being steered toward its best possible outcome.
Our number-one goal is getting you and your family back to financial security as soon as possible. Contact us online for a free, no obligation case evaluation and we’ll tell you how we can help. J. Price McNamara ERISA Insurance Claim Attorney serves clients nationwide and has brick and mortar locations by appointment only in New Orleans, Baton Rouge, and Houston.
You may also call us at 225-201-8311. J. Price McNamara and his legal support team are focused on building a strong case for you.
Call or text (225) 201-8311 or complete a Free Case Evaluation form
