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RECOVER YOUR DENIED INSURANCE BENEFITS

LET A FORMER INSURANCE COMPANY ATTORNEY
GUIDE YOU

Long Term Disability / Life /
Accidental Death / ERISA

Our past years of representing insurance companies taught us a thing or two about how they work behind the scenes. Let our experience work for you.

Insurance Companies and ERISA Denied Claims in Louisiana

Most insurance companies market themselves as sympathetic and compassionate, filled with people eager to extend helping hands to other people in their times of need. In reality, however, they are businesses looking to maximize their profits and satisfy their shareholders. This is not to say that insurance companies are the “bad guys.” In general, they abide by the terms of the policies they issue and provide an important service. Nevertheless, they will take advantage of every opportunity to deny claims, even if the reasons sometimes boil down to simple errors in paperwork.

 

We answer any questions
you have FREE OF CHARGE.

(866) 248-0580

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 or the opportunity to visit with you in person to answer any questions you may have. We also provide FREE comprehensive case reviews. There is no obligation to hire us as your ERISA attorney.

Why I Love Our Mission Of
Helping People Like You…

Too much is at stake to guess about the best approach and strategy for fighting your denied insurance claim — years and years of financial security.

After spending years representing insurance companies, we don’t guess. We know their playbook and how they work behind the scenes. Using that knowledge, we’ve developed our own Clear Advantage Process for fighting claims.

It’s personally satisfying to use what I’ve learned as an insurance company insider, now for the good — helping families reverse unfair denials of insurance benefits they paid for, need and deserve.

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About J. Price McNamara

Price McNamara began his law practice in 1990 representing insurance companies.

In 1995, Mr. McNamara founded McNamara Law Offices, where he represents people across the U.S. who are wrongfully denied long-term disability insurance, life insurance, and accidental death insurance benefits, with special focus on ERISA claims and lawsuits.

His is a member of the Louisiana and Texas Bars, with office locations by appointment only in Baton Rouge, Metairie, and Houston. He lives in Baton Rouge, Louisiana with his wife and their three children.

See How We Have Helped Others In Situations Just Like Yours.

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When it comes to ERISA claims, the legal scales are tilted in favor of the insurance companies. Under ERISA, insurance companies and other plan administrators are given tremendous leeway in terms of the conditions they can impose on claimants, both when they file their initial claims and, if applicable, when they file their appeals. If an ERISA case is brought before the court, the judge is compelled to give deference to the decision of the insurance company.

The best way to balance the scales of justice is to secure the services of a skilled Louisiana ERISA attorney such as J. Price McNamara as early in the claims process as possible. Attorney McNamara has a proven track record of success in handling ERISA cases and has demonstrated time and again that he will not be intimidated by even the largest, most powerful insurance companies.

 

Our number-one goal is getting you and your family back to financial security as soon as possible.

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Baton Rouge Office

10455 Jefferson Hwy,
Suite 2B
Baton Rouge, LA 70809
Phone: (225) 201-8311
Fax: (225) 201-8313
(By Appointment)

New Orleans Office

4141 Veterans Memorial Blvd.
Suite 212
Metairie, LA 70002
Phone: (504) 458-8455
Fax: (225) 201-8313
(By Appointment)

Houston Office

363 N Sam Houston Pkwy E
Ste 1100 PMB, #114
Houston, TX 77060
Phone: (713) 439-0339
Fax: (225) 201-8313
(By Appointment)

Handling Louisiana Insurance Companies

Prior to the passage of ERISA, it was possible for employees to file suit against insurance companies that denied their claims for employee-provided disability benefits. The court would have full discretion over the case, guided by state insurance laws. If a judge determined that an employee was in fact disabled according to the terms of the insurance contract, that employee would be awarded his or her benefits. Depending on the circumstances and the laws of the state in which the lawsuit was filed, employees might also be able to collect additional damages covering breach of contract, interest accrued on the unpaid benefits, the employee’s attorney’s fees, emotional distress, and even punitive damages.

By preempting state insurance laws, however, ERISA immediately limits the rights of disability claimants. The law does not allow for litigation to be brought against an insurance company until the claimant first exhausts all administrative remedies stipulated by the ERISA plan document, which may even require a second administrative appeal if the first appeal has been rejected. If the claimant, after being notified by the plan administrator that it is his or her right to sue, decides to pursue litigation, ERISA:

  • Prohibits jury trials.
  • Gives a single federal court judge full discretion over the case.
  • Does not allow claimants to collect punitive and certain other damages, including breach of contract, insurance bad faith, emotional distress, and (with occasional exceptions) attorney’s fees.
  • Prevents the introduction of evidence to the court beyond that which was considered by the plan administrator, except in cases in which the court finds that the administrator abused its discretion or acted arbitrarily.
  • Disallows, in most cases, de novo review.

What is de novo review?

In rare cases, a claim denial may be reviewed de novo by a court. In such cases, the court will consider an ERISA case based solely on the evidence presented, which may include evidence not included in the original claim or subsequent appeal if deemed necessary by the court to making its decision. The court will not give deference to, or even take into consideration, the insurance company’s prior decisions.

However, ERISA cases can only be reviewed de novo if the insurance company or other plan administrator has not been given discretionary authority over claims decisions and interpretation of the plan’s provisions. Since virtually all official plan documents now establish this discretionary authority, de novo review of ERISA claims has become extremely uncommon.

Doctor’s Ruling on Disability

While your physician’s diagnosis and opinions will certainly carry substantial weight if they are thoroughly supported and properly documented, insurance companies know that the “treating physician’s rule” will generally be rejected in ERISA cases. This rule allows the court and would compel insurance companies to give deference to the opinion of the physician that treated the claimant. Precedent for the rejection of this rule in ERISA cases was established in Black and Decker Disability Plan v. Nord, 538 U.S. 822, 123 S. Ct. 165 (2003):

Plan administrators…may not arbitrarily refuse to credit a claim’s reliable evidence, including the opinions of a treating physician. But, we hold, courts have no warrant to require administrators automatically to accord special weight to the opinions of a claimant’s physician; nor may courts impose on plan administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician’s evaluation.

In other words, your physician’s opinions will be given no more weight than the contrary evidence and testimony presented by the insurance company.

Contact an Experienced Louisiana ERISA Denial Lawyers

Ultimately, insurance companies have little motivation to approve ERISA claims regardless of their validity. They know that they have a substantial advantage under the law and that claimants who don’t have qualified legal representation are essentially fighting with one hand tied behind their backs.

With ERISA disability attorney J. Price McNamara in your corner, however, you will have the assurance of knowing that your claim or appeal will be comprehensively researched, supported, and compiled. The insurance company will likewise know that you are not going into battle on your own – that you are represented by an experienced legal professional who will fight tirelessly and fearlessly for your rights.

Attorney Advertising. This website is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship. Testimonials are not a guarantee, warranty, or prediction of the outcome of your case. By providing certain contact information herein, you are expressly authorizing the recipient of this message to contact you via the methods of communication provided.

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