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Many participants in ERISA insurance plans mistakenly assume that they are automatically entitled to their disability benefits if and when they need them. They may be unaware that their insurance policy, which is also a contract, may exclude coverage in certain situations.
For instance, if you were drinking alcohol or had recently consumed alcohol before an accident or injury for which you are seeking disability benefits, you may be facing an uphill battle. Even if you were under the legal limit for your blood alcohol content (BAC), your ERISA disability insurance company could use this fact to deny you benefits.
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.
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.
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.
“Price showed no fear. The only thing I can use to actively describe what I saw that day in court was someone standing there protecting our family and fighting for them at the same time…he took control of the situation and was truthful.”
“It was a smooth process. I didn’t have to guess about what was going to happen next…I was reassured that he was going to do the right thing. I was reassured that he was looking out for me.”
“He was ready to fight for me…I felt like he had my best interest in mind. It wasn’t just for the paycheck at the end.”
“Price worked for an insurance company in the past and now he’s working against the insurance company so it was because of that we trusted that he knew how an insurance company worked and how to fight them.”
“I feel blessed that I can help turn things around for my clients who have been denied that piece of mind of financial stability and we make sure that the insurance company and the court realize that these are actual people, these are families that are suffering greatly.”
I want to say thanks to J. Price McNamara for the sound free advice he gave me related how to increase my chances of being approved for Long Term Disability of being denied. I must say after implementing elements of…
I needed an attorney with a specific specialty and Price McNamara was definitely the right choice. His representation was based on principles that are probably unsurpassed by any other attorney in the field. McNamara represents individuals, not big-money corporations, like…
I found Mr. McNamara to be practical and efficient. He did what I needed in a reasonable amount of time, keeping me well informed and with excellent results. He communicated with me clearly and on a timely basis. I will…
I am a current client of Mr. McNamara’s. He is very accessible and responds to my emails and phone calls in a timely manner. I find him to be very professional and knowledgeable, as well as ready, willing and able…
I am an attorney. Price represented me, and in a separate suit represented my daughter, for injuries. He moved the cases at lightning speed and obtained maximum recovery. I was grateful and surprised. I would recommend Price to anyone who…
I would recommend Mr. Mcnanmara to anyone at any time. He was the best attorney that my family and I came in contact with. About three years ago we had a very tragic, accidental death in our family and the…
Price and Sara are great. They helped us in a time of need. Their communication was always spot on and I never felt out of the loop with what was going on with our case.
Price is very professional, honest, and reliable. Whatever he says, he will follow through with the utmost integrity. He will turn over every stone and pays close attention to even the smallest detail. I’m glad I secured his services.
Without going into the painful details regarding the reason for having to hire Price, his compassion and communication helped my family during an extremely difficult time. If you need legal help because you or a family member was injured by…
My client’s cause for an ERISA accidental death and dismemberment denial lawsuit began when both Esther and her husband were involved in a tragic head-on collision with an 18-wheeler. This tragic accident resulted in severe injuries to Esther, as well as David’s untimely death.
Our client, a young husband with two children, sustained closed-head brain injury as a result of an automobile accident. The at-fault driver’s insurance company initially refused to pay, but shortly before trial, agreed to pay the entirety of its insurance policy limits of $2,000,000.
Our client was a floor hand and Jones Act seaman who suffered a shoulder injury while working for Blake Offshore, LLC. Suit was filed in federal court in New Orleans. Blake and its insurance company offered relatively little in settlement, so the case proceeded to trial.
Our client sustained a fractured hip and reduced ability to earn wages in the future as a result of an accident sustained on the offshore drilling rig to which he was assigned. Suit was filed in federal court in New Orleans.
Rejection on these grounds is legal in this state but may not be appropriate in all circumstances or permissible in all contracts. A skilled ERISA attorney may be able to help you if your insurance company is denying you coverage based on the intoxication exclusion for ERISA disability insurance in Texas.
The intoxication exclusion for disability insurance in Texas states that they exclude from coverage disabilities that stem from any accident for which the intoxicating influence of alcohol, drugs, or any impairing substance was a factor.
While the insured party may not be able to argue that such an exclusion is not present in the policy, the way the insurance company obtained their information, what information they are using to make their denial decision, and how the policy is interpreted could be contested and used in favor of the claimant receiving their benefits.
Our number-one goal is getting you and your family back to financial security as soon as possible.
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An insurance company that denies disability coverage based on their policy’s intoxication exclusion must conclude that the insured was intoxicated at the time of the accident based on scientific proof. Furthermore, they must prove that the intoxication was the cause of their accident or injury.
In White v. Life Insurance Company of North America, the U.S. Fifth Circuit Court of Appeals ruled that the presence of intoxicating substances is not sufficient evidence by itself to justify a denial of coverage based on intoxication. Additional evidence, such as witness statements about the state of the claimant at the time of the injury, documented physical symptoms, and conclusive evidence of a specific amount of such substances would be required to enforce the denial. In other words, information used to support an intoxication exclusion for a Texas ERISA disability insurance policy must be tangible and have factual support.
When an insurance company pays on a claim, they are almost always losing money. Therefore, ERISA insurance companies often look for reasons to deny disability claims. If they believe alcohol was at all involved in the circumstances that led to you filing for disability coverage, they can and likely will use this information to contest your claim.
Fighting a coverage denial based on an intoxication exclusion for ERISA disability insurance in Texas can become a complex legal situation. The stakes are high for your physical wellbeing and financial future during this time, so seeking an experienced Texas ERISA attorney may better position your case for a positive outcome.
Qualified lawyers may be able to find multiple legal reasons why your ERISA insurance company must provide disability benefits to you. Call today to find out more about ERISA representation and how a dedicated attorney may be able to assist you.
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