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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.

Louisiana Long Term ERISA Disability Eligibility

When you are unable to work, you may need LTD benefits to maintain your financial security. However, insurance companies tend to deny disability claims, especially if your policy provides high-value benefits. Before you file a claim for benefits, you need to be well-prepared. Long-term ERISA disability lawyer J. Price McNamara can help.

 

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.

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Eligibility for Long Term Disability Benefits in Louisiana

Insurance companies typically pay long term disability benefits, and your eligibility will depend upon the terms and conditions of your policy. Before you file for LTD benefits, you should get copies of your current Summary Plan Description (SPD) and Plan Document. LTD plans must set out their eligibility criteria and claim process in writing. The SPD will give you an overview of these issues, while the full Plan Document provides a comprehensive (and more formal) discussion of the plan’s criteria and processes.

While eligibility varies from plan to plan, there are some common requirements. Typically, to be eligible for LTD benefits you must:

  • Complete a waiting period (from several months to several years),
  • Have medical evidence that contains a clear and fact-based diagnosis, and
  • Have work restrictions that prevent you from performing either your occupation or all occupations.

If there is any doubt that you meet your plan’s criteria, your claim will be denied. While a denial can be upsetting, do not assume that you are ineligible for LTD benefits.

 

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)

Reasons for an LTD Denial

Long term disability claims are denied for many reasons. There may be a technical problem, such as a late filing or a short-lived disability. However, most LTD claims are denied for more nuanced reasons, including:

  • Insufficient medical evidence,
  • Lack of a clear diagnosis (or an unusual diagnosis),
  • Disagreement about the severity of your condition and your ability to work,
  • Concern about substance use or dependency,
  • Questions about your credibility, or
  • Non-compliance with insurance company requests (such as failure to complete forms or attend a medical examination).

Moreover, insurance companies frequently deny legitimate long term disability claims. If your claim is denied, contact a long term disability lawyer for assistance. An experienced lawyer will perform a detailed analysis of your claim, create a customized appeal strategy, and ensure that you follow your plan’s procedures.

Filing a Long Term Disability Appeal in Louisiana

The LTD process varies depending on whether you have an ERISA or non-ERISA plan. The Employee Retirement Insurance Security Act (ERISA) is a federal law that controls employee benefit claims. If your long term disability plan is employer-funded, ERISA typically applies. However, ERISA does not cover employee benefits offered by governments and religious organizations. If you have a personal LTD policy, it is a non-ERISA plan. If you need help assessing your plan, contact a long term disability lawyer for assistance.

ERISA Long Term Disability Appeals

In an ERISA claim, you cannot immediately file a lawsuit disputing the insurance company’s denial. Instead, you must exhaust your administrative remedies by filing an appeal with your plan administrator (typically the insurance company). In an administrative appeal, you must follow the procedures set out in your SPD and Plan Document. If you do not follow these procedures, your appeal will be denied.

It is important to provide all of your evidence at the administrative appeal level. Once the insurance company has issued a decision in your ERISA appeal, it is very difficult to submit additional evidence. For this reason, you must review the insurance company’s complete file and supplement it with any missing evidence (including medical records, vocational information, and other important data).

If the insurance company denies your administrative ERISA appeal, you may file a federal lawsuit. Filing deadlines may vary, depending on your plan. If you do not file a timely appeal, the federal court will dismiss your claim.

In a federal ERISA appeal, you will not have a jury trial. Instead, a judge or magistrate will review your claim and written arguments and issue a decision. Since these appeals are highly technical, consider hiring a skilled long term disability lawyer to assist you.

Non-ERISA Long Term Disability Appeals

In a non-ERISA claim, you may immediately file a lawsuit against the insurance company, appealing your denial. In most cases, your lawsuit should be filed in a state court. You may be able to request a jury trial and seek punitive damages if the insurance company denied your claim in bad faith.

Regardless of whether you have an ERISA or non-ERISA claim, it is important that you build the strongest case possible. This will involve a detailed analysis of your plan’s terms and conditions, your medical records, and vocational information. Many disabled individuals cannot do this on their own. A long term disability attorney can help you follow the correct legal procedures, build a compelling case for benefits, and maximize your recovery.

Consult an Experienced Louisiana Long Term ERISA Disability Attorney

Long term disability attorney J. Price McNamara has over 20 years’ experience handling LTD and other insurance claims. Contact his office for more information.

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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