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Pottstown, PA ERISA Lawyer

Pottstown, PA ERISA Lawyer

Over 50% of workers in this country earn health benefits through their jobs, in addition to other benefits such as profit sharing, retirement plans, COBRA plans, and disability insurance. If you are one of these Americans and have been denied benefits to which you believe you are entitled, having an experienced ERISA attorney on your side can dramatically impact the results of your appeal.

What is ERISA?

ERISA, the Employee Retirement Income Security Act of 1974, is a critical federal plan designed to protect the interests of employees who work under the umbrella of the plan. These plans relate to private employers who offer employer-sponsored benefits and do not cover religious or government entities. ERISA creates standards of accountability and transparency, setting forth specific requirements to inform employees about their plans. Canons of conduct for fiduciaries and plan managers are designed to ensure that monies are not abused or mismanaged.

Appealing a Denial

Let us say you have filed a claim and were surprised to see that your provider denied the benefits. What now? Section 503 of ERISA guarantees claimants the right to a fair review of denied claims. The appeals process, however, can be quite daunting, so this is the time to get some serious legal assistance. The coming weeks and months will involve a fair amount of paperwork and some aggressive maneuvers:

  • Obtaining all relevant documentation and scouring over it to understand what is covered, time limitations, requirements, the process to file an appeal, and so forth;
  • Carefully analyzing the specifics of the denial, including what the carrier’s physicians have concluded about your condition, in order to objectively address the issues;
  • Assembling additional evidence of your disability, including employment records, medical records, witness statements, detailed physicians’ affidavits, and other pertinent documents;
  • Writing a comprehensive explanation detailing precisely how the disability impacts your ability to work.
  • Filing an appeal within the required time frame.

The Appeals Decision

Within a specified period of time—it varies depending on the type of claim–you should receive written notice of the claim decision. In the event it is still denied, the explanation must include the explicit reasoning behind the decision and unambiguous references to provisions within your plan to back up the denial. At this point, your lawyers will have to negotiate through a second appeal. Ultimately, all internal procedures must be exhausted prior to ultimately taking the case to court in a civil action.

Advocating for You

If you have been denied the benefits you need, it can be incredibly frustrating, adding to the agony of an already untenable health event.  In Pottstown, the experienced ERISA legal team at the Law Offices of J. Price McNamara is dedicated to pursuing your claim to get you the help you need as quickly as possible. Quite often, simply tightening up the documentation in the appeal is all that is necessary. But when further action is required, we do not shy away from the task. If you have been blindsided by an unfair denial, contact us today for a free, confidential consultation.

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