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ERISA disability benefits could be denied for a variety of reasons. If you applied for disability benefits under an ERISA plan, you may be surprised to learn that you might be denied benefits due to pre-existing conditions.
While health insurance companies cannot deny coverage or benefits due to pre-existing conditions under the Affordable Health Care Act, your disability claim may be denied for a pre-existing condition due to your specific policy. If you were denied access to your benefits based on a preexisting condition exclusion for ERISA disability insurance in Texas, a Texas ERISA disability claim denial lawyer could help you appeal your denial and secure your disability insurance. A well-practiced ERISA attorney may have the experience to guide you through the appeal process and give you a peace of mind.
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.
Based on the case law and the Employee Retirement Income Security Act Of 1974 (ERISA) regulations, an insurance policy is a contract between the insurance carrier and the insured. This contract might often include exclusions or situations under which coverage may not be provided.
ERISA disability insurance policies may often include an exclusion for preexisting medical conditions or conditions the insured had at the time the policy commenced. Pre-existing conditions may generally be defined as any sickness or injury for which the claimant may have taken prescription drugs, received medical treatment, consultation, care, or services. This could bar the claimant from having a claim approved that involves their pre-existing condition.
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While it generally cannot be debated whether a policy does or does not have a pre-existing condition exclusion, the verbiage of the policy and how it applies to a specific claimant’s case may actually favor the claimant receiving their disability benefits. Because of this, claimants who receive denial letters may be advised to carefully examine the insurance company’s reason for doing so.
The exact policy wording that was used to determine a denial of ERISA benefits should be included in the claimant’s coverage denial letter. Ambiguity in the policy language usually works in favor of the claimant when it comes to court decisions. Contact a Texas ERISA disability claim denial lawyer to discuss your policy’s wording.
Generally, a pre-existing condition exclusion only applies for the first year after ERISA coverage has started. This is known as the look-back period. Some insurance policies may only have a three-month look back period. Either way, the look-back period could help deter people from seeking employment for the purpose of getting long term disability benefits based on a condition they had prior to their employment.
If an insurance company denies coverage based on a preexisting condition, the claimant may need to determine what the policy states in regards to the time frame of this exclusion. A Texas pre-existing condition exclusion for ERISA disability insurance cannot be used as a valid reason for benefit denial if the time frame for the exclusion has passed.
If your long term disability claim is denied, you should know that you have legal rights and options. A knowledgeable Texas ERISA disability claim denial lawyer may be able to guide you on the best ways to appeal your claim or assist you in litigating your claim. A pre-existing condition exclusion for ERISA disability insurance in Texas may not always be a valid or legal reason for insurance companies to deny benefits.
Since deciphering ERISA laws, disability insurance policies, and benefit denial letters could be confusing and complex, consulting with an attorney may significantly benefit your case and increase your chances of receiving claim approval. Call today to find out what help may be available for you.
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