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Seneca ERISA Appeals Lawyer

Seneca ERISA Appeals Lawyer

Are you having difficulties collecting benefits from an ERISA pension or health plan in the state of South Carolina?  If so, it would be prudent to seek the legal counsel of a local attorney who is familiar with this federal program.

What is ERISA?

The United States Department of Labor created the Employee Retirement Income Security Act of 1974 (ERISA) in order to establish basic standards for health and pension plans that are established voluntarily in the private sector. They do not apply to religious or government entities. ERISA plans may have several components:

  • Short-Term Disability Plans that address medical bills and salary compensation for a limited period of time;
  • Long Term Disability Plans that deal with illness or injury that may or may not be job-related, and that impact health for a lengthy period of time, or for which a complete recovery is not expected;
  • Health care plans to address the needs of your family;
  • Pension or retirement plans such as 401k, ESOP, and profit sharing plans;
  • Life insurance to provide for your loved ones in the event of your death.

Filing Claims

Employees who wish to file a claim should first ensure that they are entitled to benefits.  It is possible in some cases that waiting periods exist before coverage kicks in, or that dependents do not have coverage after reaching a particular age. In the event you do have coverage, ERISA guidelines provide timelines under which your claims must be addressed, all of which may be extended under particular circumstances:

  • Urgent Care claims are those that need quick decisions; otherwise, the health implications could be serious. They must be addressed as soon as possible, but in no longer than 72 hours;
  • Pre-service claims are essentially preauthorization for medically required procedures that are planned for a future date. There is a 15-day response time for most claims;
  • Post-service claims are for services previously rendered.  They must be decided within 30 days.
  • Disability claims involve making a determination as to a disability that has short- or long-term implications.  These must be decided within 45 days of request for consideration.

Appealing a Denial

What happens when these timelines are not met, or when the response is a denial of benefits?  The frustrating process of appealing a denial should not be undertaken alone. You have at least 180 days to file an appeal if your claim is denied, and you could seriously benefit from the knowledge and experience of an attorney at The Law Offices of J. Price McNamara. Our legal team knows how to proceed:

  • By documenting in depth your medical and work history;
  • By requesting documents and information related to your claim denial, including consultants who considered your claim;
  • By assembling the necessary evidence to proceed;
  • By conducting professional negotiations with plan administrators on your behalf;
  • By taking your case to court if ultimately necessary.

Contact Us

Do not become overwhelmed by the mountains of paperwork and technical jargon that is used to intimidate you. Let us help you through the appeal process. Contact our adept team at the Law Offices of J. Price McNamara in Seneca today for a confidential consultation.

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