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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.

The Administrative Record in Louisiana

When an ERISA case is brought before a federal judge, the administrative record represents the only evidence that will be considered. The record contains every form, record, letter, and other types of document provided by the claimant or created by the plan administrator, from the filing of the original claim for disability benefits to the final denial of the appeal. Either side can file a motion contesting the inclusion of certain documents, along with a brief explaining the supporting case law. In most cases, however, the administrative record contains every piece of information relevant to the disability claim.

 

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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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If your ERISA claim has been denied and you are currently preparing your ERISA appeal, you should assume that:

  • Every document you submit and all other information you provide to your plan administrator will be added to the administrative record;
  • Every document submitted and all other information provided by your doctor, employer, co-workers, family members, and other relevant parties will be added to the administrative record;
  • Your plan administrator will be extremely thorough in collecting evidence that contradicts and discredits your disability claim and adding it to the administrative record;
  • Any document or piece of information that you have not provided to your plan administrator during the claims and appeals processes will not be added to the administrative record, and therefore will not be considered by the court in the event of litigation.
  • If your case is presented before a federal judge, he or she presumes no knowledge of your professional duties or your condition, and it is your job to educate him or her on both counts.

This is why it is essential that you provide as much specific, detailed information in support of your claim as possible at every stage of the ERISA process. An experienced Louisiana ERISA attorney can help to ensure that your administrative record contains comprehensive evidence of your disability and your right to collect the benefits due to you.

 

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)

Documents Included in The Administrative Record

In general, the administrative record includes any document available to orreviewed by the plan administrator during the evaluation of your claim, such as:

  • The official plan document
  • The policy, if different from the plan document
  • The summary plan description (SPD)
  • Your original claim for disability benefits
  • All medical records relevant to your injury
  • All correspondence exchanged between you and the plan administrator
  • Your job description
  • The letter notifying you that your original claim had been denied
  • Your appeal letter
  • Any further documents you were required to provide with your appeal
  • The letter notifying you that your appeal had been denied
  • Internal documents generated by the insurance company, including reports, records, results of any surveillance it conducted, and other pertinent data

In order to ensure that your case is fairly represented in the administrative record, it is important that you do not rely exclusively on the forms provided by the insurance company, especially those that require information from your doctor. While it is necessary that your doctor answer the questions contained in these forms, these responses alone will probably not tell your entire story. In fact, these forms generally include very little space for detailed responses, which is no accident. If your doctor does not provide sufficient information regarding your injury and your inability to perform your professional duties as defined by your job description, your plan administrator will have defensible cause to deny your claim or appeal.

Presenting Evidence of the Injury

As you collect evidence of your debilitating injury to present to your plan administrator, keep the following tips in mind:

  • The insurance company does not have your best interests in mind, no matter what its representatives might claim.
  • You should be as thorough and detailed as possible in describing the duties associated with your job. If your job description is vague or incomplete, your plan administrator will fill in the gaps with information suggesting that you are able to perform your duties and therefore are not entitled to disability benefits.
  • Assume that the insurance company has you under surveillance at all times. Don’t participate in any activity against which your doctor advises or that otherwise might contradict your claim for benefits.
  • You are not limited in the amount of evidence you can provide supporting your injury and your inability to work. Your plan administrator may suggest that you will be given all of the forms you need to submit your claim or appeal, but this is far from the case. You can include:
    • Certified statements from doctors other than your own, as well as other medical specialists.
    • The results of any research you have done into your condition, including articles from medical journals and other reliable sources.
    • Reports of physical, psychiatric, and vocational rehabilitation evaluations.

While this may seem like a lot of work, you can be assured that the insurance company has the resources to fill the administrative record with substantial and compelling evidence that contradicts yours. In fact, the insurance company is prepared for possible litigation from the moment you submit your initial claim.

Contact an Experienced Louisiana ERISA Appeals Lawyer

An experienced ERISA attorney can take the burden of collecting and organizing all of this evidence off your shoulders and make sure that it is submitted in accordance with the terms of the summary plan description.

ERISA lawyer J. Price McNamara has extensive experience in presenting the strongest cases possible on behalf of injured workers. He can make sure that your evidence measures up to that collected by the insurance company and that the administrative record represents your evidence fairly, accurately, and thoroughly.

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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