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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.

Writing the ERISA Appeal Letter in Louisiana

A well-written, thoroughly supported appeal letter can improve your chances of winning your ERISA appeal. Further, if your appeal is unsuccessful and you pursue litigation, the letter can be fundamental to presenting your evidence in the best possible light when it is reviewed by a federal judge.

One of the great advantages of hiring an experienced Louisiana ERISA attorney such as J. Price McNamara is that he has written numerous ERISA appeal letters and knows the precise language to use and theexact organization to follow. He can ensure that your appeal letter is based in fact and provides a compelling summary of your stance, the evidence you have of your injury and your inability to work, and why the original denial by your plan administrator should be overturned.

 

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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Remember that while the appeal letter is important, it is only one part of a successful appeal. Think of it as a helpful guide that your plan administrator (and, if necessary, the federal judge) can use to navigate all of the documents you are providing as part of your appeal. The letter, by itself, no matter how well-written or thorough, will not suffice in convincing the plan administrator to rescind its initial decision.

Prepare The Appeals Letter in Louisiana

Before you can write an effective appeal letter, you must first know:

  • The deadlines you must meet
  • Exactly to whom you must address all correspondence
  • Specifically what is required by the plan administrator in the appeal
  • Why your initial claim was denied

 

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)

Uncertainty and lack of clarity are your enemies in preparing an ERISA appeal. Unfortunately, plan administrators can be frustratingly brief, and sometimes even vague, in providing their reasons for denying a claim for disability benefits. According to ERISA, plan administrators must indicate their specific reasons for rejecting a claim in a denial letter, detailing the plan provisions and any internal policies used to arrive at the adverse ruling. Despite this, most denial letters are relatively short and generic in nature.

The surest way to write an appeal letter that addresses all of the pertinent points of the claim denial is to request a copy of the administrative record beforehand. ERISA guarantees you the right of access to all of the documentation in the administrative record, including plan documents, benefit policies, medical records, employment records, analyses and reports prepared by or for the plan administrator, relevant telephone logs and emails, and other data and information relevant to your case.

How do I write the best possible appeal letter?

First, it is important to note that your appeal letter should be written to a very high standard. A sloppy, disorganized appeal letter filled with spelling and grammatical errors will only harm your chances of winning your appeal.

In addition, a strong appeal letter will include:

  • Clear, concise information about you, the ERISA plan in question, and your claim that had been denied.
  • A specific summation of your appeal and the decision or decisions you are contesting.
  • A precise statement as to what you hope to achieve through the appeals process.
  • A straightforward explanation of why you are appealing the decision, being sure to mention all relevant facts and details.
  • An introduction to the evidentiary documents you are including in your appeal, along with a table of contents so that each document can easily be located.
  • A conclusion that summarizes your points and expresses gratitude for the consideration of your appeal.

While you will want the letter to be as concise as possible, avoiding unnecessary detail and undue repetition, you also want to make sure that it is comprehensive. Don’t leave important details out simply because you want to keep your letter brief.This is your only real opportunity to state your case. If your appeal is denied and you do pursue ERISA litigation, the appeal letter will be the closest thing to an opening statement that you will be afforded.

Is there anything I should not include in my appeal letter?

In developing your appeal letter, you will want to stick to the facts and your general argument against the claim denial. You are not a medical expert, so don’t pretend to be one; your opinions regarding your health and condition do not hold as much weight as your doctor’s. It is a great idea, however, to summarize your doctor’s opinions in your letter and point out where they can be read in full in your appeal.

Likewise, you will not want your letter to rely too heavily on appeals to emotion. While it is appropriate to describe the physical, mental, and emotional hardships you have faced as a result of your debilitating injury, this description should be secondary to the facts of your case. You do not want to get weighted down in sentimentality, as this tack will not find favor with the plan administrator or a federal judge. (Remember that these parties may feel compassion toward you and still rule against you based on the strength of your evidence, or lack thereof.)

In general, the appeal letter should not be the primary source of any evidence you are providing. Even something as seemingly simple as a description of your job should not be left to the appeal letter alone. The brief job description contained in your appeal letter should point to a more thorough and well-documented description included with your other evidentiary documents.

Contact a Louisiana ERISA Appeals Lawyer Today

Ultimately, the best way to ensure that your appeal letter is as strong and persuasive as possible is to enlist the assistance of a legal professional who has a history of drafting successful appeal letters on behalf of a variety of clients. J. Price McNamara is just such a professional, and he would be pleased to put his experience and skill to work for you.

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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