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.
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.
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 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.
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.
Before you can write an effective appeal letter, you must first know:
Our number-one goal is getting you and your family back to financial security as soon as possible.
Complete the confidential form for a free, no obligation case evaluation and we’ll tell you how we can help.
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.
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:
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.
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.
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.
How did we do?
Note: Your review may be shared publicly.