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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.
Employer-sponsored benefit plans are usually governed by the Employee Retirement Income Security Act of 1974 (more commonly known as ERISA) — a federal law that was initially put in place to safeguard employee rights. However, the insurance companies now have a strong incentive to deny benefits under this statute, given that if the appeal case gets to federal court, the insured will not be entitled to a trial by jury.
If your claim for ERISA benefits has been denied, the Dallas ERISA appeals attorneys at the Law Offices of J. Price McNamara can assist you with understanding your denial letter and filing an appeal in your case. Our legal team welcomes the opportunity to file an administrative appeal on your behalf, and if necessary, to litigate your case through the federal court system.
The administrative appeals process is the process by which a benefits denial is disputed directly with the insurance company. These types of appeals are handled in-house, and it is the insurance company that decides the ultimate outcome.
When your insurance company sends you a denial letter stating why your claim was denied, it will outline the specific steps that you must follow to file an administrative appeal – and it will note the deadline by which you must file your appeal. When filing an administrative appeal, your lawyer can assist you with assembling the necessary supplemental documentation, such as additional medical reports, to include with your appeal.
Once the insurance company reviews your administrative appeal, it can choose to accept or deny the appeal. If your appeal is denied, you may have one more administrative appeal option. Otherwise, you will have to file an appeal in federal court.
After you have exhausted the administrative remedies provided by your insurance company, you may be able to file a complaint in the federal court system against your insurance company. Once the case is in federal court, you will no longer have the opportunity to supplement the administrative record with additional documentation that supports your claim. Therefore, it is very important that you do this when the appeal is still with the insurance company.
In a federal court appeal, the judge ultimately has the authority to accept or deny your claim, once and for all. You will not have the opportunity for a jury trial in federal court. A Dallas ERISA appeals attorney can assist you throughout every step of the appeals process in federal court.
At the Law Offices of J. Price McNamara, our legal team will walk you through each step of the ERISA benefits appeals process and will be sure to file a timely administrative or federal appeal on your behalf. To schedule a free case evaluation and legal consultation with an experienced Dallas ERISA appeals lawyer, please contact us online today.
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