Texas Insurance Laws
If your employer does offer insurance coverage to employees, including group medical coverage, it must comply with the applicable state laws which are currently on the books. Specifically, your employer-sponsored policy must comply with all of the following:- The policy which is in place must offer coverage for certain mandated benefits
- Employees must be afforded the opportunity to continue their coverage – or to change to an individual insurance policy, in the event the employer loses the group coverage
- The policy which is in place must limit certain restrictions on coverage
- The policy in place must mandate that dependents be covered pursuant to a court order
ERISA Applicability
If you receive insurance benefits pursuant to an insurance plan which your employer sponsors, your plan will likely be covered under the Employee Retirement Income Security Act of 1974, which is a federal statute. This includes health plans, long-term disability plans, accidental death plans, life insurance plans, and other plans that are sponsored by an employer (and in which the employee is the insured individual). If you are denied benefits under an ERISA plan, the insurance company must send you a denial letter that lets you know specifically why your claim is being denied. You will then have at least one attempt to administratively appeal your claim denial with the insurance company. For example, you may need to provide additional medical documentation in support of your claim. The insurance company will then decide whether or not to accept or deny your claim. In the event your ERISA claim is denied, you may then have the option to file an appeal in federal court. Since federal court appeals tend to favor employers and the insurance companies with whom they work, experienced legal representation at the federal level is essential.Talk to a Texas Insurance Benefits Lawyer Today
At J. Price McNamara ERISA Insurance Claim Attorney, our legal team can pursue the benefits you need under an employer-sponsored plan of insurance. To schedule a Free Denial Review and legal consultation with a knowledgeable Texas insurance benefits attorney, please contact us online today.
J. Price McNamara
Attorney
Losing my own brother, then my father and sister after long, disabling illnesses just a few months apart drove a career change for me. Before that experience, I never truly understood the place you’re in. I never understood the dramatic impact that receiving (or not receiving) the disability and life insurance benefits you paid for and counted on can have on your life especially when you need to focus on family and healing. What I experienced with my own family now drives the way I view my clients and my work, and I will never forget it!
Author's Bio