Insurance plans and policies in the State of Texas can be complicated – most especially when these plans fall under the Employee Retirement Income Security Act of 1974, sometimes called the federal ERISA statute. Moreover, many employees in the State of Texas are unaware that Texas law does not require employers to offer insurance plans to their employees in the first place, including group health insurance plans. However, the majority of employers in Texas do offer insurance plans to their employees.
Moreover, if your employer does offer insurance plans, including health insurance plans, it must comply with certain regulations that are mandated by the State. If your insurance company wrongfully denies you benefits under an employer-sponsored plan, there are certain legal steps that you may be able to take.
The knowledgeable Texas insurance benefits lawyers at the Law Offices of J. Price McNamara are experienced at resolving legal issues that are related to employer-sponsored ERISA insurance plans. Please contact us online today for more information and to schedule a free case evaluation and legal consultation.
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
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 the Law Offices of J. Price McNamara, our legal team can pursue the benefits you need under an employer-sponsored plan of insurance. To schedule a free case evaluation and legal consultation with a knowledgeable Texas insurance benefits attorney, please contact us online today.