Residents of Houston can much more efficiently seek the benefits they deserve under their employer-sponsored insurance plan when they work with a knowledgeable Houston ERISA lawyer.
If you experienced a violation of your rights under ERISA or your employer’s insurer denied your group long-term disability insurance claim, do not hesitate to contact J. Price McNamara ERISA Insurance Claim Attorney. We understand the emotional and financial hardships associated with the denial of your disability insurance claim.
We have the resources and experience to advocate for your rights and fight for the benefits you deserve. Call (713) 300-0462 to receive a Free Denial Review. Since we typically work on contingency, we will only collect a percentage of any long-term disability benefits we help you to secure. You will pay us nothing out of pocket.
What Does ERISA Cover?
There are over 3 million nonfarm jobs in the Houston Metropolitan Statistical Area. Many private employers in Houston offer their employees insurance benefits plans, most of which the Employee Retirement Income Security Act (ERISA) of 1974 covers.
In addition to health insurance, many employees in Houston also receive disability and life insurance benefits through their employers. However, it is not uncommon for insurance companies to deny employees’ claims for ERISA-covered benefits.
ERISA is a federal law designed to protect the rights of employees who receive employer-provided insurance benefits such as retirement benefits, health insurance benefits, and many more.
The 1974 law sets minimum requirements for benefit plans provided by private employers in Houston, Texas, and across the country. The vast majority of employer-sponsored retirement and health plans are covered by ERISA, while government-funded benefit plans are largely exempt from federal law.
The Employee Retirement Income Security Act provides three fundamental protections for employees (beneficiaries and participants):
- The right to sue for plan benefits when their attempts to appeal are unsuccessful;
- The right to file a lawsuit against fiduciaries for failure to fulfill their obligations under ERISA; and
- The right to continue receiving benefits covered by the Pension Benefit Guaranty Corporation (PBGC) when the original plan gets terminated.
Contact a skilled Houston ERISA lawyer if you believe that your rights under ERISA were violated. J. Price McNamara helps employees address the various obstacles they face during the ERISA claims and appeals process.
Why You Need a Houston ERISA Lawyer
If your employer’s insurance company is delaying the claims process or your claim ends with a denial, you need an experienced Houston ERISA lawyer to discuss your legal options. Residents of Houston can benefit from help from J. Price McNamara.
Mr. McNamara provides legal counsel in the following ERISA-related cases:
- Long-term disability insurance
- Health insurance
- Life insurance
- ERISA litigation
- Accidental Death and Dismemberment (AD&D) insurance
- Bad faith insurance
Please note that this is not an exclusive list of ERISA-related matters that J. Price McNamara ERISA Insurance Claim Attorney handles. We offer a free, no-obligation consultation to our prospective clients to allow them to understand whether they need an ERISA lawyer.
What Are ERISA Standards?
ERISA sets strict standards for the following aspects:
- Conduct. ERISA requires fiduciaries to adhere to stringent rules for conduct.
- Reporting. ERISA sets strict requirements for reporting to the federal government.
- Disclosures. Plan administrators must provide certain disclosures to participants and beneficiaries, including guidelines for obtaining ERISA-covered benefits.
- Procedures. ERISA requires fiduciaries of covered plans to establish written policies as to how participants should file claims, how they can appeal denials, and explain other procedural requirements and nuances.
- Good faith. ERISA requires plan administrators to act in the best interests of participants. Administrators must handle claims in good faith and fulfill their fiduciary obligations.
Speak with an experienced attorney to find out more about ERISA standards and regulations.
What Are the ERISA Fiduciary Obligations?
ERISA provides protections for beneficiaries and participants in covered benefit plans and also imposes fiduciary obligations on those who manage employee benefit plans and assets. ERISA requires fiduciaries to act with a reasonable degree of care, prudence, and diligence (29 U.S.C. § 1104).
While fiduciaries, including plan administrators and insurance companies, are legally required to act in the best interests of beneficiaries and participants, breaches of fiduciary duty are not unheard of in ERISA-related cases.
A participant or beneficiary can sue a fiduciary for their failure to fulfill their obligations imposed by ERISA, including:
- Mishandling plan assets
- Failing to handle a claim on time
- Failing to properly calculate plan benefits
- Not following the terms of the benefit plan
- Wrongfully denying an ERISA-based claim
If you believe that a plan administrator or another party breached their fiduciary duty when processing, handling, or denying your claim, do not hesitate to speak with an ERISA lawyer.
Mistakes to Avoid When Filing an ERISA-Based Claim in Houston
While most employees know that their employer-sponsored benefit plans are under ERISA, many of them are not familiar with the filing process. As a result, many participants and beneficiaries end up making mistakes when filing claims. These mistakes often lead to the denial of their claim.
An experienced ERISA lawyer on your side can help you avoid mistakes when filing a claim and seeking benefits under an ERISA-covered plan.
Claimants often make the following mistakes when applying for ERISA-covered benefits without an attorney:
- Not consulting with a lawyer before filing a claim
- Not reading the terms of the benefit plan
- Relying on the policy interpretations from your employer or insurance company
- Thinking that having your primary care physician’s testimony is enough to prove that you are disabled
- Failing to supplement your claim with sufficient evidence, including medical records, to support your ERISA-based claim
- Engaging in activities that could result in the denial of your claim (many claimants do not know which activities are prohibited when seeking benefits)
- Reapplying (or not doing anything at all) when denied instead of filing an appeal
- Failing to follow your doctor’s orders
- Waiting too long to file a claim
You must understand all of your rights and obligations when seeking benefits under an ERISA-covered plan to avoid mistakes and get the benefits you deserve. J. Price McNamara ERISA Insurance Claim Attorney can help you with all aspects of your claim so you avoid mistakes when filing your claim.
What to Do if You Receive a Denial of Your Claim for ERISA-Covered Benefits?
If you are seeking benefits covered under ERISA, but your employer’s insurance company denies your claim, you need to understand what steps you should take to appeal the insurer’s decision and obtain the benefits you paid for—and deserve.
If your claim ends in a denial, the first thing you should do is request a copy of the benefit plan. Under 29 U.S.C. § 1024, ERISA-protected participants and beneficiaries have a right to request copies of the formal plan document and other plan materials.
You need to follow the procedural requirements for appealing the denial of your claim according to the specific language of the benefit plan. While the plan documents will specify how much time you have to appeal the denial of your claim, most plans give claimants 180 days to file an appeal.
ERISA law requires claimants to exhaust all of their administrative remedies, including filing an appeal directly to the insurance company, before filing a lawsuit in federal court. If the appeal process does not bring the desired outcome, you can proceed with a lawsuit.
Your lawyer will help you understand all the nuances associated with appealing the denial of your claim for ERISA-covered benefits.
Can You File a Lawsuit When You Receive an ERISA-Based Claim Denial?
Under ERISA, claimants have a right to sue their employer’s insurance company or plan administrator if their claim ends with denial. However, a claimant can only file a lawsuit once they exhaust their administrative remedies, such as filing an appeal directly to the insurer.
It is advisable to seek the legal counsel of a Houston ERISA lawyer if your claim is denied. An attorney will help you follow all the strict rules regarding handling the appeal. If your appeal case is unsuccessful, you can file a lawsuit.
Once you file a lawsuit in federal court, the defendant (the insurance company) will have 21 days to respond with a counterclaim (FRCP Rule 12). Contact an experienced lawyer to prepare you for ERISA litigation. ERISA-related claims are subject to tight deadlines, which is why you should not hesitate to speak with a lawyer.
Reasons You Should Hire a Houston ERISA Lawyer After a Claim Denial
The denial of any insurance claim is a stressful and overwhelming experience, especially if you are seeking short-term or long-term disability benefits. However, you do not have to go through this alone.
It is advisable to have representation from a skilled lawyer who can help you pursue the right course of action in your particular case.
Let’s discuss the four reasons you should hire a Houston ERISA lawyer when a plan administrator or insurance company denies your claim.
- Your lawyer will help you understand your rights and options. Navigating the insurance claims process can be a confusing experience. Many claimants are not fully aware of their rights when pursuing benefits under ERISA-covered plans. Your attorney will help you navigate the claims process and ensure that you receive the benefits you deserve.
- Your lawyer knows how to appeal the denial of your claim and sue the insurance company. When you receive a denial of your ERISA-based claim, we cannot overstate the importance of acting as quickly as possible. You have a limited amount of time to file an appeal after your claim gets denied. Our lawyer will help you appeal the insurer’s decision and, if the appeal is not successful, file a lawsuit on your behalf.
- Your lawyer will gather the required evidence to win your case. If a plan administrator or insurer denies your claim, you have no time to waste. You need to begin preparing evidence for your appeal. If your claim ends in denial, the insurer is likely to deny your claim when you file an appeal unless you submit clear and convincing evidence proving your entitlement to the benefits. The evidence you submit to the insurer may also be used in ERISA litigation when you pursue a lawsuit in federal court.
- Your lawyer can help you get the benefits to which you are entitled. Many insurance companies undervalue claims in an attempt to pay claimants as little as possible, while others outright deny valid claims. You need to understand how much your claim is worth to know what benefits you are entitled to. Your ERISA lawyer will properly evaluate your case to ensure that you receive the full amount you need.
You can schedule a free, no-obligation consultation with J. Price McNamara to discuss your options and determine whether or not you need an attorney in your ERISA claim.
How J. Price McNamara Can Help You
Our dedicated and results-driven attorneys at J. Price McNamara ERISA Insurance Claim Attorney can help you with every stage of the ERISA claims process, including:
- Gathering medical records, documentation, and other evidence to prove that you are entitled to benefits
- Arranging medical examinations
- Filling out the necessary forms
- Filing your ERISA-based claim
- Handling communications with the plan administrator and insurance company
- Appealing the insurer’s decision to deny your claim
- Filing a lawsuit against the insurance company after exhausting other administrative remedies
Price McNamara has a track record of success in handling ERISA-related cases. Mr. McNamara has built a solid reputation for his zealous advocacy and ability to give every case the personalized attention it deserves. We handle all matters related to the Employee Retirement Income Security Act, including claim denials, appeals, and ERISA litigation.
Do not hesitate to schedule a free case review with Mr. McNamara by calling (713) 300-0462 or filling out our contact form.
