United Healthcare does not have a reputation as a particularly helpful or reasonable insurance company across its products. Combine this with insurance with a high rate of coverage denials and power given by an insurer-friendly law, and claimants may find themselves with issues that can cripple their long-term finances.
United is a massive corporation with many legal tools and deep pockets. To successfully stand up for the benefits you deserve, you want a law firm on your side that has experience taking on large insurers. At J. Price McNamara ERISA Insurance Claim Attorney, you will find the advocates you need to fight against United and its resources. We are not hesitant to deal with United Healthcare directly or in federal court.
Reach out today to learn how we help clients with disabilities recover the benefits they need and how we might assist with your case.
Your employer has likely provided you with long-term disability coverage as one of your benefits. Employers appreciate this benefit because it gives them peace of mind if they are sick or injured and cannot work. The problem happens when you try to apply for these benefits.
You must file the application at an extremely challenging point in your life because your physical condition is such that you cannot work. You can be dealing with a medical condition or the aftermath of an injury. Regardless of the cause, not working will have a devastating effect on your finances.
Long-term disability coverage can pay you up to 60 percent of your previous salary. During your career, the total value of this claim can be worth more than $1 million. These funds come directly from the insurance company. The more claims that they deny, the more money they make.
As of this writing, United Healthcare has a market capitalization of nearly half a trillion dollars. It is one of the most valuable companies listed on the stock market. United Healthcare makes nearly $20 billion each year in profits.
A substantial fraction of these profits come from money that United Healthcare should have paid in claims but did not. By avoiding responsibility for claims that the company had to pay, United Healthcare pads its profits. All of this comes at your expense. The company you expected to be there for you can become your sworn adversary.
The problem here is that employee benefits fall under a law called ERISA. Congress passed this law to protect employees and their benefits. In practice, ERISA has been anything but employee-friendly.
Instead, the law seems to give more protection to employers. They often feel like they have the license to deny any claim that seems to be a close call because they often escape any responsibility for it.
Some long-term disability insurance providers face enforcement actions and class action lawsuits. However, the average denial will not lead to many repercussions for insurance companies.
Even though ERISA seems to give insurance companies more power, you are not powerless as a claimant. The first thing you can do to improve the chances that you will get benefits is to hire us. We can put in as much work as possible on the front-end when applying for benefits.
Remember that the insurance company is looking for a reason to deny your claim. Therefore, you make sure that your medical information is as clear as possible before submitting the claim.
You should review your plan’s definition of disability before filing the claim. For nearly all plans, the definition of disability in your plan for the initial claim is not performing the duties of your own occupation.
Over time, many insurance companies will change that definition to give them a reason to terminate your benefits. Many policies will reset the definition of disability to not performing any work. In other words, many insurance companies expect you to do some work or even learn another profession when you are dealing with an illness or long-term injury.
ERISA requires the insurance company to respond to your initial application for benefits within 45 days. Often, adjusters use this period to circle their wagons to make their denial of your claim as strong as possible. There are some cases where the insurance company will approve the initial benefits application (however, they might still terminate benefits later on). Insurance companies usually approve initial applications when your disability is more clear-cut.
If United Healthcare denies your initial application, they must provide you with the reason and documents they relied on to reach the decision. The most common story that they will tell is that you do not meet the plan’s definition of disability.
One of United Healthcare’s favorite tactics is to use its network of doctors to reach decisions about your health and ability to work. These doctors have never met you or laid eyes on you before. They do not listen to the opinion of your doctor, who has seen you. Insurance companies cannot get away with this, but first, you need to challenge them.
United Healthcare has other tactics that it likes to use to deny your benefits. One of their favorite weapons against claimants is to investigate their lives.
Long-term insurance companies often:
The goal is to find any nugget they can use against you to deny benefits. As a claimant, you argue that you are disabled and cannot work. However, if the investigator thinks that they saw something inconsistent with that, United will use it to reject your claim.
In many cases, insurance companies look to cherry-pick details that they can use to their benefit.
United Healthcare can also do everything possible to terminate your benefits. They may subject your claim to a review after giving you benefits for some time. Many claimants have gotten used to getting benefits when United terminates them.
While ERISA gives power to insurance companies, the law gives you one powerful weapon at your disposal. United Healthcare does not get the final say over your application or when they terminate your benefits. Every claimant has appeal rights when they get an adverse decision.
However, the ERISA long-term disability appeal process works differently than a workers’ compensation claim. In the latter, claimants can go directly to a neutral third party who will review the claim. For ERISA claims, you cannot go straight to court to appeal the denial. Instead, you must first go to the insurance company for the first level of review.
If you think that going to the same company that denied your claim in the first place for an objective review seems wrong, you are not alone. However, this is how ERISA works, and you must play by these rules if you want a chance at benefits. Not only that, but you must take the insurance company appeals process seriously because that will be the record that you use throughout your case.
When appealing to the insurance company, you must take your time to get things right. The most important step of this process is building the record for your appeal.
The appeal record will include:
The chances are that the insurance company will not give your appeal the robust review that it deserves. Most people who file insurance company appeals will get back more of the same, albeit with different words. The appeal decision will usually be a defense of their initial denial.
However, the insurance company’s appeal is not the last word. The next step is going to a federal district court to have a judge review the record. Federal court is often where the real battle happens.
To make your best showing in front of a judge, you need an experienced ERISA appeals attorney who knows how to present arguments to the court. An ERISA appeal will be a closely contested legal matter, and you must put your best foot forward.
The foot that you put forward in an ERISA appeal will make all the difference. Much of your case comes down to your arguments about why the insurance company made a mistake in denying or terminating your benefits. Your attorney can submit a brief explaining the record that the insurance company reviewed and why they were wrong.
Depending on the language of your plan, the judge may give the insurance company’s initial decision some degree of deference. However, in an ERISA appeal, wrong is wrong. If the insurance company made a mistake, a judge will not allow it to stand.
No matter how self-interested and conflicted the insurance company was, the judge is limited to reviewing the same documentation at issue in your initial appeal. You do not get to start your case from scratch and build a new record for federal court.
Accordingly, you need a lawyer at J. Price McNamara who will put all possible effort into the insurance company appeal. If you wait until federal court to begin your case, the chances are that you will lose because you will not have the record necessary for the judge to conclude that the insurance company made a mistake.
Hire an attorney at the very beginning of the process when you file your initial claim. A lawyer will give you help and guidance to allow you to put forward the most compelling possible evidence in support of your claim.
If you do not have a lawyer when the insurance company denies your claim, immediately hire one. The ERISA appeals process does not give claimants any advantages, nor does it do them any favors. There is simply too much at stake to try to handle this on your own.
Even are in litigation, your case can end in a range of outcomes. By denying your claim, for example, UnitedHealthcare Specialty Benefits may try to force you into settlement negotiations. They think they can save money by making you more desperate to take less.
An experienced attorney knows when you have a strong case and leverage against the insurance company. If you choose to negotiate a settlement, your lawyer will work to maximize the money that you can receive. Although you may have to fight, the insurance company does not have complete and absolute power over you.
Long-term disability claims can have millions of dollars at stake for you. Your success can make or break your family financially in the long run. You should understand how critical the process is before you begin. Preparation and documentation are the two keys when you deal with UnitedHealthcare Specialty Benefits.
Your financial future is at stake during the claim and appeal, so do not leave anything to chance.
The law firm ofJ. Price McNamara ERISA Insurance Claim Attorney has extensive experience taking on large companies like United Healthcare when they have wrongfully denied claims. We are not afraid of corporate bureaucracies and their armies of lawyers. We are your force multiplier when you feel like these companies are taking advantage of you and trying to push you around. Call us today at (504) 420-6962 or contact us online for your free initial consultation.
This has been a very difficult time for myself and my family. Mr. Mcnamara did his best to be as empathetic and compassionate as possible. He is very knowledgeable and a man of great integrity.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded the Law Offices of J. Price McNamara, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts