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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.
People often maintain life insurance, accidental death insurance, long term disability insurance, dental insurance, and other types of insurance benefits through a plan that is sponsored by their employer. When that is the case, the federal ERISA statute typically controls the plan.
Under ERISA, insurance companies have a strong legal incentive to deny insured individuals the benefits that they need. This is because if the case ultimately ends up in the federal court system, there is no chance of having a jury trial. Instead, a federal judge will decide the outcome of the case.
If your claim for ERISA benefits has been denied by your insurance company, the San Antonio ERISA denial lawyers at the Law Offices of J. Price McNamara can help you respond to the denial, file an appeal, and pursue the benefits that you deserve and which you need.
Claims for ERISA benefits are routinely denied for a variety of reasons. In some cases, the insurance company that issues the policy may argue that you did not file your claim in a timely manner. The insurance company might also contend that you did not provide sufficient documentation to support your claim. For example, if you were making a claim for disability benefits, the insurance company might state that your claim lacked sufficient medical documentation from a healthcare provider.
A knowledgeable San Antonio ERISA denial lawyer can assist you with interpreting your denial letter, figuring out what went wrong, and responding to the claim denial by filing an administrative appeal with your insurance company.
Administrative appeals that a person files in response to a claim denial go forward in-house. In other words, it is the insurance company that will decide the outcome of the appeal. During the administrative appeals process, you have the option of submitting additional documentation in order to pursue benefits and support your claim.
It is important that you introduce this additional documentation at the insurance company level, because if the matter ultimately goes to federal court, you will not be able to supplement the record at that time. On appeal, the insurance company will review all of the new documentation and make a decision in your case. If your claim is denied again, you may have one more opportunity to file an administrative appeal of the claim denial.
If your claim is denied for a second time, then you have the opportunity to file a complaint against your insurance company in federal court. Once the case goes to federal court, it will be in the hands of a judge to decide whether or not you are entitled to receive ERISA benefits. An experienced San Antonio ERISA denial lawyer can explain the appeals process to you in more detail and assist you with appealing your benefits claim denial.
At the Law Offices of J. Price McNamara, our knowledgeable legal team will be able to help you appeal an ERISA benefits denial. To schedule a free case evaluation and legal consultation with an experienced San Antonio ERISA denial attorney, please contact us online today.
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