If you are seeking ERISA-covered benefits through your employer’s insurance, it is advisable to contact a Texas ERISA lawyer to help you get the benefits you are entitled to. Texans may seek different types of benefits through their employer-provided insurance, including long-term disability, life insurance, health care, and others.
In Texas, employer-provided insurance accounts for more than half of all health insurance coverage provided to the non-elderly population in the age group of between 0 and 64.
Let an experienced Texas ERISA lawyer help you receive the benefits you deserve. At J. Price McNamara ERISA Insurance Claim Attorney, we provide reliable and responsive legal representation to clients dealing with ERISA-related issues throughout Texas.
We are not afraid to stand up to big-name insurance companies and fight for the clients’ needs and best interests in out-of-court disputes and ERISA litigation. Get immediate assistance with your ERISA claim with a free consultation with J. Price McNamara. Call (713) 300-0462 now.
There is no such thing as “qualifying” for the Employment Retirement Income Security Act (ERISA). You can be a participant under an ERISA plan depending on how you receive your benefit plan coverage. If your employer, union, or trade organization sponsors a benefit plan, ERISA likely applies unless you work for a government entity.
ERISA governs the vast majority of all benefit plans provided by employers in the private sector.
ERISA is a federal law enacted in 1974 that sets minimum requirements for employee benefits plans.
Under 29 U.S.C. § 1002, ERISA-covered employee benefits plans can fall into two categories:
If you seek benefits through an employer-sponsored plan in Texas, chances are that the plan must follow ERISA guidelines.
Contact an ERISA lawyer if you pursue benefits through your employer-provided insurance plan.
Not all benefit plans fall under ERISA, as the federal law explicitly excludes specific plans from ERISA coverage.
Here’s a list of benefit plans that do not have ERISA coverage:
If you are not sure whether ERISA covers the benefit plans your employer provides, speak with an attorney.
ERISA law requires fiduciaries, including plan administrators, to comply with the following duties when handling claims or distributing plan assets:
If you believe that your employer’s insurance company or the plan administrator breached any of the above duties when handling your ERISA-covered claim, do not hesitate to consult a lawyer.
Yes, if your employer owes you any fiduciary duties under the Employee Retirement Income Security Act, you may be able to hold your employer responsible for breaches of fiduciary duties.
Some of the most common types of breaches that occur in ERISA-related cases include:
If you believe that your employer or another fiduciary breached their duties owed to you, it is vital to contact an experienced attorney to help you sue the liable party for the breach of duty and recover damages.
When seeking benefits covered under ERISA, the investigation process looks like this:
If an insurance company denied your ERISA-covered claim, you should contact a skilled attorney as soon as possible. Your Texas ERISA lawyer will help you appeal the denial of your claim and, if necessary, protect your rights during ERISA litigation.
Under ERISA regulations, people seeking ERISA-covered benefits have to exhaust their administrative remedies before filing a lawsuit against the insurance company. Appealing directly to the insurance company is usually enough to satisfy the requirement.
When filing an appeal to the insurance company, support it with as much evidence as possible. Your ERISA lawyer will help you strengthen your appeals case by gathering all available evidence to improve your chances of success.
One of the ERISA provisions that many people are not aware of is that you may not be allowed to submit any new evidence during a lawsuit. In other words, the judge will be limited to the evidence that was brought by the claimant when filing their initial claim and during the administrative appeals process.
For this reason, we cannot overstate the importance of collecting all the evidence that may help you succeed. You should seek the legal assistance of an experienced ERISA lawyer to help you prepare a strong case when filing an appeal.
ERISA requires insurance companies to give claimants a certain amount of time to appeal the denial of their ERISA-covered claim. The amount of time to appeal depends on the type of benefit at issue in the claim.Your attorney will review the terms of your benefit plan to determine the best strategy to succeed in appealing the denial of your claim.
If the insurance company decides to approve your appeal, you may receive the requested benefits shortly after the approval. However, if your appeal does not succeed, you may bring a lawsuit against the insurer and/or plan administrator.
As mentioned earlier, you have a right to bring a civil lawsuit against defendants in ERISA litigation once you have exhausted all of your administrative remedies, including filing an appeal directly to the insurance company that denied your claim.
Here are several things you should know when filing a lawsuit against the insurance company:
You should always contact a skilled lawyer after you receive a denial of your claim. Your lawyer will help you file an appeal and represent your rights in front of the judge. It’s actually best to call our Texas ERISA lawyers before you apply for benefits so that we can submit it properly. Definitely call us as soon as you receive the first denial letter from the insurer.
Many claimants hesitate to file lawsuits because they worry that doing so could cause them to lose their job. But can your employer fire you for seeking ERISA-covered benefits? The short answer is “no.” Employers may not fire or take any other adverse employment actions against employees who seek benefits under ERISA-covered plans. If your employer retaliated against you for seeking ERISA-covered benefits or filing a civil lawsuit, call a lawyer immediately.
There are many reasons to hire an ERISA lawyer when seeking benefits covered under ERISA, especially if the insurer denies your initial claim.
Consider the following reasons to retain a skilled lawyer who has experience in handling ERISA-related cases:
Contact a Texas ERISA lawyer to help you effectively handle your ERISA-based claim and get the benefits you deserve under your employer-sponsored plan. Without the right legal assistance, you risk losing the benefits that you need and that you deserve under the law and your employer-sponsored coverage. Insurers are often more responsive when a claimant has legal representation.
Schedule a free initial consultation with J. Price McNamara ERISA Insurance Claim Attorney. We can help you seek the benefits the law gives you under your ERISA-covered plan. Mr. McNamara has successfully represented numerous clients in Houston and throughout Texas.
Call (713) 300-0462 or complete our contact form for a free, no-obligation case review. We work on a contingency basis, so if you don’t win your case, you will owe us nothing. Our law firm is ready to help with complex ERISA matters.
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