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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.
Disability benefits that workers acquire through an employer-sponsored plan typically fall within the purview of the Employee Retirement Income Security Act of 1974 (ERISA). Individuals who have these disability plans are often surprised when they make a claim and the insurance company denies it. In fact, long-term disability benefit denials are not that uncommon, and it sometimes takes two or more tries before an applicant is successful in receiving long-term disability benefits.
The knowledgeable Texas long term disability insurance attorneys at the Law Offices of J. Price McNamara can assist you with making a claim for benefits or appealing a claim denial on your behalf.
In order for you to be eligible for long-term disability benefits, a healthcare provider needs to state, to a reasonable degree of medical certainty, that you are suffering from a long-term illness or injury. Moreover, the healthcare provider must establish that this injury or illness does not allow you to work at a job.
Given that this is a very high standard to meet, it is important that you have a healthcare provider involved in your case from day one. An experienced Texas long-term disability insurance attorney can assist you with proving your eligibility for benefits and making sure that you have a knowledgeable healthcare provider on board in your long-term disability benefits case.
The knowledgeable team of Texas long-term disability insurance lawyers can assist you with appealing a denial of long-term disability benefits. Insurance companies have an incentive to issue these denials because doing so saves them a significant amount of money. Insurance companies make money by keeping the premiums that their insureds pay — not by paying out disability claims.
If the insurance company denies your long term disability benefits application, you should review the denial letter to find out exactly why your claim was denied. This letter will also state the procedures and protocols that you need to follow in order to submit an administrative appeal. Insurance companies must allow you at least one opportunity to file an administrative appeal, although some insurance companies will allow two such opportunities. During the administrative appeals process, you can supplement the record with additional documents from your healthcare provider that support your claim.
After you have exhausted the administrative appeals process, if you still do not have long-term disability benefits, you have the option of filing a complaint against your insurance company in the federal court system. A Texas long-term disability insurance attorney can assist you with filing this appeal and litigating your case in court. At a federal court hearing, the judge will determine whether you are entitled to recover long term disability benefits.
The skilled lawyers at the Law Offices of J. Price McNamara will be able to answer all of your legal questions about long term disability insurance. To schedule a free case evaluation and legal consultation with an experienced Texas long term disability insurance lawyer, please contact us online today.
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