When dealing with insurance companies, you need an Orlando ERISA lawyer who is not afraid of facing your employer or the insurance agency. You need someone with experience in an array of ERISA-related claims who can help you gather information to support your claim and fight back against an invalid denial. Call Law Offices of J. Price McNamara today at (504) 458-8455.
What Is ERISA?
ERISA, or the Employee Retirement Security Act, is a federal law that regulates both retirement and welfare benefits offered by employers. Approximately 684,000 retirement plans fall under ERISA, and more than 141 million workers and beneficiaries have rights under ERISA.
Specifically, ERISA addresses requirements for the following:
- Retirement plans
- Health insurance (i.e., major medical, dental, vision, and prescription drug benefits)
- Health flexible spending accounts (FSAs)
- Life insurance
- Accidental death & dismemberment (AD&D) plans
- Long-term disability insurance
- Short-term disability insurance
- Funded vacation benefits
- Day care benefits
- Funded scholarship benefits
Many retirement and welfare benefits offered by employers are regulated by ERISA. However, other plans of these types that are not offered by employers may also have to comply with state and local rules and laws. An Orlando ERISA lawyer can review both your benefits and plan documents and determine which laws apply to your benefits.
Disability Insurance Benefits
If you have short-term or long-term disability through your employer, it is likely regulated by ERISA. The plan administrator, which may be the insurance company, your employer, or a third party, must provide you with written documentation of plan details, including the following:
- Eligibility for benefits
- Disability benefits amounts
- Claims processes and procedures
- Filing deadlines and other schedules
- An appeals process if your claim is denied
This information is provided in the Summary Plan Description and Plan Document. An Orlando ERISA lawyer can review your information and help you submit a claim or appeal a denial, if necessary.
If your loved one passed away and you are seeking life insurance benefits from a plan provided by an employer, we can help. Life insurance claims are often denied for the following reasons:
- Conflict over beneficiary eligibility
- Misrepresentation of nondisclosure of information
- Cause of death ineligibility (for example, suicide or drug use)
If you have questions about a life insurance plan and need help submitting information or completing documents by company deadlines, contact our Orlando ERISA lawyer for more information.
Accidental death and dismemberment (AD&D) insurance applies when the cause of severe injury or death was an accident. If the cause was a medical condition or non-accident, your claim may be denied. It can be difficult to prove the cause of death or severe injury.
However, an experienced Orlando ERISA lawyer can help you gather evidence necessary to complete an AD&D claim.
Insurance Claims Process
The insurance claims process typically begins by submitting a form online or in writing requesting payment of plan benefits under an ERISA insurance policy. Most insurance companies will request additional information, and they may want documentation from a third party, such as a doctor. If your claim is denied, you have a right to appeal; however, you must meet very strict deadlines to submit additional information. An Orlando ERISA lawyer can help you submit the necessary information right away as well as meet all deadlines presented by the insurance company.
If your appeal is denied, you may need to file a lawsuit in court to force your insurance company to comply with the benefit plan. This may require submitting a complaint with supporting information to a local or federal court. It’s essential that you have an Orlando ERISA lawyer on your side throughout this process. Both the insurance company and your employer will have powerful teams of attorneys on their side. So you deserve to have a strong advocate as well.
If your claim was denied without valid cause, your insurance company may be acting in bad faith. If they fail to fairly evaluate your claim or delay the process without good cause, they may be liable for punitive damages, or an award that is meant to punish the company for intentional improper conduct.
A bad faith insurance claim can be complex and also requires that you have significant evidence against the insurance company. You should work with an Orlando ERISA lawyer who has experience with bad faith insurance claims. The Law Offices of J. Price McNamara has extensive experience working with clients who submit claims against their insurance companies who have acted in bad faith, and we can help you as well.
An Orlando ERISA Lawyer Can Help You Today
At the Law Offices of J. Price McNamara, we have faced many insurance companies who failed to pay benefits according to their policies. We will submit a demand for payment and then take them to court, if necessary. We will also be an aggressive leader in your case to help you obtain the compensation you deserve from your insurance policy. Call an Orlando ERISA lawyer today at (504) 458-8455.