Consulting an Insurance or ERISA Lawyer
An Experienced ERISA Insurance Attorney Can Help Protect Your Life, Health Insurance, and Disability Benefits
When is a good time to get a lawyer involved in your claim? If cost were no concern, we would always advise that an attorney should be involved right from the beginning. An experienced ERISA insurance attorney can:
- Shed light on the meaning of complicated health insurance policy or disability plan provisions;
- Identify the kinds of evidence necessary to convince a claim administrator (or court) to approve your short or long term disability claim, or to authorize health insurance coverage for a medically necessary surgery, hospitalization, or drug;
- Provide advice regarding applicable state and federal laws, and the impact these may have on your health, life, or disability insurance claim; and
- Use their experience to identify emerging insurance company practices that suggest bad faith or may be suitable for a class action lawsuit.
Many of our clients are surprised to learn that their health, life, or disability insurance policy imposes a duty of cooperation that requires compliance with all reasonable requests by the insurance company. This may include providing private or sensitive information, such as: tax returns or psychotherapy records; participating in personal interviews or a deposition; allowing claim personnel into your home; and allowing yourself to be examined by a health care professional — a so-called independent medical examination — arranged by your insurance company. Although there may be steps to take to protect yourself from or limit such intrusions, an outright refusal to cooperate can result in a court throwing out your health insurance, life insurance or disability claim, even if that claim is valid and fully supported by the evidence.
In ERISA cases, the administrative record — that is, the evidence submitted to your insurance company to support your life, health insurance, or disability claim — is critically important to your prospects for succeeding in any ensuing court action. Courts may refuse to consider any evidence outside the administrative record. Consequently, the guidance of an experienced ERISA attorney during the initial claim application and, in the event of a claim denial, during the appeal, can be crucial.
We try to provide flexible levels of service to accommodate the different functional and financial needs of our clients. If a client feels able to write an insurance appeal, we can participate in an advisory capacity — providing initial suggestions and then commenting on draft versions of the appeal. If a client is able and willing to do leg-work, such as obtaining medical records, this can reduce attorney time dramatically. Similarly, client questions presented by letter, fax and e-mail, can sometimes be more efficient and cost-effective than doing so by telephone. Finally, in certain appropriate cases, a contingency fee arrangement may be mutually satisfactory (rather than a straight hourly billing arrangement). Such an arrangement may not reduce the amount of fees ultimately paid, but may postpone the fees until an award or settlement of your life, health, or disability claim is achieved.
We strongly urge those with health, life and disability insurance issues to seek a lawyer’s assistance sooner, rather than later, and to express their financial needs and concerns at the outset, so that a mutually beneficial relationship can be structured within those constraints.
New York ERISA and Private Insurance Attorneys (including Manhattan, the Bronx, Queens, Brooklyn, Staten Island, Albany, Amherst, Buffalo, Cheektowaga, Hempstead, Levittown, Mount Vernon, New Rochelle, Rochester, Schenectady, Syracuse, Troy, Utica, White Plains, and Yonkers)