Our Lawyers Provide a Wide Variety of Health, Life and Disability Claim Services
Our attorneys are experienced in ERISA, employee benefits law, and New York insurance law, and routinely handle matters involving disability benefits, health insurance claims, and life and accidental death benefits. To assist our clients, we provide a wide variety of services. The most appropriate type of service will depend on the nature and status of your claim at the time you contact us.
- Life, Health, and Disability Insurance Consultations: Consultations may be the most appropriate level of service if you have a discrete question, or are in the initial stages of exploring your rights and options under your life, health or disability insurance policies. Such questions and inquiries may occur before a claim has been filed (do I qualify for benefits? what is the claim procedure like?). You may be struggling to work with a disability and fearful that you’ll be terminated because of your decreased performance or targeted for termination in a more general layoff or reduction in force. This may raise such questions as: “Can I claim disability if I’m being fired?”; “Can I claim disability and simultaneously seek a severance package?”; or other similar questions that may be answered in a consultation. You may also have questions while your claim is being paid (will a trial work effort affect my disability benefits? will my health insurance coverage or disability benefits be negatively affected if I change my residence?).
- ERISA, Employee Benefit, and Individual Insurance Claim Preparation: Once you have decided to file a claim for life or disability benefits, or to pursue coverage for a particular drug or medical treatment under your health insurance plan, you may want advice and assistance in preparing your claim forms and other submissions. Again, this may be at the initial stages of a claim, or later, when benefits are already being paid but supplemental updates are requested. We can make sure that you and your doctors provide targeted responses that will address your insurance company’s concerns, the requirements of your insurance policy, and increase the probability that your life, health or disability claim will be approved or continued.
- Long Term Disability Claim Assistance: Insurance companies continue to examine, manage, and re-evaluate disability throughout the duration of a long-term disability claim. They may conduct periodic claim updates, perform an intensive “Any Occupation” review, assess whether you remain disabled by a physical disability (after you have exhausted the limited benefits for disability caused or contributed to by a psychiatric illness), or escalate the investigation of your claim by relying on their “special investigations unit” (SIU), conducting surveillance, requesting a field interview, demanding your participation in a Functional Capacity Evaluation (FCE) or Independent Medial Examination (IME), or scouring public and private internet databases for information about your activities. Our attorneys can help you successfully navigate these investigative tactics throughout the duration of your long-term disability claim.
- Appeal of Life, Health Insurance, and Disability Claim Denials: Most ERISA (employee benefit) plans, and many insurance policies, provide an internal appeal procedure for challenging a denied life, health or disability claim before filing a lawsuit. These appeals are frequently mandatory, but may include voluntary components (such as state external review procedures, which are available for some health insurance claims). Whether mandatory or voluntary, appeals are an extremely important mechanism for establishing your chances of success in a subsequent lawsuit. Indeed, by building a strong appeal, our lawyers can help you avoid the delay and expense of litigation altogether by persuading your insurance company that it’s chances in court are not good and that it would be smarter to pay your claim now.
- Negotiation of Lump Sum Disability Settlements, and of Disputed Life, Disability, and Medical Claims: Disputed claims may often be settled by mutual agreement between you and your insurance company (and, in the case of health insurance claims, your healthcare providers may also be involved). Disability claims, even when not disputed, may be the subject of voluntary lump sum payment negotiations. Our lawyers can help you to analyze settlement offers, see whether they’re in your best interest, and advocate for the best possible outcome.
- New York Litigation of Disputed Life, Health Insurance and Disability Claims: When a claim cannot be overturned or settled through internal and external appeal procedures, our attorneys are prepared to enforce your rights by filing a complaint and pursuing your health, life or disability benefits in court. Over the years, our lawyers have handled a variety of lawsuits challenging the wrongful denial of health, life and disability claims, including private claims under individually-purchased insurance policies, and employer-sponsored group plans (subject to the Employee Retirement Income and Security Act, or ERISA).
- Wills, Health Care Proxies, Coop and Condo Transactions: Our attorneys are frequently asked to handle personal matters of interest to our clients and their desire to plan for their own care, and the well-being of their friends and family. We have prepared a wide variety of legal documents, including simple wills, health care directives and health care proxies, powers of attorney, and documents relating to the purchase/sale of cooperative and condominium apartments in the New York City area.
Mark Scherzer Law :: ERISA Disability Benefits and Claims :: Health Insurance Disputes
New York Lawyers (including Clinton County, Jefferson County, Oneida County, Schenectady County, Otswego County, Saratoga County and St. Lawrence County)