What To Do if Your ERISA
Long Term Disability Claim Has Been Denied
Disability can strike anyone. Hopefully, you have long term disability insurance to protect your income should it happen to you. But insurance companies aren't exactly eager to pay claims. If your benefits have been denied, you must act quickly to protect your rights or you’ll lose them. If you’re covered through your employer, your claim is probably governed by the federal ERISA act, which is unlike any law you've ever seen before. You’ve heard the pitch line about “the secret the banks don’t want you to know”. Well ERISA is the dark secret that insurers don’t want you to know about until it's too late.
If there is one thing that my ERISA disability practice has taught me, it's that all of my clients want to work, but because of physical limitations beyond their control, they can't. This leads to frustration and often depression. While I cannot make disabilities go away, I can make insurance companies pay what they owe and that can lighten the financial (and some of the emotional) burden.
ERISA Rights of Substance Abuse, Mental Health, Eating Disorder Treatment Providers
Insurance companies often deny "out of network" claims for inpatient care, on "medical necessity" or other grounds, especially when it comes to the treatment of and substance abuse, mental health and eating disorders. If you are a health care provider, don't just write those claims off as uncollectable. Very often they're covered under the patient's ERISA-governed health plan. If you have an assignment of benefits from your patient, you will usually have standing to pursue the claim, under ERISA. This typically involves very little inconvenience or expense to either you or the patient.
And even when it comes to "in-network" claims, do not accept unreasonable reimbursement rates paid by HMO's and PPO's, if those amounts are not justified by your provider agreement. I have successfully handled hundreds of health benefit claims for providers. I might be able to help you too. Call, text or email me. It will cost you nothing so you have nothing to lose.
What Exactly is ERISA?
ERISA is an acronym for the Employee Retirement Income Security Act of 1974. The body of ERISA law includes the federal statute 29 USC. 1001, et seq.; the regulations and the "common law" (decisions of the federal courts). The law was enacted by Congress to address irregularities in pension plan administration. Originally, it was not intended to affect group life, medical or disability insurance; however, because of ERISA’s broad preemption clause, (and as the result of federal judicial decisions over the past four decades), ERISA now impacts practically all employee benefits in the private sector.
Who I am and What I do
I have been in private practice for more than 35 years. Prior to starting my own practice, I was in-house counsel for an ERISA plan administrator. I have drafted ERISA plan documents including: comprehensive plan descriptions, summary plan descriptions, administrative services agreements, and claims manuals. For over 25 years, my practice has been limited to handling long term disability and health claim disputes, litigation and appeals governed by ERISA, as well as ERISA benefit collections for healthcare providers and "in-network" provider disputes (e.g. HMO, PPO contract reimbursement). I have successfully handled hundreds of benefit claims through all levels of administrative review, mediation, arbitration, litigation in federal court and I have argued cases before the Ninth Circuit Court of Appeals. I have pursued such cases against practically every major insurer and benefit plan in the United States. I do not represent insurance companies. I only represent plan participants, doctors, hospitals and other health treatment facilities. By focusing exclusively on the work I love to do, I can do what I know I do best.
If you have a claim arising under an ERISA benefit plan, the first thing you need to do is immediately learn how the law affects you. Start by clicking on this link: Frequently Asked Questions About ERISA. You can also read some of the articles I have posted here or you can simply call, text or email me. I'll be happy to explain the ERISA-LTD process to you in detail, as well as what you need to do next to protect your rights at absolutely no charge to you.
“Michael explained the complexities of my case and all the options, . . . He answered questions, and when I grew weary of the fight and wanted to quit (again), he was patient and understanding. . . . But most of all, his extensive knowledge of ERISA laws and the ins-and-outs of the process was impressive. . . . I highly recommend him — he’s more than a lawyer. He genuinely cares and will do everything in his power to make you whole again.”
"You simply cannot find an attorney who will fight harder for you than Mike McKuin will."
"His ERISA acumen and decades of experience were clearly apparent from the beginning and throughout every step of the case."
"I was copied on every piece of correspondence that was sent out. I was always notified of what he is, and plans to do next."
"As we watched him spar, my wife and I grew increasingly grateful that we had him on our side."
Experience You Can Trust
Most cases do resolve informally by administrative appeal, but many do not. For that reason it’s important to find a lawyer who is highly experienced in ERISA litigation, including federal trial and appellate experience. I have more than 25 years of it. You will find a complete list of the cases I’ve litigated here: ERISA Litigation Experience.
My Peer Review Rating from Martindale-Hubbell is AV® Preeminent™, the highest rating achievable and I have held that rating for more than 15 years. An AV Peer Review Rating shows that a lawyer has reached the height of professional excellence. He or she has usually practiced law for many years, and is recognized for the highest levels of skill and integrity. Martindale-Hubbell is the facilitator of a peer review rating process. Ratings reflect the confidential opinions of members of the Bar and the Judiciary. For more information: Martindale-Hubbell Peer Review Ratings - FAQ.
Rated as one of "The Inland Empire's Best Lawyers". Area of Practice: Employee Benefits, Inland Empire Magazine.
5.0 / 5.0
Practice Limited to California
Beware of those so-called "national" law firms that spend a lot of money on advertising to solicit ERISA disability clients from all over the United States. Frequently, their practices are not limited to a single area of law such as ERISA. In fact, be leery of any disability firm that routinely moves cases through their offices at a rate of only a few months per case. Their business model is to attract a large volume of cases, which generally means taking every case that comes in the door and shooting for any low-ball settlement they can get. The idea is to move as many clients through their revolving doors as fast as they can. The emphasis in on quantity, not quality and they'll sell out their client’s interest for a quick fee and then move on to the next case.
ERISA is a very complicated and document-intensive area of law that simply does not lend itself to a "volume" practice (unlike other areas of law such as Social Security disability). Also, all federal circuits are not the same. California is in the Ninth Circuit and handling an ERISA benefit case in California requires an expert knowledge of the laws of this circuit. If a "national" law firm is based outside of California, its lawyers may have a limited knowledge of the case law and the unique court rules of this circuit.
I have been a licensed California attorney since 1982. My practice is strictly limited to the U.S. District Courts of California and the Ninth Circuit Court of Appeals.
My Commitment to You
If you hire me, I will be YOUR lawyer. You will have me on your side every step of the way. Every case involves teamwork between lawyer and client, but you can rest assured I will personally handle every legal aspect of your case from start to finish. You will not be passed off to some junior associate, paralegal or law clerk. Your phone calls, emails, and text messages will be promptly answered, as will your questions. You will be kept well informed during every step of the process.
I don't run a mill and I don’t do this work to make a fast buck. That means you will NEVER be pressured by me to accept some insurance company "low-ball" settlement of your claim. I don’t guarantee results. No responsible lawyer can. But I’ll put my success rate up against anyone’s. There are bigger firms that you can hire. But you won't find a better lawyer or one who will give your case the personal attention that I will. That is my commitment to you.
Free Consultation and Case Assessment
If you want to discuss your case or you have any questions about the law, call me at 760-565-7598 or email me at firstname.lastname@example.org. I'll be happy to provide you with any answers I can. I'll also review the initial documents pertaining to the denial of your claim and follow-up with you to discuss your options at no charge whatsoever. There will be absolutely no obligation on your part so you have nothing to lose. If you hire me on a contingency fee basis you will pay me nothing until I recover benefits for you.
ERISA Disability Lawyer
Areas of Practice
Ninth Circuit Appeals
HMO / PPO Provider Disputes
AAA Commercial Arbitration