Take a look at our July newsletter!
For The Ambitious Advocate BRIEF RECESS
JULY 2023
FROM THE LAW OFFICES OF J. PRICE MCNAMARA
‘A Nationwide Chorus’ SAY ‘HAPPY BIRTHDAY’ TO AMERICA WITH THIS TELETHON
The Fourth of July this year saw many patriotic displays in honor of America’s 247th birthday, with family and friends from coast to coast gathered to forget work and other obligations for barbecue, fireworks, or just to hang out together — American flag likely present at every party, celebration, hangout, and get-together. Following the holiday, many will give thought and appreciation to our greatest America’s greatest asset: freedom. One of my favorite performances for patriotic inspiration is Willie Nelson’s performance of “America the Beautiful” during America: A Tribute to Heroes, a benefit concert held in Los Angeles shortly after 9/11. It was a telethon, so it’s pretty easy to pull up online. It’s really good and worth a watch! After being introduced by Bruce Springsteen, Nelson took the stage to close out the show and brought his legendary voice and twangy guitar to the familiar tune. In addition to Willie Nelson, Bruce Springsteen, Stevie Wonder, U2, Faith Hill, Enrique Iglesias, Neil Young, Alicia Keys (who sang “Someday We’ll All Be Free”), Billy Joel, Dave Matthews, Mariah Carey, Jon Bon Jovi, Sheryl Crow, Sting, Eddie Vedder, Paul Simon (who sang “Bridge Over Troubled Water”), and Céline Dion (who sang “God Bless America”) performed as well. The whole thing is worth watching again. In his book, “Willie Nelson’s Letters to America,” Nelson reflects that some of the performers were his friends, while others met for the first time that night.
“As we sang on the stage that evening, I felt that I could hear the television audience singing too, a nationwide chorus raising our voices from sea to shining sea.”
Nelson united the entire event with his awesome concluding performance. He writes, “That inspiring event had one of the largest audiences in television history. I followed a string of great artists – Bruce Springsteen, Tom Petty, Alicia Keys, and many more. Then I get to lead everyone in an inspiring rendition of your beautiful song ‘America the Beautiful.’ As we sang on the stage that evening, I felt that I could hear the television audience singing too, a nationwide chorus raising our voices from sea to shining sea.”
I think the vast majority of us are “a nationwide chorus” who cherish our American freedom. I know I do.
Happy Fourth of July, and happy birthday, America!
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We often get calls from life insurance policy beneficiaries whose claims are denied because their deceased loved ones failed to properly “port” or “convert” their employment-based life insurance coverage. Porting or converting life insurance coverage involves moving coverage from the employer group policy to a private policy when employment terminates. Victims Are Commonly Mis The Tricky Provisions for ‘Por
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Our recent client received a denial letter in the mail for that very reason.
Our client, Susan, and her husband, Jack (not their real names), got the devastating news that Jack had terminal cancer with minimal time to live. Jack went on disability benefits for a while before dying; meanwhile, his employment was terminated, as it was clear he wouldn’t be returning to work. They told Jack’s employer and the insurer they did not want to “miss any steps” to convert his life insurance coverage to an individual policy. They were told everything was in place and that they needed to pay their life insurance premium to the employer, who would pay the insurance company to keep coverage in effect. They did everything they were told and believed all life insurance coverage for Jack remained effective.
A summer garage sale is a tried and tested way to earn a little cash while eliminating things you no longer need. But it’s also the perfect opportunity for parents to teach their children a few life lessons. Making your garage sale a family project can teach kids about organization, money management, and the pride of a hard day’s work. The lessons start immediately as your family determines what they no longer need. Younger children, in particular, often struggle to part with their possessions. A garage sale is an opportunity to discuss what they use, what they don’t, and why we can’t keep every object we own forever. This process will teach kids organization as they create their “keep,” “sell,” and “toss” piles. On the big day, your children can also play a significant role in organizing and displaying your merchandise. Kids can help determine which items should share a table and what should be front and center to catch buyers’ eyes. Math and money management also play a pivotal role in any successful garage sale. First, you must determine what the items you’re selling are worth. While letting your kids set prices is probably unwise, you can help them understand market value and what people will pay for used merchandise. Your children can take a more active role in the sale itself. Depending on their ages, they can gain valuable experience making change for customers or negotiating a deal on the items for sale. The best part of using your garage sale as a learning opportunity is that your children can personally experience the value of hard work. They’ll watch their old possessions disappear and the cash trickle in. More than anything, they’ll probably love adding up the day’s takings. Whether or not you give your kids a cut of the earnings is up to you. But even if they don’t end up with fatter pockets, your children will walk away from the family garage sale with lessons that will last longer than any extra cash could. What Your Summer Garage Sale Can Teach Your Kids
Imagine Susan’s dismay upon receiving the life insurance denial letter — a second gut punch while still reeling from her husband’s death.
Does your office turn away calls about “long-term disability insurance” claim denials because you don’t handle administrative appeals or “ERISA litigation” in federal court? We want to hear from you! We happily share fees on referred ERISA long-term disability, life insurance, and accidental death insurance denial cases. Send us an email at BriefRecess@jpricemcnamara.com or call (225) 201-8311 to start the referral process! WE VALUE YOUR REFERRALS!
ERISA is all we do!
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We worked closely with Susan to help her build her claim carefully and systematically with new, undeniable evidence far beyond what she had presented before. We proved that the premium for Jack’s life insurance policy was deducted from his pay and received by the insurance company until his death. Our investigation also disclosed 20 pages of email exchanges between the employer and insurer, demonstrating that Jack inquired specifically about all steps necessary to convert his coverage. We presented all this evidence to the insurer in an administrative appeal of Susan’s claim. However, they STILL refused to pay, claiming that Jack did not take the technical step of sending in a form requesting porting his life insurance coverage. We sued the insurance company in federal court, and finally, close to the time of a scheduled trial and faced with a likely federal court judgment against them, the insurance company agreed to pay full benefits to Susan. In the end, because Susan continued to fight, she was able to get her benefits and maintain financial security for her son and herself. It was an honor to help this wonderful lady overturn such an unfair claim denial. sled Into Lapsed Coverage rting’ or ‘Converting’ Coverage
NAVIGATING THE ERISA MAZE 2 Mistakes to Avoid in LTD Claims About 80% of U.S. LTD claims are governed by the federal ERISA (Employee Retirement Income Security Act of 1974) statute. With a few exceptions, ERISA governs all LTD claims involving insurance policies or plans offered as employment benefits. But handling an ERISA LTD claim is a complex minefield for the unfamiliar. Everything about it is different. An administrative appeal process must be exhausted before any lawsuit, and jurisdiction is exclusively federal, with its own odd procedural track. Disability insurance companies and their attorneys know how to use ERISA’s complexities to their advantage. But many claimants, and often their attorneys, don’t until it’s too late.
The two biggest mistakes we see are the failure to timely appeal and failure to put evidence into the administrative record.
Failure to Timely Appeal: Can’t I just bypass the appeal process and file suit? The simple answer is “no.” Written administrative appeal to the insurance company (or ERISA “Plan” if self-funded) that denied the claim is mandatory and must be filed within 180 days of receipt of the written denial. So, the same insurance company, which also pays benefits if it reverses itself, decides the appeal — crazy but true.
Sazon Grilled Chicken Thighs Inspired by AmbitiousKitchen.com
When attorneys and claimants miss the deadline, those claims are as dead as a prescribed claim.
Failure to Put Evidence Into the Administrative Record: Can’t I just file suit and get serious about building a case in federal court if the appeal is denied? Again, the simple answer is “no,” and that comes as a surprise to many after it’s too late. What makes the appeal so critical is that the federal judge in the lawsuit who follows an appeal denial cannot consider any evidence that was not properly made part of the record during the administrative process. ERISA cases get their own unique scheduling orders with almost no discovery allowed. So, the appeal is your last chance to gather, create, and build the best evidence to support your client’s case later in court. Whatever case you build (or don’t) is carved in stone before you ever file suit.
Ingredients • 1 1/2 lbs boneless
• 1/2 tsp garlic powder • 1/2 tsp oregano • 1/4 tsp cayenne pepper (optional) • 1/2 tsp salt • Freshly ground black pepper
skinless chicken thighs
• 2 tbsp olive oil • 1 tsp cumin • 1 tsp ground coriander • 1 tsp turmeric
Directions 1. In a large bowl, add chicken, olive oil, cumin, coriander, turmeric, garlic powder, oregano, cayenne pepper (if desired), salt, and pepper. Toss together to coat chicken; let it marinate for 30 minutes to 1 hour. 2. Preheat grill to 400 F. Grill chicken thighs for 6–8 minutes per side or until fully cooked and an internal thermometer reads 165 F. 3. Transfer cooked chicken to a plate and cover with foil to keep warm, then chop into bite-size pieces to use in salads, tacos, bowls, and more!
So, don’t miss your appeal deadline, and load the record with every bit of evidence you can gather or create.
Shoot us an email at BriefRecess@jpricemcnamara.com if you’d like to discuss how we approach evidence-building or if you’d like a copy of our book that describes our ERISA “Win My Benefits” Appeal Process.
(225) 201-8311 3
PRST STD US POSTAGE PAID BOISE, ID PERMIT 411
ERISA INSURANCE J. PRICE MCNAMARA Claim Attorney
10455 Jefferson Hwy. Suite 130 Baton Rouge, LA 70809 (225) 201-8311 WinMyBenefits.com
INSIDE THIS ISSUE
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A Performance for Patriotic Inspiration
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Help Kids Learn While They Earn
A Terminal Diagnosis and Lapsed Policy
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Don’t Let Your LTD Claim Die!
Sazon Grilled Chicken Thighs
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The Swine That Dared to Defy
An Unconventional ‘Bacon’ of Hope In the 19th century, Denmark and Prussia couldn’t agree on where to draw their border. Both countries refused to concede or couldn’t reach an agreement on which country would ultimately control Southern Jutland, which today is Germany’s northernmost state called Schleswig-Holstein. and one white horizontal stripe. The farmers named their new pigs Protestschwein, or the Danish Protest Pig. THE STORY OF THE DANISH PROTEST PIG
This protest pig quickly became the mascot of Danish cultural independence, and their efforts didn’t go unnoticed by Prussian authorities. In 1881, a local Prussian police station sent communications back to the government in Berlin that farmers were breeding strange-looking pigs. However, while they could not prove that farmers were knowingly breeding the pigs to look like the Danish flag, “it was believed that the farmers were well aware of this and that this pig represented an affront to the Prussians,” according to records from the Red Holstein Breeders Association.
This refusal to compromise ultimately led to war, and in 1848, Denmark won control. However, their victory was short-lived, as roughly a decade later, the Second Schleswig War was underway. This time, though, Prussia was victorious. After their victory, the Prussian authorities slowly began to move into the peninsula, implementing new laws over the Danes living there. These new laws prohibited anything Danish, including all uses of the Danish flag. Needless to say, the Danes were not happy — especially the farmers. These Danish farmers knew they had to protest this oppressive Prussian government, but they couldn’t just publicly wave the Danish flag. So, they got crafty. Danish farmers began to crossbreed their pigs to create a new breed, one that had the same markings as the Danish flag. These pigs were red in color, with one white vertical stripe
Today, the Danish Protest Pig is recognized as its own breed but has a different name: the Husum Red Pied. And, the now-German
state of Schleswig-Holstein supports the protection of this pig due to the cultural significance it offered its Danish ancestors so many years ago.
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