Health Benefits Attorney in New Jersey — Fighting Denied Insurance Claims
A denied health insurance claim can leave you facing enormous medical bills and no clear path forward. Whether your employer-sponsored health plan denied a medical procedure, refused to cover a specialist, or rejected a claim after the fact, you have legal rights — and strict deadlines to enforce them.
At The López Firm, we represent New Jersey employees and plan participants in health benefits disputes under ERISA, as well as insurance bad faith claims where insurers have acted unreasonably in handling claims. Attorney Omar A. López will fight to get you the coverage you paid for.
ERISA and Your Health Benefits
Most employer-sponsored health plans are governed by ERISA. This means that if your claim is denied, you have the right to a written explanation of the denial, the right to request all plan documents and the claim file, and the right to file an internal appeal with the plan administrator.
If your internal appeal is denied, you may be entitled to an independent external review and, ultimately, the right to sue in federal court. A health benefits attorney in NJ can guide you through each step of this process and make sure the administrative record is built correctly so your case is as strong as possible if litigation becomes necessary.
Frequently Asked Questions about Denied Health Insurance Claims
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The López Firm handles a wide range of health benefits disputes, including denials of medical procedures or treatments deemed not medically necessary, refusals to cover out-of-network care in emergency situations, denials of mental health or substance abuse treatment, retroactive rescission of coverage, disputes over coordination of benefits, and claims that a condition is pre-existing and therefore excluded from coverage.
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When an insurance company unreasonably denies, delays, or undervalues a legitimate claim, it may be acting in bad faith. In New Jersey, insurance bad faith can give rise to claims beyond the value of the original denied benefit, depending on the type of plan and whether ERISA preempts state law remedies.
For plans governed by ERISA, the remedies available in federal court are more limited. But for individually purchased insurance policies and certain state-regulated plans outside of ERISA, an insurance bad faith lawyer in NJ may be able to pursue additional damages. The López Firm can evaluate your specific situation and advise you on the full range of remedies available.
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You can reach us anytime via our contact page or email. We aim to respond quickly—usually within one business day.