Please contact a lawyer from Rosenfeld & Rafik, P.C., for dedicated representation in any of these following practice areas:
Insurance Coverage Disputes
ERISA
We help people secure the employee benefits they are entitled to under the Employee Retirement Income Security Act. ERISA is a federal law that governs most employer sponsored benefits and sets strict rules for applications, appeals, and litigation. Our firm represents individuals at every stage. This includes filing claims, preparing internal appeals, and litigating denials in federal court. We handle disputes involving disability, health insurance, long term care, and life insurance benefits.
Short-Term Disability Claims
Short term disability benefits are designed to support workers during the early months of an illness or injury. These claims move quickly and insurers often require extensive documentation. We guide clients through the application process, respond to insurer requests, and challenge improper denials or terminations.
Long-Term Disability Claims
Long term disability benefits provide income protection when an illness or injury prevents someone from working. Insurers often dispute the severity of symptoms or rely on flawed medical reviews. We represent people who have been denied benefits, had benefits terminated, or had their policies rescinded. We also assist individuals whose insurers demand burdensome updates or impose unfair limitations.
Health Insurance Claims
Health insurers frequently deny coverage on the ground that treatment is not medically necessary, is experimental, or is out of network. These denials can place enormous strain on people who are already coping with serious illness. We represent individuals who are denied coverage for needed medical treatment, including adolescents and young adults seeking residential or intensive mental health treatment. Our focus is on securing access to the care that supports long term stability and recovery.
Long-Term Care Benefits
The cost of long-term healthcare such as a nursing home or regular visits from registered nurses can be covered by long-term healthcare insurance. This is insurance consumers purchase, often through ERISA governed plans. When long-term insurance is denied, people can face serious problems paying for necessary care.
Denied Premium Waiver for Disabled Policyholders
Long term care insurance helps pay for nursing homes, assisted living facilities, and home based care. When insurers deny or reduce these benefits, families can face overwhelming financial and caregiving burdens. We represent policyholders who have been denied long term care coverage through employer sponsored and individually purchased policies.
Mental Health Access to Care
Mental health treatment is often subject to heightened scrutiny by insurers. Denials can involve claims that treatment is not medically necessary, that lower levels of care should suffice, or that residential treatment is inappropriate. We represent clients of all ages who are denied access to inpatient, residential, partial hospitalization, and intensive outpatient programs. We work to ensure compliance with federal and state mental health parity laws and to secure coverage for the level of care that is clinically required.
Individual Disability Insurance Policies (Non ERISA)
Many professionals, including physicians, lawyers, executives, and small business owners, purchase private disability insurance outside the workplace. These policies are not governed by ERISA and provide broader contractual protections, but insurers still deny legitimate claims. We represent individuals who hold “own occupation” or specialty specific policies and have been denied benefits, had benefits terminated, or are facing aggressive demands for proof of ongoing disability. Our focus is on enforcing the terms of the contract and securing the income protection these policies promise.