ERISA is the acronym for the Employee Retirement Income Security Act, the federal law passed by Congress in 1974, that governs a wide range of employee benefit plans provided by private sector employers.
ERISA establishes basic rules for employment-based benefit programs, which include health insurance, disability insurance, life insurance, pension and other retirement plans, and, in some cases, severance agreements.
The information you include during the initial claim filing process is critical in influencing whether your claim will be approved. While hiring a lawyer is not mandatory, the right lawyer can prepare your claim in such a way that it will be approved early in the process. This may save you months of delay in getting your benefits paid. In the event your benefits are denied at this stage, use of a lawyer early in the process may also help put your case in a better position to ultimately be successful.
The first step is to obtain the letter formally denying benefits, get a copy of all of your ERISA plan documents and a copy of the entire claims file.
The plan documents are important because they contain the rules that tell you what you must do to obtain benefits under the plan. For example, in a disability context, your plan will tell you the definition of disability and what types of proof you may need to submit to the plan administrator to obtain benefits. It may also give you information concerning time limits that may be applicable to your claim.
Obtaining the claims file will allow you to see what information the insurance company or plan administrator has, or does not have, which will support, or detract from, your benefits claim. Once this file is obtained, a decision can be made as to what additional information should be provided to the plan administrator in order to obtain your benefits during the administrative appeal process.
In almost every ERISA-related case, you are required to appeal the denial of your claim for benefits to the plan administrator or insurance company that initially denied your benefits before you can pursue your claim in court. ERISA imposes this requirement because Congress intended as many claims as possible to be resolved without the need for ERISA litigation in court. This process is called exhausting your administrative remedies.
It depends on the type of benefits you are seeking and the particular language of your plan. Several other factors may also impact the answer to this question. One important factor is whether your plan administrator denied your benefits in accordance with the Department of Labor regulations that govern ERISA-related benefits. That being said, in most cases dealing with disability benefits, you have 180 days from the denial of your claim within which to file an appeal.
In California, this will depend upon the language in your plan. In almost all cases, you must exhaust your administrative remedies before filing a lawsuit.
In most cases, your recovery will include the benefits due under the plan, prejudgment interest and attorney’s fees.
An ERISA lawsuit can be filed in either state or federal court. However, in most circumstances the lawsuit will be removed to federal court, even if it were originally filed in state court. The court your case is litigated in will usually be in or near the county you live in.
No. ERISA-related lawsuits are usually brought against the long-term disability benefit plan and/or the insurance company that funds the plan.
The information you obtain at this site is strictly for education and not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. We invite you to contact us and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. However, we welcome this opportunity to discuss legal representation with you.