What is ERISA?
Employee Retirement Income Security Act (ERISA)
Federal legislation (U.S. Code Title 29, Chapter 18, associated Internal Revenue Code and miscellaneous provisions) that preempts state regulation of workers' medical and pension benefits. Under ERISA, an insurance program has been established to guarantee that employees receive their pension benefits in the event that a pension plan is terminated. Sounds good doesn't it. Unfortunately, this legislation is very complex and claims are limited to the amount of the benefit being claimed.
Despite its name and the purpose behind it, to protect employees from unscrupulous employers, the effect has been just the opposite. It has had the devastating effect on the ability of people who receive their insurance through their employment to have their claims fairly evaluated and properly paid. The effect is most pronounced in the area of health, life and disability claims since this insurance is most often provided through work.
Perfecting and Litigating ERISA Claims
The reason for the lack of fairness and proper payment of claims in
ERISA cases is that when an insurance company denies an ERISA claim, it
knows that even if it is wrong in denying the claim, the most the court
can force the insurance company to pay is the claim it should have paid
in the first place. If that is all the insurance company can be liable
for, what is the incentive for the insurer to pay the claim?
All ERISA claims have several things in common. They are most
frequently litigated in Federal Court, a court in which most lawyers
are uncomfortable. Before getting to court there is an administrative
appeal that you must follow. It is imperative that this appeal
procedure is followed. If it is not, you will in all likelihood lose
your right to sue the insurance company. If you wish a brief summary of
the appeal process and what you must do to make sure the appeal is
properly prosecuted, e-mail us and we will send you one.
Call for a free consultation