Established in 1974, the Employee Retirement Income Security Act (ERISA) safeguards the interests of employees enrolled in employer-sponsored benefit plans. ERISA law encompasses a range of benefits, such as retirement accounts, health care plans, life insurance, and long-term disability insurance.
In this article, we’ll look at the fundamental concepts underpinning ERISA. We’ll also explore the fiduciary responsibilities entrusted to those managing these plans and outline the available remedies in cases of ERISA violations.
Learn how ERISA empowers employees within the intricate landscape of employee benefits for long-term disability claims.
Key Concepts and Protections Under ERISA Law
Long-term disability coverage can have a life-changing impact on those who need it. To protect employee rights in long-term disability insurance, ERISA law ensures transparency, fair processes, and legal recourse in the event of disputes.
The law also empowers employees with the knowledge and tools they need to secure the protection they deserve. By doing so, ERISA promotes financial security and peace of mind for the average worker. Specifically, ERISA gives employees:
- Protections around the transparency of disability insurance plans
- An appeal process for denied claims
- Legal recourse if that appeal is denied
Transparency Standards
ERISA diligently upholds stringent standards of transparency for companies that provide long-term disability coverage. What’s more, the law entitles beneficiaries to comprehensive access to all important information concerning their benefits.
First, ERISA stipulates that long-term disability plans provide beneficiaries with a clear, comprehensive summary of the plan and a description of the benefits offered. This ensures that employees have a complete understanding of their coverage.
ERISA also stipulates that the criteria for eligibility for long-term disability coverage be clearly stated. Such clarity lets employees assess their eligibility and make informed decisions about their participation in the plan.
Claim and Appeal Process
When benefits are denied or terminated, ERISA law ensures that beneficiaries have the right to request relevant records and information from the plan at no cost. This transparency helps employees understand the decision-making process.
Then, ERISA gives claimants a crucial opportunity to appeal denied claims. To do so, they must initiate the appeal process within 180 days of denial. In response, ERISA sets strict expectations for the disability plan. Specifically, it mandates a decision on the appeal within 45 days, with a possible 90-day extension.
Legal Recourse
Section 502(a) of ERISA gives claimants the chance to seek legal recourse in a federal court if their appeal is unsuccessful, following the deadlines outlined in the plan documents. This provision supports the principle that beneficiaries have the right to challenge adverse decisions through a fair and accessible legal process.
Understanding Fiduciary Responsibilities
Within the framework of ERISA law, each long-term disability plan must have at least one fiduciary. A fiduciary is an individual or entity vested with discretionary authority to control and manage employee benefit plans.
Fiduciary obligations encompass:
- Loyalty. Fiduciaries must prioritize participants’ interests without any conflicts of interest, per ERISA’s directive.
- Prudence. Fiduciaries must manage the plan with care, diligence, and sound judgment. They must also consider relevant facts.
- Adherence to Plan Documents. Fiduciaries must follow the plan documents, unless they contradict ERISA, to ensure compliance and consistency.
Fiduciaries are essential to ERISA’s framework. They safeguard employee rights and uphold essential protections for long-term disability beneficiaries.
Remedies and Solutions for ERISA Law Violations
ERISA violations—like a failure to disclose information, wrongful benefit denials, breaches of fiduciary duty, or acts of discrimination and retaliation—can disrupt the security of employee benefit plans. Fortunately, there are avenues for recourse when such violations happen, giving participants and beneficiaries the means to address these issues effectively.
If you’ve been denied benefits, the initial step is to file an appeal. Seeking legal counsel—particularly from an ERISA attorney—is highly beneficial. They can spot any weaknesses in the claim and improve the chances of a successful appeal.
Should the appeal also be denied, the next course of action is starting a lawsuit. The nature and strength of your lawsuit will depend on the information and documentation provided in the initial appeal.
Having a long-term disability lawyer throughout this process significantly boosts your chances of success. They can make sure important information is included in your case, help you navigate complex legal intricacies, and advocate effectively on your behalf.
By pursuing these solutions, individuals can assert their rights and hold those responsible for ERISA violations accountable. As a result, they gain justice and restore the integrity of their benefits.
ERISA Law FAQs
If you’re navigating long-term disability claims, this FAQ section provides clarity on common questions regarding ERISA cases.
Is My Claim Governed by ERISA Law?
Probably! ERISA law covers almost all employer-sponsored benefits. In fact, only some self-employed individuals, government employees, or those who work for a religious organization may be ERISA-exempt.
How Does ERISA Impact My Long-Term Disability Claims?
ERISA provides avenues to get the long-term disability coverage you deserve. When your claim is denied, ERISA gives a time frame in which you can appeal the denial. If denied again, ERISA gives you the right to file a lawsuit.
What Information Am I Entitled to Under ERISA Law?
ERISA requires transparency of any relevant information about your benefits. The fiduciary must update participants on any changes to the plan and provide a regular fee disclosure. Additionally, claimants may receive any relevant information about their benefits or claims free of charge.
Can I Take Legal Action if My Benefits Are Denied?
Yes. If your long-term disability benefits are denied, you may first file an appeal. If that is also denied, you may file a lawsuit in federal court. ERISA lawsuits are based on the appeal and any documents that were submitted to or considered by the fiduciary in the denial of benefits. You must file an appeal before taking your case to court, and the contents and thoroughness of your appeal is very important..
What Are Requests for Review or Appeals?
If your claim for benefits was denied, ERISA law provides a way to challenge the ruling before filing a lawsuit against the insurance company. This is called an appeal or a request for review.
Should I Have an Attorney Help Me?
Yes. Consulting and hiring an experienced ERISA attorney will give you a better chance of winning your case. They can help you file your appeal and ensure that all the relevant information is included in the documentation.
An ERISA lawyer also understands the nuances and updates to ERISA that will be relevant to your case. In short, working with a specialized ERISA attorney can help you get the long-term disability benefits you deserve.
Secure Your Employee Benefits with ERISA Attorneys
ERISA law plays a vital role in safeguarding employee benefits. From the fiduciary responsibility it imposes to the pathways to confront ERISA violations, the law protects the rights of those seeking long-term disability benefits.
When choosing an attorney, seek one well-versed in ERISA law. They can make a critical difference in your pursuit of rightful benefits. They’ll guide you through appeals, ensure your appeal includes all pertinent information, and help you navigate the nuances of ERISA that impact your case.
At Kantor and Kantor, our team of dedicated ERISA attorneys is ready to advocate for you. If you’re facing challenges with your employee benefits or long-term disability claims, we’re here to help you secure the coverage you deserve. Contact us today for a consultation and take the first step toward protecting your financial security and peace of mind.
