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Facing issues with your employee benefits can feel like an uphill battle. Our San Jose ERISA attorneys at Kantor & Kantor are here to make that journey smoother for you.

Our team of dedicated San Jose ERISA attorneys is here to provide you with the guidance, support, and expertise you need to navigate the intricacies of ERISA law with confidence. With decades of combined experience and a deep understanding of ERISA regulations, we are committed to helping individuals like you overcome obstacles and secure the benefits you deserve.

We believe in building strong relationships with our clients, listening to your concerns, understanding your unique circumstances, and developing personalized strategies tailored to your needs. Whether you are dealing with a complex legal dispute or simply seeking clarity on your rights under ERISA, we offer compassionate guidance and effective advocacy every step of the way.

At Kantor & Kantor, we do not just see ourselves as your attorneys; we are people helping people and your partners to pursue justice and protect your rights. With our results-driven approach and unwavering dedication to our client’s success, you can trust that your case is in capable hands.

Contact us at 408-539-0081 to schedule a free consultation and take the first step toward securing the benefits and peace of mind you deserve.

Contact Kantor & Kantor at 818-886-2525 to book a free phone, video, or in-person consultation.

What Is ERISA?

ERISA, the Employee Retirement Income Security Act, is a federal law enacted in 1974 to regulate employer-sponsored benefit plans and protect the interests of employees and beneficiaries participating in these plans. ERISA applies to a wide range of employee benefit plans, including pension plans, retirement savings plans (such as 401(k) plans), health insurance plans, disability insurance plans, and life insurance plans offered by private-sector employers.

The original and purported intention and purpose of ERISA was:

  • To ensure transparency and accountability regarding employee benefits.
  • To establish minimum standards for the operation and administration of employee benefit plans, including fiduciary responsibilities, funding requirements, and plan governance.
  • To protect participants’ rights, such as the right to receive promised benefits and the right to participate and contribute to benefit plans.
  • To provide remedies for violations.

However, ERISA has ultimately resulted in many unsatisfactory and unjust resolutions. ERISA carries its own set of fiduciary duties, obligations, and rules. The difference between ERISA and non-ERISA cases is that with ERISA, individuals do not possess the ability to file for the tort of violating the covenant of good faith and fair dealing. The inability to file for this tort means that individuals are not able to obtain consequential damages for their losses, nor is there the possibility for punitive damages. This allows individuals limited options, if any at all, for ensuring that their insurance company treats them fairly. Additionally, under ERISA, common protections, such as the right to a jury trial, do not exist. Individuals will not be given the right to submit additional evidence once a trial begins, nor be given the opportunity to testify as to their medical history or their ability to work.

If an individual were to have to litigate their benefit denial in federal court, the maximum amount they could pursue is what the insurance company originally failed to pay. This practice emboldens and incentivizes insurance companies to unjustly deny legitimate claims because they do not need to fear substantial financial ramifications.

Tactics Used by Insurance Companies to Deny ERISA Claims

When individuals file claims for benefits under ERISA, they rightfully expect their insurance companies to honor their obligations and provide the benefits they are entitled to. However, insurance companies often employ various tactics to deny or delay ERISA claims, leaving claimants frustrated and powerless. Here are some common tactics used by insurance companies to deny ERISA claims:

1. Selective Interpretation of Plan Language

Insurance companies may selectively interpret the language of the ERISA plan to support their decision to deny a claim. For example, an insurance company may define a person’s migraines as “self-reported symptoms,” and thus deny their claim, despite brain MRIs verifying the existence and frequency of said migraines. Alternatively, insurance companies may state that an individual’s claim is “caused” by mental health issues, when in reality they are only suffering from mental health issues because of the pain they are experiencing due to their physical disability.

In other cases, insurance companies may attempt to make unfair or improper allegations of pre-existing conditions, such as interpreting language too broadly as to capture items they are not allowed to capture. Some clauses will explicitly say you have to be disabled from the same diagnosis for the clause to apply, even if the pre-existing condition is directly related to the disabling condition.

2. Utilization of In-House Medical Experts

Insurance companies rely on in-house medical experts to review claims and provide opinions that favor denying benefits. These experts may downplay the severity of a claimant’s medical condition or argue that the treatment is unnecessary. Often, in-house medical experts will purport to know individuals better from afar than their physician does up close. These in-house medical experts are not merely biased, but are either bought and paid for and/or repeatedly employed by these insurance companies because they produce continued denials.

3. Selective Use of Surveillance

Insurance companies may conduct surveillance on claimants to find evidence that contradicts their disability or medical condition. They may use this selective surveillance to dispute the severity of the claimant’s impairment and deny benefits accordingly. For example, insurance companies may choose to highlight a claimant’s ability to perform short spurts of activity, while not addressing the days of surveillance where the claimant remained bedbound or showed signs of pain and weakness on many more occasions than function was observed. Further, insurers will try to use activities that claimants admit to performing that in no way undermine their disability to make them appear “less disabled.”

4. Inadequate Explanation of Denial

Insurance companies may provide vague or insufficient explanations for claim denials, making it difficult for claimants to understand the reasoning behind the decision and effectively appeal the denial. Insurance companies will also leave out evidence that supports disability or undermines the denial, forcing claimants to request the claim file and find such deficiencies themselves.

What Can I Do If My ERISA Claim Is Denied?

Having your ERISA claim denied can feel like a major setback. There are steps you can take to challenge the decision and potentially turn things around. Here is a guide on what to do next:

  • Understand the Reason for Denial: The first step is to understand why your claim was denied. The denial letter should provide a detailed explanation.
  • Request a Copy of Your Plan Documents: You have the right to request a copy of your insurance plan documents. These documents outline the terms of your coverage and can provide insight into why your claim was denied. Review these carefully to understand your plan’s requirements.
  • Gather Additional Evidence: If your claim was denied due to insufficient evidence, gather additional documentation to support your case. This can include medical records, doctors’ notes, and any other relevant information. Make sure all evidence is clear and comprehensive.
  • File an Appeal: You have the right to appeal the denial. The denial letter should include instructions on how to file an appeal and the deadline for doing so. Follow these instructions carefully. The appeals process can be complex and time-sensitive, so act quickly.
  • Seek Professional Help: Consider hiring an ERISA attorney. ERISA laws are complex, and having a lawyer on your side can make a big difference. They can help you understand your rights, navigate the appeals process, and build a strong case.
We are people helping people and can help you navigate the intricacies of ERISA.

Why Choose Kantor & Kantor?

When facing complex ERISA challenges, choosing the right legal representation is crucial. Here is why Kantor & Kantor stands out in San Jose:

  • Recognized Competence: With years of experience handling ERISA cases nationwide, we possess a deep understanding of the legal landscape and a proven track record of success. Our expertise ensures we are well-equipped to navigate even the most intricate cases.
  • Nationally Recognized: We are not just a local firm; our reputation extends nationwide. This recognition reflects our commitment to excellence and dedication to achieving positive outcomes for our clients.
  • Comprehensive Representation: Our team possesses expertise in all aspects of ERISA law, allowing us to address your concerns, no matter how complex. We can handle appeals, litigation, and negotiations, ensuring you have the necessary support throughout your case.
  • Client-Centered Approach: We are deeply committed to fostering strong relationships with our clients, prioritizing clear and consistent communication throughout the legal process. We understand the emotional and financial stress associated with ERISA challenges, and we aim to alleviate those burdens by keeping you informed and actively involved in every facet of your case.
  • Results-Driven: Our focus is not just on legal processes but on achieving tangible results for our clients. Whether through alternative dispute resolution, negotiation, or litigation, we are results-driven in our approach. We tirelessly pursue the most effective legal strategies to protect your rights and secure the benefits you deserve. Our commitment to achieving favorable outcomes sets us apart as advocates who get results.

How Our San Jose ERISA Attorneys Can Help You

Our team of dedicated San Jose ERISA attorneys is here to provide comprehensive legal support and guide you through every aspect of your ERISA case. Here is how we can help your case:

  • Claim Evaluation: The first step in tackling your ERISA case is understanding the specifics of your situation. We will sit down with you, listen to your story, and review your claim in detail. This initial evaluation helps us identify any potential issues and develop a strategic plan tailored to your needs.
  • Documentation Assistance: One of the most difficult parts of an ERISA claim is gathering and organizing the necessary documentation. We know this process can be overwhelming. Our team will assist you every step of the way, ensuring you have all the required medical records, employment documents, and other evidence needed to strengthen your claim.
  • Appeals Representation: If your ERISA claim has been denied, you have the right to appeal. We are here to guide you through this complex and often time-sensitive process. We will craft an appeal that addresses the reasons for the denial and highlights the merits of your case. Our goal is to turn that “no” into a “yes.”
  • Litigation Support: Sometimes, despite our best efforts, an appeal may not result in a favorable outcome. In such cases, litigation might be necessary. Our experienced ERISA attorneys are prepared to take your case to court, advocating on your behalf. We will stand by you, providing the support and representation you need to fight for your rights.

Contact Our ERISA Attorneys in San Jose Today

Do not let ERISA-related challenges stand in the way of your rightful benefits. Contact the ERISA attorneys at Kantor & Kantor in San Jose today. We are committed to standing by your side and advocating for your rights.

Contact us at 408-539-0081 to schedule a free consultation. Your future deserves the best legal representation; we are here to provide it.
Attorney Glenn Kantor, California

Attorney Glenn R. Kantor

Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]