The Employee Retirement Income and Security Act of 1974 (ERISA) is a federal law that protects employee's rights to claim benefits under their employer's plans. ERISA covers employer-sponsored long- and short-term disability insurance, life insurance, health insurance, as well as dental, vision, and accident insurance. Workers' compensation plans are covered under different sets of state laws.
What is an ERISA Claim?
ERISA claims are federal lawsuits for damages resulting from wrongful denials of employee benefits claims. The law gives employees the right to appeal to the insurance company upon claim denial. An employee must appeal the decision to the insurance company before taking an ERISA claim to court.
Appeals have time limits. Disability and health plan appeals must be filed within 180 days of the denial. Appeals for other benefits must be filed within 60 days. Insurance companies must also decide health and disability claims within specific time periods, usually 45 days for disability claims and 30 days for health claims. Urgent healthcare plan appeals must be decided in 72 hours.
Insurers may have one or two levels for appeals. If two levels of appeals are required, the insurer must decide the appeals faster for certain types of claims. For example, health claim appeals are shortened to 15 days.
Once they exhaust the appeals process, employees have the option of filing a lawsuit. Judges, rather than juries, hear ERISA lawsuit claims. Their decisions are based on the written record supplied by the plaintiffs and defendants.
Do You Need a Lawyer for an ERISA Claim?
Legal representatives always recommend an attorney if pursuing an ERISA claim in court. Federal court cases are complicated and time consuming. Courts require many detailed requirements be fulfilled for an ERISA claim to succeed. Pro se litigants who are unfamiliar with these requirements often face summary dismissal of their lawsuits, even if their claims are strong on their merits.
ERISA claims often center on disability insurance claims. Since these claims can be worth substantial sums of lost income—sometimes a lifetime's worth—insurance companies often deny them. Insurance companies often argue that despite serious injuries, the claimant does not meet their strict definition of disability.
Courts give credence to these insurance-company claims, leaving the plaintiff with the burden of proving they qualify for the disability coverage. To succeed, plaintiffs need tough, experienced ERISA litigators who know how to fight back against insurance-company tactics.
If you have concerns about an ERISA related claim or have had a claim denied, don't hesitate to contact our disability insurance lawyers at Dabdoub Law Firm.
Call today to discuss your potential case.