Passed into law in 1974, The Employment Retirement Income Security Act (ERISA) applies to policyholders of private employers who offer employee benefit and pension plans.
Among other rights, ERISA rules provide policyholders of private sector health plans several safeguards, including:
- Opportunity to obtain detailed benefit policy information
- Access to a timely benefit claims process
- Option for temporary continuation of group health coverage
- Proof of coverage under a group medical plan
- An ability to recover benefits under a group medical plan
ERISA regulations also provide a structured process for application for disability benefits under an employee benefit plan and an appeals process in the event the initial claim is denied.
Why a Skilled ERISA Attorney is Important
ERISA rules are complicated and procedurally specific. As we have all heard, insurance companies are not in business to pay benefits and many are notorious for refusing to pay legitimate disability claims.
Many policyholders are not aware of the technicalities of pursuing a disability claim because of ERISA's complex nature. This includes the work involved in appealing claims previously denied by an insurance company.
Important points to keep in mind about disability claims include the following:
- Your rights: Policyholders with benefit plans under ERISA are limited in their avenues of relief for denial of a disability claim. Foreclosed from suing an insurance company for bad faith, wrongful conduct, or punitive damages, policyholders must approach the ERISA appeals process very carefully.
- Your insurance file: The administrative record, or insurance file, of a disability claim is extremely important. Only information contained within your administrative record can be considered on appeal or in a subsequent lawsuit. An administrative record may include job descriptions, medical records, opinion letters from medical or disability professionals and other documentation.
- The time limits: Close attention to administrative time limits and technical requirements required under your specific employee benefits plan is vital. If you miss a deadline, ignore a suggestion by your insurance company, or fail to file appropriate documentation, your right to pursue your claim may be lost.
- The need for a lawyer: Upon receipt of a benefits denial letter from your insurance company, it is crucial to retain a qualified ERISA lawyer to assist with your disability claim. While long-term disability may last forever, your opportunity to recover under a disability policy is not, especially if a claim denial letter has already been issued.
Help with ERISA Regulations in Northern California
If you are denied disability benefits by your insurance company, we can help. With extensive, successful experience in disability claims and ERISA regulations, the Law Offices of Laurence F. Padway compel insurance companies to pay under the policies they offer. Contact us or call 510.814.6100 to schedule a free consultation.
