What is E.R.I.S.A. and Why Should I Be Concerned About It?
ERISA, short for Employee Retirement Income Security Act of 1974, is a comprehensive Federal statute that governs many claims related to employee benefits. In some cases, ERISA can prevent injured or ill employees from receiving their full insurance benefits, if their LTD insurance is provided by their employer as a benefit. Unfortunately, insurance companies and ERISA administrators often wrongfully deny or delay LTD benefits to workers who are legitimately disabled.
If you're suffering from a long-term disability (LTD) and trying to recover LTD benefits purchased as part of your employment, it is the first thing you need to be concerned about because having an ERISA professional on your side who knows how to navigate this tricky law can mean the different between a denial of your long-term benefits or an award of all the benefits you deserve. At Taylor, Warren & Weidner, we put our knowledge and experience to work to help you recover more on your ERISA claim.
What You Need to Know About ERISA:
ERISA governs nearly all health, disability and life insurance benefits provided by an employer.
Denials under any ERISA plan or insurance policy must be appealed to the insurance company before suit is filed. If you fail to appeal to the insurance company first, your case will likely be dismissed with prejudice, meaning you cannot re-file. You have no recourse.
The time to appeal an ERISA denial can be as short as 180 days.
In most ERISA disability cases, the world of medical records and evidence that can be reviewed by the court is extremely restricted and is often limited solely to the insurance company's file. Meaning, only the evidence gathered by the insurance company—that has incentive to downplay your injuries and pay less on your claim—will be considered by the court.
ERISA trumps state law, grants jurisdiction to the Federal Courts, and eliminates jury trials and extra damages that are typically allowed in contract cases.
If all of that sounds a little complicated and hard to understand, that's because it is. ERISA is a complicated area of law that draws upon both trust and contract principals. People seeking LTD benefits need a highly skilled team that specializes in ERISA claims to fight for their wrongfully-denied LTD claim. The appeals process is long, complicated, costly and skewed in the insurance company's favor.
Helpful Links and Resources
The Patient Advocate Organization's guide to Navigating the Insurance Appeals Process (ERISA claims, page 6).
American Bar Association article on wrongful denial of an ERISA claim.
U.S. Department of Labor's guide to understanding ERISA insurance plans and benefits.
Learn about the fiduciary duties of ERISA plan managers from the U.S. Department of Labor.
Helpful resources and links on ERISA Plan Administration and Compliance.
Learn how to report and file an ERISA disability benefits claim.
At Taylor, Warren, and Weidner, we draw on our years of experience and vast knowledge of ERISA procedures and have successfully litigated hundreds of ERISA claims. We devote specialized resources, including medical and vocational experts, to help employees like you, who are unable to work due to a long-term illness or injury, win their claims and achieve financial security. Do not try to fight your ERISA appeal alone. We never charge an initial fee or cost to sit down with you and explain your LTD benefit rights under ERISA.