What Makes ERISA-Covered Plans Unique?
In 1974, Congress enacted the federal Employee Retirement Income Security Act (ERISA) in order to shield plan participants from management misconduct that could affect their assets. ERISA applies to a variety of private, employer-sponsored benefits plans, including retirement, disability and healthcare plans. In the context of short-term and long-term disability insurance (where policyholders often secure such coverage through their employer), many such plans are covered by ERISA.
When a dispute arises concerning an ERISA-covered plan, it’s important that you work with a qualified Chicago ERISA attorney who has specific experience handling ERISA disputes from appeal to litigation.
ERISA Benefits Plans Both Protect and Limit Policyholders
ERISA protects plan participants in the sense that it promotes transparency and proper management of plan assets. This is particularly useful in the context of retirement benefits plans where the plan participant has suffered losses due to the mismanagement of fund assets by the plan administrator (and their agents). ERISA gives plan participants a cause of action against those who violate their statutorily-defined fiduciary duties.
Additionally, insurers must make their plan documents available to their policyholders upon request.
On the other hand, ERISA-covered plans can present unique challenges for policyholders in many ways. As a plaintiff-claimant with an ERISA-covered plan, you are only entitled to recover damages equivalent to the benefits that you would have received had your benefits not been denied, undervalued or delayed. You cannot, for example, bring a bad faith cause of action against your long-term disability benefits insurer on the basis of their “wrongful denial” of your disability claim. You can, however, sue and recover damages equivalent to your purported benefits (as well as attorneys’ fees and costs).
ERISA is also rather stifling in the sense that it imposes a strict appeals process on potential claimants looking to challenge the decision of the insurer. Let’s take a look.
- Related Article: 5 FAQs About Private Disability Insurance Claims
The Appeals Process Under ERISA
If your benefits (in an ERISA-covered plan) are denied and you wish to challenge the decision of the insurer, you will have to go through a structured appeals process.
Under ERISA, Plans are required to give 180 days to file an appeal on a denial or termination of long term disability benefits. During this time you will have to gather all the relevant documentation and evidence necessary to support your arguments. This is a critical time to seek legal counsel. Bear in mind that this will likely serve as the final evidentiary record if you eventually push through to litigation. That means that any evidence that was not provided to the insurance company is unlikely to be reviewed by a court in case of further appeal.
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Contact Us Today to Speak With an Experienced Chicago ERISA Lawyer
If you are making a claim for disability benefits pursuant to an ERISA-covered plan, or if you are currently in a dispute concerning such benefits, make sure to get in touch with an experienced Chicago ERISA lawyer as soon as possible. Here at Bryant Legal Group, P.C., we have decades of experience representing policyholders in disputes relating to their ERISA-covered insurance plan. We understand that many policyholders may not be fully apprised of their rights under their ERISA-covered plan, and we are well-equipped to effectively handle such disputes while keeping our policyholder-clients informed of developments throughout the process.
Call (312) 561-3010 to request a consultation with one of our ERISA attorneys today. We look forward to assisting you with your claims.
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