What Does it Mean to Exhaust Your ERISA Administrative Remedies?
Group disability insurance policies often come under the umbrella of the federal Employee Retirement Income Security Act (ERISA), which establishes a separate regulatory scheme for such benefits plans. Policyholders in ERISA-governed disability plans are subject to a number of unique limitations and entitlements that can seem confusing to those who do not have prior experience handling claims and disputes in the group insurance context.
ERISA-Governed Plans and the Administrative Exhaustion Principle
If your plan is governed by ERISA — in other words, if your disability insurance plan is employer-sponsored and your employer is neither a public entity nor a qualified religious organization — then you will be subject to the various limitations imposed on policyholders pursuant to the ERISA regulatory scheme. This includes the requirement that claimants first exhaust their administrative remedies prior to bringing a civil action against the insurance company or plan administrator for damages.
What does administrative exhaustion mean in the ERISA context?
In Illinois, and throughout the country, all ERISA benefits plans — including disability insurance coverage — involve a complex administrative appeals process through which your claim will be evaluated pursuant to internal review.
Many claimants mistakenly believe that this administrative appeals process will be quick and informal, but in reality, the ERISA administrative appeals process has its own set of deadlines and procedures. Further, it’s important to note that — with the assistance of a skilled ERISA disability lawyer — you may be able to secure benefits through the internal review process and thereby avoid the hassle of litigation.
Depending on the language of your ERISA plan, you may be required to go through up to two rounds of administrative appeals before you have fully “exhausted” your administrative remedies.
Speak to a Seasoned Chicago ERISA Disability Lawyer for Guidance on Your Insurance Dispute
Bryant Legal Group, P.C. is a boutique insurance litigation firm based out of Chicago, with attorneys who have decades of experience representing the interests of disability insurance policyholders in disputes against their insurers and plan administrators. We understand the unique difficulties associated with such disputes, and the particular challenges, limitations, and vulnerabilities that policyholders are exposed to when their disability insurance plan is employer-sponsored (and therefore subject to ERISA regulation).
Over the years, we have secured favorable results for our clients through negotiated settlements (i.e., insurance buyouts) and in trial litigation. Here at Bryant Legal Group, P.C., we believe deeply in the provision of comprehensive legal advocacy — by developing a close and transparent working relationship with our clients, we are able to put forth a persuasive case for benefits (and other damages) on their behalf. This approach to insurance disputes takes into account the individualized nature of the conflict at issue.
Contact us at (312) 634-6415 or submit a case evaluation form to arrange a consultation with an experienced Chicago ERISA disability lawyer at Bryant Legal Group, P.C.