In Illinois, the federal Employee Retirement Income Security Act, commonly known as ERISA, governs many employer-sponsored and employer-provided short- and long-term disability benefits. If you have an ERISA short-term disability or long-term disability policy, this means that there are specific requirements to which your employer or insurance company must adhere.
In the ERISA dispute context, for example, most state law causes of action, such as bad faith claims, are preempted and cannot be brought even if you are wrongfully (and even maliciously) denied benefits without cause. Fortunately, a qualified Chicago ERISA disability lawyer can help you file a claim or an appeal so you can obtain the benefits you deserve.
The attorneys at Bryant Legal Group are experienced in assisting clients with short-term and long-term disability claims that qualify as ERISA plans. We know the nuances of the law and how ERISA rules can impact your ability to obtain the benefits you need. Unlike many other insurance litigation firms, we are committed to client-oriented representation. When you work with us, we take the time to explain the contours of the law and to provide clear and straightforward answers to any questions or concerns that you may have.
Contact us today to schedule a consultation.
What Is ERISA and How Does It Impact My Insurance Claims?
ERISA became federal law in 1974 as a reaction to years of manipulation and financial abuse by plan administrators and insurance companies in employer-sponsored benefits plans. As initially envisioned, ERISA was meant to protect plan participants and insurance policyholders from the wrongful conduct of those in control of the actual assets funding the plan itself.
For example, ERISA regulation established conflict-of-interest laws and various fiduciary duties to give those whose plan assets were diminished (say, in an employer-sponsored pension plan) the opportunity to litigate against the defendant responsible for the losses.
Over time, ERISA gradually expanded into a much more comprehensive set of insurance regulations meant to cover all employer-sponsored benefit plans. Even standard denial of benefits issues come under the purview of ERISA. In fact, federal ERISA regulations preempt state regulations in many situations, which can substantially change your legal options and strategies.
Differences between ERISA and non-ERISA plans include:
- Damages for bad faith, which may include punitive damages, are not available to policyholders with ERISA-governed benefits.
- ERISA policyholders must navigate a complex administrative appeals process and must exhaust their administrative remedies entirely before they are entitled to bring a civil action against the insurer in court.
- ERISA imposes various duties on plan fiduciaries such as the plan administrator, and it gives policyholders the right to sue and recover damages for losses related to the violation of those fiduciary duties.
- ERISA grants some unique protections to policyholders that they might not otherwise have access to through a standard insurance benefits plan. For example, ERISA prohibits employers from retaliating against employees who make an ERISA benefits claim (or who exercise their rights in challenging or litigating the denial of a claim).
- ERISA requires that insurers provide the summary plan description document to policyholders who request such information. The document includes relevant information concerning the policyholder’s benefits plan. Failure to provide the summary plan description upon request could expose the insurer to significant liability.
So, ERISA and non-ERISA plans are quite different, but how do you know if your particular benefits plan is governed by ERISA regulation?
Generally speaking, ERISA-governed plans are those that are “employee welfare benefit plans,” where the plan involves a benefit (such as disability, health coverage, life insurance coverage) and is sponsored, established, or otherwise provided by the employer. For example, if you receive disability coverage through your employer, then there’s a strong possibility that your insurance plan will be governed by ERISA regulations.
There are a few major exceptions to ERISA coverage, even where the plan qualifies as an “employee welfare benefit plan” that is provided by your employer. Specifically, ERISA rules do not apply to welfare benefit plans that have been sponsored, established, or otherwise provided by a public employer (i.e., the government or any entity thereof) or by a religious organization, such as a church. For example, if you work as an organizer and administrator for a church association, your employer-sponsored disability benefits coverage will not be governed by ERISA regulations.
How Our Chicago ERISA Lawyers Can Protect Your Rights
Employees with employer-provided benefit plans have several important legal rights under ERISA, including the right to obtain copies of their benefit plans. The benefit plan is a detailed document that sets forth specific information about your entitlement to benefits along with any exceptions and limitations.
If you are ready to file a disability claim or have been denied benefits under an ERISA policy, Bryant Legal Group can help. When you work with us, an ERISA disability attorney in Chicago will immediately request a complete copy of your benefit plan. We are very familiar with the complex language used in these types of plans and will thoroughly review documents to determine the rights and benefit you are owed. Our team will also assist you with the filing of your disability claim and take swift action to appeal any unfair or unreasonable decisions associated with your claim.
At Bryant Legal Group, an experienced Chicago ERISA attorney can assist you in several different ways as you navigate the complexities of your ERISA-governed insurance benefits dispute.
Developing a Comprehensive Insurance Claim File
Developing a comprehensive claim file that contains all of the evidence supporting your disability claim is crucial to the success of your ERISA benefits dispute. What is the claim file, exactly?
The claim file consists of all the evidence collected by and submitted to the insurance company when considering your claim. It includes everything that you submitted as part of your original benefits claim or in response to the insurance company’s requests for additional information. This file can include a broad range of different evidence, such as medical records, bills, paystubs, vocational and job reports, expert analysis, video surveillance footage, and more.
Importantly, if you do not resolve your dispute during or after completion of the administrative appeals process, you may be entitled to bring a civil action against the plan administrator or insurer for benefits and other damages. Depending on the jurisdiction where your case can be filed and the law that applies, the court may be limited to review of the claim file. As such, you’ll want to make sure that your claim file is “complete.”
Meeting ERISA’s Strict Filing Deadlines
It’s important that you consult with a qualified Chicago ERISA attorney as soon as possible so that your dispute can be handled in a timely manner. ERISA gives insureds just 180 days to file their administrative appeal. Further, after you have exhausted your administrative remedies and are ready to sue the insurer in court, you will be subject to the applicable statute of limitations. Statutes of limitations in ERISA plans vary widely and may be as short as 60 days, so it is very important to seek legal counsel right away.
Identifying and Litigating Related Employment Conflicts
ERISA prohibits retaliation by an employer against their employee for engaging in conduct for the purpose of obtaining an insurance benefit. For example, if you submit a claim for disability benefits under your ERISA plan, your employer cannot put you on a damaging alternative career track (i.e., an adverse action) as a means of retaliating against you for simply exercising your rights.
The attorneys at Bryant Legal Group have experience identifying employment-related issues that arise from ERISA disputes, and we provide assistance to clients in such circumstances.
Objecting to Untenable Provisions in Your ERISA Plan
If you have been on the receiving end of a denied ERISA disability claim, a Chicago attorney may be worth contacting for further guidance. Skilled attorneys can identify clauses in your insurance policy that are unenforceable, and your lawyer can advocate aggressively on your behalf to secure the rights that were impeded by the insurer.
For example, suppose that you have challenged the denial of your disability benefits under an ERISA-governed plan. Since you have exhausted your administrative remedies, you decide to pursue civil litigation against the insurer. It turns out, however, that a limitations clause in the policy shortened your limitations period to just six months after the original decision in which the insurer denied your benefits. This might lead to the dismissal of your claim unless your attorney challenges the unreasonable clause and preserves your right of action.
Going Through the Administrative Appeals Process
ERISA requires that welfare benefits plan participants, including those who are disability benefits plan participants, first exhaust their administrative appeals before they are entitled to pursue civil litigation. In other words, you cannot sue the plan administrator and insurer in a court of law until you have properly challenged the denial of your benefits and gone through the administrative appeals process. Only once you have moved through the administrative appeals process (which involves strict procedural requirements and a comprehensive re-evaluation of your submitted benefits claim) are you entitled to bring an action in court.
However, the administrative appeals process is not an unnecessary barrier to the resolution of your benefits dispute, however. In fact, with the aid of a skilled Chicago ERISA disability lawyer, you can potentially overturn the denial and receive the benefits to which you’re entitled. Depending on the strength of the evidence and legal arguments submitted to support the claim, the insurer may choose to award benefits and avoid the messiness of civil litigation.
Avoiding civil litigation is generally a positive. Litigation can be time-consuming and frustrating, and your lawsuit will be a public matter that could be scrutinized by others. This applies to both parties. As an insured, you may simply feel that it’s not “worth” the trouble of suing the insurer in court. As such, an early and favorable resolution to the dispute, perhaps through the administrative appeals process, is much preferable.
Denied an ERISA Disability Claim in Chicago? an Attorney Can Fight for Your Benefits
If you are sick or have been injured and are unable to work, it is essential to consult with an experienced Chicago ERISA attorney as early on as possible in the process. Waiting too long to appeal a denial or failing to submit enough evidence to support your claim can hurt your case, and we may not be able to help at that point.
When you contact our firm early on, we can work with you to prepare and file a claim with the necessary supporting evidence. In most situations, if your claim is denied and an appeal is unsuccessful, you will not be permitted to submit any additional information during the litigation process. This means that it is very important to work with a skilled ERISA attorney who will gather and file all the evidence needed to build a comprehensive case on your behalf.
Schedule a Consultation With a Chicago ERISA Disability Lawyer From Bryant Legal Group to Discuss Your Benefits
Cases involving ERISA plans and benefits are riddled with procedural irregularities. This means that you need an experienced disability law firm who can properly advise you on your rights to pursue your disability benefits. The disability attorneys at Bryant Legal Group understand the complex rules and requirements under the ERISA statute and will work with you to ensure you receive all the benefits your plan provides. Contact a Chicago ERISA disability attorney at our firm today by calling (312) 561-3010 or completing our online form.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.