Millions of Americans receive important health care benefits through their employers or through employee organizations like unions. The information below provides some basic information about ERISA, a federal law that regulates the way that employers and insurance companies administer covered life insurance and other insurance plans.
ERISA, or the Employee Retirement Income Security Act of 1974, is a federal law that provides protections for beneficiaries of employer retirement plans and healthcare plans. The law requires that participants have access to certain information about their plans, imposes a fiduciary duty upon individuals who manage plans, and also creates a several private causes of actions allowing participants to bring suit against plan administrators in certain situations.
Individuals who have had health care claims denied by a plan covered by ERISA have the right to file an appeal regarding the denial of benefits. It is important for plan participants to be aware, however, that there are strict time limits for filing such an appeal. In addition, the process of administrative review of a claim denial is often extremely important and the record that is developed through this process is often dispositive regarding the way a case is ultimately resolved. For this reason, it is critical for anyone that has had a claim denied by an ERISA plan to talk to an experienced lawyer as soon as possible.
As mentioned above, ERISA creates a private cause of action that allows individuals who have had their claims wrongfully denied by an ERISA plan the right to sue. Importantly, plan participants and beneficiaries can only file claims once all other avenues for appeal have been exhausted. Importantly, the record developed through the appeals process will be relevant if and when a lawsuit it filed, so the assistance of an attorney during this time is invaluable. If a claimant has exhausted all of his or her administrative remedies, he or she may file a lawsuit under ERISA in federal district court.
Individuals who are claiming health care benefits under an ERISA plan do not generally need to retain an attorney during the process of filing an initial claim form benefits. If a claim is denied, however, it is extremely important to retain legal counsel immediately. In many instances, the earlier an attorney becomes involved in an ERISA case, the better the chances for success at a later date.
ERISA is a complicated piece of legislation that confers significant legal rights to employees who participate in employer-sponsored health plans. ERISA can be confusing and, for this reason, anyone who believes that his or her claim for benefits has been wrongfully denied should contact an experienced lawyer immediately. To schedule a free consultation with an experienced claims attorney, call Roberts Bartolic LLP today at (312) 635-1600.
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