How ERISA Affects Your Insurance Claim

The Employee Retirement Income Security Act (ERISA) was passed in 1974 to protect hard-working Americans that rely on the continued support of pensions and insurance they obtained from their former employers.

As a federal law, ERISA takes precedence over state law and provides the highest level of protection to citizens in the country. If you have an insurance plan from your employer, this law guarantees your benefits remain in place for the rest of your retirement.

Recent storms pummeling the coast have left insurance providers concerned for their profits, and that’s why we want to remind you of your protection. This is a notice to our clients and future friends to alert you of the ill intentions at play by insurance companies across the country. The law has not changed, and your policies are still in place. When insurance companies feel threatened, they go after what they perceive as the easiest target. Unfortunately, this may or may not involve you, and that’s where we come in.

What You Should Know About ERISA

  • ERISA only applies to private employees. In a recent decision, the courts upheld a legal decision that government agencies are exempt from ERISA’s protection, including political subdivisions at the national and state level. Non-private sector employers may still offer you a plan, but it will not be considered an ERISA plan.
  • ERISA fiduciaries include your employer and the insurance provider. The private company offering your claim is known as the “plan administrator”, and is considered a fiduciary, or trustee, of your plan. The plan administrator is responsible for providing all documentation regarding your plan’s coverage in writing. Insurance providers are also considered fiduciaries under ERISA, and are called “claims administrators”. Their duties are separate and include providing all supporting documentation used to make the decision on your claim. This documentation includes medical records, financial assessments, contractor estimates, and internal notes.
  • The fiduciaries can be sued. Employees that have been treated unfairly have the right to sue the responsible fiduciaries under ERISA. The complicated law stipulates policy limits and requires employees to file all documentation for their appeal in a narrow time frame. Once the appeals process has been completed, policyholders can sue the fiduciaries responsible for making a decision on their claim. Legal action is sometimes the only way to hold insurance providers accountable.
  • State laws may not be able to help you. ERISA is a federal law that often trumps state legislation. However, there are some instances where this is not the case. To better understand your options, contact your plan’s representative and ask any questions you may have regarding your coverage. They are required to assist you through this process.
  • Sometimes claims get denied, always appeal. ERISA protects you from wrongful denials, but that doesn’t mean insurance providers will avoid trying to trick you. Remember: you have the right to appeal any decision made concerning your claim. The best way to get the most out of your appeal is to hire legal representation experienced in ERISA law because the appeals process is critical. If the appeals process fails, and you are denied benefits again, the only option is to sue for your rights. The courts will only decide based on the evidence you submit in your appeal. No new evidence is allowed once the claim is denied a second time, and an effective attorney is able to properly prepare for this outcome.

ERISA law is complicated and the appeals process has several limitations. If you are denied coverage, any appeal must be completed properly and within a timely manner. As soon as your claim is denied, it is in your best interest to seek legal counsel immediately.

We were raised by the motto “When you make a deal, you stick to it.” Nowadays, insurance companies have gotten too big for their britches, and sometimes they feel entitled to neglect their end of the agreement. At Williams Hart, we recognize this as a serious breach of good faith and will fight on your behalf. The best years of your life are still ahead, and you deserve full access to your insurance coverage.

Deceitful practices are all-too-common among large insurance providers. They intentionally inflate their policies with confusing language and make it extremely challenging to interpret. With nearly unlimited resources compared to an individual policyholder, these corporate giants act more like bullies in a schoolyard than supportive allies. When they decide not to honor your legitimate claim, it can feel like the end of the road. Luckily for you, the law is on your side.

If you are struggling with a careless insurance company, and find yourself in a frustrating battle with unfair representation, it is critical that you reach out for help. With superior insight into their own policies, fighting for what you deserve can feel overwhelming and nearly impossible. We have been fighting for people like you for over 30 years, and we have the knowledge it takes to hold insurance companies responsible. Less experienced attorneys may encourage you to just settle for less, but at Williams Hart, we refuse to settle for anything less than what is owed to you.

Because of the complex nature of these types of laws, it is best to work with a law firm that has the skills necessary for interpreting federal and state legislation. The success at Williams Hart has proven time and time again that we have the experience it takes to handle these types of lawsuits.

Our nationally-recognized team of compassionate attorneys is ready to share our legal prowess, and will help you with your insurance claims. We are willing to take the time to explain the intricate procedures at play, and want to answer any questions you may have. As members of the community, we see this as an opportunity to give back to the golden members of our society and defend against the greedy intentions of insurance companies trying to make a quick buck. Contact us at [phone number] today and get free legal consultation. You don’t have to settle for unfair practices with Williams Hart on your side.


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