What Is Your Experience In Guiding Clients Through The ERISA Disability Claim Appeals Process?
My entire professional experience has prepared me to assist my clients with the Employee Retirement Income Security Act (ERISA) appeals process. As a 1992 graduate of the University of Florida College of Law, and a graduate of the College of Nursing, I found myself drawn to disability law. I began my legal career as a prosecutor, where I gained invaluable jury trial experience. Later, I became a workers compensation attorney, a social security attorney, and now an ERISA lawyer…Read More
What Is ERISA? Why Is It So Important?
The Employee Retirement Income Security Act of 1974, 29 USC § 1001, et. Seq (ERISA) is the federal law governing group benefit plans sponsored by private employers and unions. With a national population of approximately 300,000,000 people, it has been said that ERISA covers approximately one-third of that population…Read More
Where Must Someone First File An Insurance Denial Appeal?
The appeal must be filed according to the procedure, which is set out in the Summary Plan Description, which all ERISA plans must issue. Typically, the appeal is filed with the insurance company. Some plans, typically self-funded, require the appeal to be filed with the plan administrator…Read More
What Is The Process Of Litigation For A Federal ERISA Lawsuit?
Once an ERISA complaint is filed in federal court, then the defendants need to be served with process. Process includes the complaint and a summons. Once the defendants are served with process, then the next step in the litigation is for the insurance company to file its answer…Read More
Why Do Insurers Deny Long-Term Disability Claims?
Insurers deny claims for a variety of reasons. It could be because they failed to receive the documents needed to make the decision within the regulatory timeframe. It may be because you failed to cooperate with them, like not attending a scheduled exam. It might be because the evidence does not support your claim or your condition is excluded from coverage under the policy. It may also be that they simply don’t want to pay. They might have recognized that your case will cost hundreds of thousands of dollars, so they deny or terminate your claim….Read More
Does ERISA Govern How Employers Must Handle All Employee Benefits, From The Frontline Workers All The Way Up To CEOs?
ERISA provides a uniform minimum standard to ensure that employee benefit plans are established and maintained in a fair and financially-sound manner. While ERISA does not require an employer to provide a benefit plan, if an employer chooses to do so, they have an obligation to provide promised benefits and satisfy ERISA requirements for managing and administering the plan. This applies to how they handle all employee benefits from the frontline worker all the way up to the CEO…Read More
What Is The ERISA Disability Claims Process & Procedures?
The Employee Retirement Income Security Act (ERISA) is a federal law that sets the minimum standards for disability benefit plans in the private sector…Read More
What Will The Claim Administrator Do To Investigate The Claim?
The insurance carrier can obtain your medical records, conduct a phone or an in-person interview with you, and conduct surveillance of your activities, both online and in person. Social media is one of the biggest ways they can conduct an investigation without even leaving their office. They can also send you to their doctor for a medical exam…Read More
How Does The Department Of Labor Enforce ERISA?
The regulations of an employee benefit plan are enforced through the Internal Revenue Code and ERISA. The two agencies that share responsibility for enforcing ERISA are the IRS and the EBSA, also known as the Employee Benefits Security Administration. Active enforcement activities include investigations, lawsuits, and the dissemination of information. Documents published by EBSA include the Reporting and Disclosure Guide for Employee Benefit Plans…Read More
What Are Possible Reasons To Sue A Plan Or Fiduciary Under ERISA?
The ERISA statute does have a civil enforcement scheme, which permits claimants to go to court. One cause of action under ERISA is a claim for benefits, which is frequently seen in long-term disability situations. There could be claims for breach of fiduciary duty, if the administrator failed to do something or did something that was not in the best interests of the plan. There could be a COBRA violation, if there is an issue with the health insurance plan, or a violation of the Anti-Interference or Anti-Retaliation Act provisions of ERISA, if you were retaliated against…Read More
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