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The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that protects employee pensions and provides rules for many health and welfare benefit plans such as long-term disability (LTD) insurance, life insurance, and health insurance. ERISA typically applies to employer sponsored group benefit plans, provided that the employer is not a church or government.

ERISA is a complex statute full of rules and procedures.  However, there are some fundamental principles, for example:

  • Plans must provide participants with accurate information regarding the features and benefits of the plan, as well as its funding sources.
  • Plan administrators who control plan assets must adhere to strict fiduciary responsibilities.
  • Plans must establish a clear and well-defined appeal process for claimants who are denied benefits.
  • Plan participants have the right to sue for benefits in federal court.

ERISA preempts most state laws designed to protect consumers. This creates challenges for claimants whose benefits are wrongly terminated or denied. Claimants typically have to file an appeal to the very same insurance company that wrongly denied benefits. In addition, claimants typically must submit all evidence that they would need to win their case in court to the insurance company before the final appeal denial. This is because, with few exceptions, claimants are not allowed to add new medical or vocational evidence to the record after the final appeal denial.

Therefore, it is important that you consult with an experienced ERISA attorney as early in the process as possible, before you file your appeal.

The ERISA attorneys at Chisholm Chisholm & Kilpatrick LTD understand the complexities of ERISA cases and are able to take on the powerful insurance companies. They may be able to handle your LTD, life insurance or health insurance appeal on a contingency basis, with no upfront cost to you.

Call now for a free consultation to see if CCK can assist you: 401-331-6300.

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