ERISA: How it Impacts Your Claim
What is ERISA?
ERISA stands for the Employee Retirement Income Security Act of 1974. It is a comprehensive federal law that governs most employee benefits provided through private, non-governmental, employers, including health care, long-term disability, and retirement plans. Among other things, ERISA oversees how plans are established and communicated to employees, and requires that plan participants are able to appeal denied claims.
It is this appeal process of denied claims that we handle at JuneLaw.
An unusual aspect of ERISA is that there is no single procedure for how to try a case that involves ERISA across the country. Social Security and Medicare, for example, have standardized procedures. Consequently, it’s completely different to handle an ERISA case in Michigan than it is in California.
Appealing Your Denied Benefit
Your appeal to the insurer is your only opportunity to submit evidence. Once the administrative record is closed, it is locked permanently, and neither side can add anything new in court. Contact JuneLaw before filing your appeal, not after.
When your request for an employee benefit that is covered by ERISA is denied by the insurance company, there are things you can do. The first step in the process is to send an appeal to the insurance company. Only then can you file a lawsuit.
How you handle the appeal process is extremely important.
- Don’t be late! After receiving a denial letter, the clock starts on your ability to appeal their decision. Check your plan documents to make sure you appeal in time.
- Get ALL your documents together. Make sure that the appeal contains everything you want to submit. It can be tempting for people to attempt the appeal process themselves, and to send a letter that says, ‘I appeal,’ without any additional information. The result is that the insurance company gets to say, ‘Any other evidence is not to be considered.’ The JuneLaw team will ensure that you gather all the potential evidence that could possibly support your claim and submit this with your appeal.
The JuneLaw team has decades of experience and a track record of success in appealing denied insurance claims. Contact us early to get the best results!
There are many trap doors in ERISA. It is critical that your lawyer understand the law inside and out. The JuneLaw team has decades of experience and a track record of success in appealing denied insurance claims.
Bob June, JuneLaw
Why it is important to Contact JuneLaw early in the process
If we think you don’t need to hire us, we will tell you that.