ERISA Benefits Claims Attorneys

The Employee Retirement Income Security Act of 1974 (ERISA) is the federal law that establishes minimum standards for most voluntarily established retirement and health plans in private industry. ERISA protects employee benefit plan participants by requiring the disclosure of relevant information to beneficiaries, ensuring fiduciaries do not misuse assets, and providing remedies and access to federal courts.

When a person obtains insurance through their employer, the insurance is not part of the employment contract but is instead considered an employee benefit. ERISA applies to most employee benefits and the rules are not the same as traditional court processes because ERISA operates under its own civil procedure.

If you or your loved one needs assistance with any kind of ERISA benefits claim, you are going to want to be sure that you are working with an experienced lawyer. ERISA claims are extraordinarily complex and you will want legal counsel for help recovering all of the benefits you are entitled to.

Abell and Capitan Law understand the complexity of ERISA claims and can fight to protect your rights. We can help you understand all of your legal options when you call (267) 419-7888 or contact us online to schedule a free consultation.

Do I Need An ERISA Benefit Claims Lawyer?

The complicated nature of the ERISA claims process not only makes an attorney critical for a person, but also a lawyer who understands the ERISA process and is actively involved in it. Many attorneys who largely handle Social Security Disability Insurance will also accept ERISA claims but may not give the cases the full time they deserve.

The handling of any ERISA claim is critical because there are a number of very important concerns in these cases. ERISA is often governed by very strict and confusing time limits, so appeal rights need to be preserved in the most appropriate fashion.

Some insurance companies may not be completely forthright with evidence, and others may have committed significant errors in the administration of your benefits. An experienced lawyer is going to be able to identify these types of issues and help you resolve them.

ERISA applies to most defined contribution plans and defined benefit plans of most private employers. You will want to contact an attorney if you believe that plan managers failed to act in your best interests, you suffered significant investment losses in a pension plan, or have not been provided with plan documents and information about benefits.

Why Choose Abell and Capitan Law To Handle My Case?

Abell and Capitan Law only represents disabled individuals, never insurance companies. Our firm takes pride in helping people with ERISA benefits claims.

Erik Abell litigates ERISA governed disability claims in federal courts across the nation. He received his Bachelor of Arts from the University of Kentucky before obtaining a Juris Doctor from the Louis D. Brandeis School of Law at the University of Louisville.

Joe Capitan was named a Pennsylvania Rising Star by Super Lawyers in 2013, 2014, 2015, 2016, and 2017. He is a member of the Pennsylvania Association for Justice, Philadelphia Bar Association, and Pennsylvania Bar Association.

You will want to work with Abell and Capitan Law because we will charge you nothing up front to handle your case. We only collect legal fees when you obtain your benefits.

Types of ERISA Benefit Claims Cases We Handle

Abell and Capitan Law handles on ERISA benefit claims involving such issues as:

  • Group medical and health plans (such as the Affordable Care Act [ACA], Health Insurance Portability and Accountability Act [HIPAA], and Consolidated Omnibus Budget Reconciliation Act [COBRA])
  • Defined benefit pension plans
  • 401(k) plans
  • Profit sharing plans
  • Multiemployer plans
  • Employee stock ownership plans (ESOPs)
  • Preapproved retirement plans
  • Davis Bacon plans
  • Voluntary employees’ beneficiary associations (VEBAs)
  • Cafeteria plans (employee benefit plans governed by Section 125 of the Internal Revenue Code)

Our firm can also assist with qualified domestic relations orders, medical child support orders, and deferred compensation programs. Abell and Capitan Law is experienced in ERISA litigation when a case has to go to federal court.

Frequently Asked Questions about ERISA

What benefit plans are covered by ERISA?

The two kinds of plans ERISA applies to are employee welfare benefit plans and employee pension benefit plans. An employee welfare benefit plan is defined as a plan, fund, or program established or maintained by an employer or by an employee organization (or both) that provides health insurance, group life insurance, long-term disability income, severance pay, funded vacation benefits, apprenticeship or other training programs, or day care centers, scholarship funds, prepaid legal services, or any benefit described in section 302(c) of the Labor Management Relations Act (other than pensions on retirement or death) through insurance or otherwise.

An employee pension benefit plan is any plan, fund, or program established or maintained by an employer or by an employee organization (or by both) that provides retirement income to employees or results in a deferral of income by employees for periods extending to the termination of covered employment or beyond. employee pension benefit plans include profit-sharing retirement plans, stock bonus plans, money purchase plans, 401(k) plans, employee stock ownership plans, and defined benefit retirement plans.

When are benefit plans not governed by ERISA?

ERISA exempts employee benefit plans provided by governmental entities and religious organizations. Certain religious organizations may opt into ERISA. Most individual policies purchased without an employer’s involvement are not subject to ERISA, but most group disability, health and life insurance policies are subject to ERISA when they are plans, funds, or programs established or maintained by employers or employee organizations (or both) for the purpose of providing medical, surgical, hospital care, sickness, accident, disability, death, unemployment or vacation benefits to participants or their beneficiaries.

A group disability insurance policy will not be governed by ERISA if no contributions are made be an employer or employee organization, participation in the program is completely voluntary for employees or members, the sole functions of the employer or employee organization with respect to the program are, without endorsing the program, to permit the insurer to publicize the program to employees or members, to collect premiums through payroll deductions or dues checkoffs and to remit them to the insurer, and the employer or employee organization receives no consideration in the form of cash or otherwise in connection with the program, other than reasonable compensation, excluding any profit, for administrative services actually rendered in connection with payroll deductions or dues checkoff. If any one of these four factors is not satisfied, however, then the policy is governed by ERISA.

Does ERISA govern unwritten plans, practices, or informal arrangements?

Any plan, fund or program that provides the type of benefits listed for employee welfare benefit plans and employee pension benefit plans is covered by ERISA, even if it is unwritten or an informal arrangement. Such plans are usually considered covered by ERISA when a person can ascertain the intended benefits, a class of beneficiaries, the source of financing, and procedures for receiving benefits. Failure to comply with ERISA’s disclosure and reporting requirements will not allow an employer to escape ERISA coverage.

What are the time limits for ERISA claims?

Under 29 Code of Federal Regulations (CFR) § 2560.503–1(f), a plan administrator must notify a claimant of a claim being wholly or partially denied within 90 days. This is commonly referred to as the “90-day rule.” Notification must be provided within 45 days for disability claims. The plan administrator is permitted to request one 90-day extension or two 30-day extensions for disability claims.

A plan must afford a reasonable opportunity to any beneficiary whose claim has been denied for a “full and fair review by the appropriate named fiduciary,” meaning that at least one appeal needs to be provided to plan participants and beneficiaries with 180 days to file such an appeal. The plan administrator must decide the appeal in 60 days, or 45 days for disability claims under 29 CFR § 2560.503–1(i). Other claims have specific deadlines, including 72 hours for urgent care claims, 15 days for preservice claims before treatment, and 30 days for post-service claims.

What is the standard of review for ERISA claims?

In Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), the Supreme Court of United States held that a denial of benefits challenged under 29 U.S. Code § 1132(a)(1)(B) is to be reviewed under a de novo standard, which means taking an entirely new look at an issue and rendering a decision without any presumption favoring the earlier decisions. The Supreme Court wrote that applying a deferential standard of review “would afford less protection to employees and their beneficiaries than they enjoyed before ERISA was enacted,” which goes against ERISA’s stated purpose to promote the interest of employees and their beneficiaries.”

While The Supreme Court held that a District Court must review ERISA claims de novo, it provided an exception when a benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan. This has become known as the “Firestone exception” and led to many benefit plans inserting language into their agreements to prevent de novo review.

Contact an ERISA Benefits Claims Attorney Today

Do you need help with an ERISA benefits claim? You should not wait to contact Abell and Capitan Law. Our firm understands the most effective ways of handling ERISA claims so we can help clients recover all of the benefits they need and deserve. Call (267) 419-7888 or contact us online to receive a free consultation.

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