ERISA

Many employers offer benefit packages to their employees. In addition to common benefits like health insurance and paid time off, companies may also provide workers with life insurance and Accidental Death & Dismemberment (“AD&D”) insurance coverage. Such benefit plans are governed by a federal law known as ERISA (Employee Retirement Income Security Act of 1974).

Employees count on these promised benefits when planning for their financial futures. Knowing their employer provides this coverage, an employee may choose not to secure similar insurance on their own. But all too often, the insurance companies that are supposed to deliver benefits through employer-sponsored plans unjustifiably refuse to pay or drag their heels on a claim for months or years. When that happens, families are left in the lurch, feeling betrayed and wondering how they will pay bills and expenses they rightfully thought would be covered by their life or long-term disability insurance.

If you find yourself in this unfortunate position, the ERISA attorneys at Life Legal are ready to help. We focus our practice exclusively on getting people like you the insurance benefits you have paid for and deserve. We understand every policy nuance, every detail of ERISA and other laws governing insurance benefits, and every tactic or excuse insurers use to avoid paying claims.

When you contact us for your free initial consultation, we will listen to your story, learn about the facts and circumstances surrounding your claim and the insurer’s response, discuss your options, and develop a plan to challenge or appeal the insurer’s position when warranted. We know first-hand the struggles and stress caused when expected and deserved benefits never come, and we fight relentlessly on behalf of our clients to get them every dollar to which they are entitled. And if you hire us as your ERISA attorneys, you won’t have to pay us anything unless we recover benefits for you.

ERISA is a federal law that governs all private employer-provided employee benefits and pension plans, including those that offer life insurance and AD&D insurance benefits. The former type of coverage pays benefits to an employee’s family after they pass away, while the latter provides benefits if the death meets the plan’s definition of “Accident.”

Although ERISA sets the rules for benefits plans offered by private employers, it does not require employers to provide such plans. Once an employer establishes a plan, however, it must follow ERISA’s minimum eligibility, disclosure, vesting, and funding requirements. ERISA also codifies rules that apply to trustees and other individuals who administer and manage these plans regarding how they handle claims, communicate with insureds, and deliver benefits. When these individuals, known as fiduciaries, violate ERISA’s rules, they can be held personally liable in civil lawsuits brought by beneficiaries or plan participants harmed by their actions.

Like other types of insurance companies, the insurers who provide coverage under employer-sponsored plans don’t like paying claims if they can find a plausible reason not to. Every dollar they pay out to insureds or beneficiaries is a dollar they lose in profits. That is why they routinely deny claims for benefits under ERISA — often without good cause.

The excuses insurers give for denying life insurance or AD&D claims under employer-sponsored insurance plans can include:

• Cause of death not covered by the life insurance plan.
• Insured/beneficiary failed to disclose required information.
• Insured/beneficiary committed fraud.
• Insured failed to pay premiums.
• Insured converted/continued coverage following termination of employment.
• Paperwork mistakes.
• Missed deadlines.
• Lack of medical evidence.
• Ineligible dependents
• Pre-existing conditions.
• Undocumented symptoms and inappropriate treatment.
• Policy exclusions or limitations on benefits or coverage.

Often, the claimed reasons for denying a claim are not based on the facts or rely on dubious interpretations of policy terms. Whatever the basis given, an ERISA claim denial can have serious and immediate impacts on a family’s life and should not be taken lightly. Getting the benefits you deserve requires experienced counsel who can cut through the insurer’s smokescreens and excuses. If your claim under an employer-sponsored insurance plan has been denied, contact the experienced life insurance lawyers at Life Legal today for a free consultation.

Following an insurance claim denial, you have specific rights as stated in ERISA’s claims procedures regulations. Your rights under ERISA include the right to receive specific information regarding the denial and the right to appeal the decision. Specifically, following a denial, your plan administrator must provide you with a notice containing the following information:

• The reason(s) for the denial.
• The specific plan provisions on which the insurer based the denial.
• A description of any additional information or material needed for the insurance company to reconsider the original claim.
• A description of the plan’s review procedures, including all deadlines and timeframes.
• The internal guideline, rule, or protocol relied on by the plan administrator to make the adverse benefit determination.
• If the insurer based the denial on medical necessity, an explanation of the clinical or scientific judgment used to determine that the claim should be denied.
• A description of the review process applicable to your claim.

If your ERISA life insurance or AD&D insurance claim is denied or delayed, contact one of Life Legal’s ERISA attorneys for assistance as soon as possible. Life Legal works with individuals and families across the country to help them navigate the ERISA litigation process and get them the benefits that are rightfully theirs.

When you come to Life Legal for assistance with your denied claim, we will guide you through the legal process and fight hard to protect your rights. With Life Legal in your corner, you can rest assured we will always keep you apprised of the status of your case, advise you about any significant developments, and be available any time you need us.

If you are ready to fight back and take the first step toward obtaining your denied benefits, please contact us today to schedule a free consultation with one of our talented attorneys. And remember, you pay nothing until we recover proceeds for you.