Many professionals are provided with private insurance and other benefits by their employers as part of their benefits packages. Because this coverage, including disability coverage, is private, the terms, such as the amount of coverage and its duration, can vary considerably, but there are important federal laws in place to help ensure that the benefits apply and are processed fairly. If you have a benefit claim that the insurance provider does not address in accordance with the applicable laws, an experienced ERISA attorney in Palo Alto can help.
ERISA refers to the Employee Retirement Income Security Act (ERISA), which governs the insurance plans (and more) that employers provide their employees (outside of any coverage they are required by law to provide, such as workers’ compensation coverage). While employers are not required to develop benefit plans, those that want to recruit top professionals tend to do so. And once they do, ERISA implements highly specific rules that address all the following:
There are also careful rules in place that govern how trustees and others who administer these benefit plans do so.
ERISA addresses the full scope of employer-provided benefits, including:
If you apply for the benefits your employer provides and your claim is denied, a dedicated ERISA attorney can help.
If your claim is denied, you will need to file an appeal, and this appeal will play a critical role in anything that follows. Your ERISA attorney will very likely draft an appeal letter that lays out all the relevant evidence in your case – in strong support of the denial being overturned and the applicable benefits being either reinstated or granted to you. If your appeal fails to achieve the desired result, you and your ERISA attorney may move forward by filing a lawsuit in federal court requesting it to determine that the original decision was arbitrary and capricious and that the benefits originally sought should be awarded – along with your court costs and reasonable attorney fees.
Your appeal regarding a claim denial will play a pivotal role in what comes after (if the appeal is denied). The only evidence you can use to build your strongest case against the insurance provider in federal court is the evidence that is included in your appeal, which makes having a solid appeal essential. The claims process for denied employer benefits is especially complicated, and having professional legal guidance in your corner is always in your best interest.
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