When your employer provides benefits plans, you are entitled to receive your rightful benefits without unnecessary obstacles. Too often, someone files an employer-sponsored benefit claim and is wrongfully denied benefits they need for their health and welfare. When this happens, the process of appealing the denial is complicated due to governing laws, and you want to consult with an experienced ERISA lawyer in San Francisco.
Roberts Disability Law, P.C. knows how to help clients with ERISA benefit claims, so please reach out today so we can assess your situation.
ERISA refers to the Employee Retirement Income Security Act of 1974, and this federal law governs not only retirement benefits but also health and welfare benefits offered to employees. These insurance plans include:
If you work in the private sector and have a benefit plan from your employer, it is likely that ERISA governs it. While ERISA is intended to ensure fair treatment of employees regarding benefits, the law has complex rules and restrictions during the claim or appeal process.
When ERISA applies, all state and local laws are preempted. You will need to seek any legal remedies or relief under what ERISA provides. Unfortunately, ERISA provides limited remedies to employees who have their valid benefits claims denied, and ERISA procedures make the appeal process overly complex.
If a non-ERISA benefit is denied, you could file a claim against the insurance company in state court to seek what you deserve. This is not the case with ERISA benefit claims. Instead, you must:
You must wait until you receive a final denial from the insurance company according to its procedures and policies. This can take time, and the chances of a repeat denial are high. This delays benefits for many people who need them as soon as possible for financial support.
Once you receive the final denial, you must file a federal court claim, which involves quite different procedures from state court claims. Further, the federal court will only consider the file on which the insurance company based its final denial. You cannot present any additional information to persuade the court. This makes proper handling of the administrative appeal process critical.
There is no doubt that ERISA complicates what could be a straightforward insurance claim appeal. At Roberts Disability Law, P.C., we can assist you at every stage of the claim process. We know how to prepare and file initial claims for the best chance of approval. If you receive a denial, we know how to create a complete record during your administrative appeal and navigate a federal court case when needed.
Contact us for more information about how we might help in your situation.
LEAVE YOUR MESSAGE
We know how to get your insurance claim paid. Call today at: