The Employee Retirement Income Security Act (ERISA) is a legal measure that was adopted by congress under federal law for the purpose of providing oversight on the exercising of employee rights to benefits offered by employers. Thus, while ERISA is designed to facilitate employees’ endeavor to gain all the expected benefits in an unobstructed manner, the latter is not always the case. The insurance companies do not get into any trouble when they unlawfully refuse to pay for benefits, which make many employees struggle in order to obtain what rightfully belongs to them. In the event that you are caught in this position, then it is advisable to seek the services of a distinguished ERISA Appeals Oakland CA lawyer from Monahan Tucker Law.
What is an ERISA Plan?
ERISA plan refers to an employee welfare or pension benefit plan that an employer offers or maintains with regard to employees; the plan comes under federal rules. These plans consist of retirement, health, life insurance and disability benefits. The participants of the plan are supposed to be provided with a SPD, plan document and, and annual reports according to the ERISA. The following rules apply to all justification of ERISA insurance claims – If your insurance claim is denied under an ERISA plan and you wish to challenge the determination, you must first appeal it. The appeal must be filed within six months, & if it is refused an individual can continue to legal proceedings in the federal court.
As is the case with other lawsuits which fall under ERISA, the discovery process is very limited; the court considers only the papers contained in the insurance claim file. This limitation is a nice understanding of the fact that one should always seek the assistance of an attorney before filing an appeal to insurance so as to ensure all supportive information is included in the claim file. The unavailability of a jury trial also fosters the problem where decisions are arrived at by a judge in a trial without any witnesses in the case of ERISA cases. The court can only allow for the payment of benefits due and, where necessary, the reopening of your claim for consideration. However, the insurance company still has the right to cancel the plan in this regard the right to do so at any time he or she wants.
The Challenges of ERISA Appeals
Ironically, the direct form of litigation and simplified procedure designed for handling benefit claims under ERISA causes employees to lose out. Insurance companies suffer no penalties if they wrongly deny claim payment; they just have to pay the amount they ought to deliver if compelled by the law or a court order. What is however strange is the fact that there are very few punitive measures to discourage insurance companies from denying valid claims. Additionally, insurance companies cannot be held accountable for consequential damages or punitive damages or for people’s emotional distress according to ERISA. Potential liabilities may be the benefits which have been awarded and owing to attorney fees in certain situations.
Who Needs a Non-ERISA Plan?
Non-ERISA plans are those that are not subject to the federal ERISA law but regulated by the state law. Such plans entail the benefits provided to the government employees, the church employees, and the other employees who serve employers who avail self-funded plans. Conversely, any insurance plan that is made personally, including one with a group scheme offered by a bank or trade union is categorized here. Non-ERISA plans are generally less restricted than the ERISA ones, the rules of which can be different.
Non-ERISA claims on the other hand do not require an appeal before instituting a lawsuit as a remedy for denial of benefits. Litigation under state law is substantially similar to federal litigation, and it includes discovery, in which the parties must produce the requested information and may be interrogated. It is also common that there is a jury trial with witnesses; other states might also bring punitive damages and/or elder financial abuse claims as well.
ERISA affects the administration of employer sponsorship benefit plans in several ways and it is important for every employee to differentiate between ERISA and non-ERISA plans. Certain protections do exist through ERISA plans however; one of the main issues which arise from such programs is the absence of penalties for the wrongful denial. Despite this, there are Non-ERISA plans which are certain plans of different states with their rules and regulations therefore; there could be other legal options available. Should you stand a case where you require help in Oakland, CA, concerning ERISA appeal, it is our pleasure to offer our services at Monahan Tucker Law. Choose us today to prevent any injustice and to obtain the proper rewards for your contribution.