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If your ERISA benefits have been denied, you may be feeling overwhelmed and left with questions about what you should do now. The most important thing to know is that you should not give up. You need to keep fighting. Unfortunately, insurance companies often deny valid ERISA claims. If your benefits have been denied, please contact a nearby ERISA lawyer for immediate assistance.
The Employee Retirement Income Security Act of 1974, also known as ERISA, is a federal law that regulates many employer sponsored retirement and health plans. The law regulates several different aspects of these plans, from the funding requirement to the process by which claims should be handled. In the modern business world, most ERISA plans are ‘funded’ through the use of insurance policies. As such, most claims now involve dealing with a large insurance company.
If your plan is governed by ERISA, then those regulations will control your claim. The following includes three of the most important things you need to know about ERISA and filing appeals:
ERISA Preempts State Law
ERISA supersedes California state law. The only rights and remedies that you will have available to seek your benefits are those that are available under ERISA. It is critically important that you work with an attorney who understands ERISA’s rules and regulations to ensure that you exercise your rights in the most effective way possible.
You Must File an Administrative Appeal Before You Can File a Lawsuit
The courts have interpreted ERISA to require you to exhaust all of your available remedies before you can get into the courtroom. In other words, you cannot file a lawsuit to get your benefits until you file an internal appeal with your plan administrator. Most often, this means filing an appeal with an insurance company. It is critically important that you get this appeal right. This is true for two different reasons: 1) Because a well-crafted appeal could get your claim successfully resolved more quickly; and 2) Because you need to ensure that you get all relevant information into the record when you file your appeal.
You Must Get All Information, Evidence and Documents Into Your Claim File
The insurance company will keep a claim file (known as an Administrative Record) pertaining to your case. In the event that your appeal is denied, and your case does go to court, the information contained within the claim file is likely the only evidence that the judge will be able to consider when ruling on your claim. This means that if you fail to get an important piece of evidence into the file, such as a key medical document, then you will lose out on your ability to use that evidence at trial. This could destroy your case. Do not let this happen to you. Get an attorney involved in your ERISA litigation case as soon as you receive the initial denial letter.
The ERISA lawyers at Kantor & Kantor LLP are standing by, ready to help. For a free review of your claim, please do not hesitate to call our team today at (510) 992-6130. We have lawyers available throughout the Bay Area, including at our offices in San Jose, San Francisco, and Alameda.
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