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The Employee Retirement Income Security Act of 1974 (ERISA) is one of the most complex pieces of legislation that has ever been passed by the U.S. Congress. The law sets minimum standards for many, but not all, employer sponsored retirement, health and welfare benefits plans. While the law provides many important protections for claimants, it has also become extremely complicated and very difficult to navigate for applicants. If your employee benefits, for any reason, have been denied, it is imperative that you consult with an experienced national ERISA attorney who can protect your legal rights and financial interests.
The minimum requirements that ERISA sets for employer sponsored benefits plans are very important. These legal requirements help to ensure that the plan will be stable and that employees will have a fair process to seek their benefits. For example, some of the minimum legal requirements include:
Most importantly for plan beneficiaries, ERISA sets up strict standards for how your claim should be filed and how your appeal (if necessary) will be processed. All key information about your specific plan and the appeals process should be contained within the official Summary Plan Description (SPD). A copy of this document must be provided to you under federal law. If you are having trouble getting your SPD, please consult with an attorney.
If your initial application is refused by the insurance company, you should expect to receive a written denial letter. This letter should inform you precisely why your claim was denied. The reasoning given by the insurer, whatever it may be, should be adequately addressed in your appeal. If you do not address their reasoning, you are likely to receive another adverse result.
Notably, under ERISA regulations, you must go all the way through the insurance company’s internal appeals process before you can file a lawsuit. If a lawsuit becomes necessary, the court will generally be limited to looking at the evidence contained within your claim file, and nothing else. In other words, if you fail to submit important evidence or documents when filing an appeal, you could lose out on the benefit of the evidence forever. You should work with a lawyer who will protect you from making this mistake.
At Kantor & Kantor LLP, we have extensive experience handling all aspects of ERISA claims. If you having any trouble recovering your full and fair benefits under your ERISA-regulated plan, we can help. From our offices in the Bay Area of California, we handle ERISA claims nationwide. To set up a free review of your case, please call our main office today at (510) 992-6130.
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