Filing an ERISA Complaint
If you have been denied benefits that you were entitled to under the Employee Retirement Income Security Act of 1974 (ERISA) you may have options to find relief.
The first step following a benefits claim denial is to file an appeal, followed by the option for filing an ERISA complaint in court. This process can be complex, but it’s often worth the effort.
Who Can File an ERISA Complaint?
ERISA governs the minimum standards for employer-offered benefit programs and exists to ensure that employees receive the benefits they are dependent upon. Qualified plans are any plan that requires contributions by the employer or salary deductions from the employee.
Non-qualified plans that still fall under ERISA regulation include bonus plans and tax-deferred compensation. Some of the benefits that the ERISA may cover include:
- Health care insurance,
- Long-term disability,
- Group life insurance,
- Vacation benefits,
- Training programs,
- Daycare centers,
- Scholarship funds, and
- Pension benefits.
Your employer is required to provide participants with information about the plan, including features and funding. If you are owed any of these benefits according to your benefits plan and have had a claim denied, you may be eligible to file an ERISA complaint.
The ERISA Claim Process
Your benefits plan should include specific information about the initial claim process. You generally do not need legal counsel during the initial claim. Some reasons to file an ERISA claim include:
- Retirement benefits have been unjustly denied;
- You have received a denial of claimed health benefits;
- Your employer has not complied with ERISA disclosure requirements;
- You need to challenge a pension plan decision that will impact future benefits;
- You want to clarify your rights to future benefits; and
- A fiduciary has inadequately managed your pension plan.
After submission, the claim can take anywhere from one to four months to be reviewed in its entirety.
Appealing Your ERISA Claim
The appeal process is the most important step to obtain the benefits you are entitled to. If your claim is denied, this is the last opportunity for you to submit substantial supporting documentation about your claim.
At this point, you should consider hiring an ERISA attorney to review your claim and conduct a thorough investigation. You have only a limited amount of time to file the appeal or the opportunity will be lost.
There are two purposes for appealing a decision. This first is to provide enough evidence that the denial is rescinded. The second is to gather information and establish a record that will carry over if you have to file an ERISA complaint.
Filing an ERISA Complaint Lawsuit
An ERISA complaint lawsuit can be initiated only once the appeal is denied. If you have not already hired an experienced ERISA attorney, you should do so before pursuing additional legal action.
District Court vs Federal Court
ERISA Section 502(e)(2) provides that legal action filed under ERISA may be brought in the district in which the plan is administered, where the breach took place, or where the defendant resides.
The plan may also specify the federal court or venue that the lawsuit must be filed in. This specification may also be listed in the correspondence for your claim denial or appeal.
The case will usually require filing an ERISA complaint and summons in the United States District Court. The defendant has 21-41 days to file an answer or counterclaim.
Each district court has a different method of handling ERISA cases. In South Carolina, there is no traditional trial for ERISA cases. Mediation is often the first option before asking the court to make a decision.
If mediation is unsuccessful, the court generally decides these cases based on the records presented and attorney briefs in support of their party’s position. This is why the appeals process and information gathering are so important.
Under ERISA, a successful ruling from the court or settlement in mediation will allow recovery of back benefits that are due. This may include reimbursement of attorney fees. Pain, suffering, and other non-economic compensation are not available in ERISA cases.
Filing an ERISA Complaint with EBSA
The Employee Benefits Security Administration is responsible for the enforcement of ERISA and compliance guidance.
As an ERISA employee, you may file an ERISA complaint with the EBSA, which may spark an investigation into your case. If an investigation does occur, the EBSA will follow up with a closing letter with recommendations that may include:
- A referral for litigation;
- A finding that corrections are needed but no formal action is necessary;
- A recommendation that the employer comply; or
- A statement that the EBSA has no findings to report.
Benefit advisors handle EBSA complaints. Valid complaints may be resolved without a formal investigation, depending on the circumstances of the case. Filing an ERISA complaint with EBSA can be done via phone or mail. You will need to have the following information available:
- Your contact information,
- An explanation of your problem,
- Evidence that you filed a claim for benefits,
- The contact information for your employer or a plan administrator,
- Employment dates, and
- Policy and other identifying numbers.
The EBSA may take up to 180 days to respond to requests for interpretations of rulings, and all advice and opinions are to serve the purpose of facilitating ERISA compliance.
Should You Hire an ERISA Attorney?
Though you may be able to handle the initial benefits claim on your own, once the claim is denied, you should seek the help of experienced legal counsel.
Negotiations with employers and insurance companies can become complicated quickly. Timing is important. The details of your claim are crucial. You need an advocate who understands the nuances of ERISA and will fight for the compensation you are entitled to.
The Peace Law Firm specializes in helping South Carolina employees find the relief they deserve. We understand that each case is unique and have successfully appealed numerous benefit denials. Contact us today for your free case consultation.