South Carolina ERISA Litigation Lawyer
If you recently received a claim denial for benefits you should receive from an employer-sponsored plan, you may have grounds to file an ERISA lawsuit. Congress passed the Employee Retirement Income Security Act (ERISA) in 1974 to standardize employer-sponsored benefit plans, such as retirement and health benefits to private-sector employees. ERISA does not generally cover benefit plans offered by government and religious organizations.
Over the years ERISA has been updated several times to clarify the minimum standards private-sector businesses must follow when setting up and administering insurance and benefit plans. These updates also protect employees’ rights and remedies under these plans. ERISA litigation can involve things like denied claims for health insurance, denied claims for long- or short-term disability, and 401(k) disbursement issues.
ERISA matters are complex and bring unique challenges. If you have an ERISA claim, you need legal counsel that is knowledgeable and well-versed in this area of law because all ERISA cases must be litigated in federal, not state, court.
John Peace is an experienced ERISA litigation lawyer in Greenville, South Carolina, who is passionate about representing real people not employers, insurance companies, or group benefit plans—to recover their rightful benefits. Call a trusted, local ERISA litigation lawyer for a free assessment of your rights and remedies.
ERISA Requirements
ERISA requires employers to notify plan participants, which include employees and beneficiaries receiving plan benefits, about certain information regarding plan eligibility, enrollment, plan modification, and participants rights under the plan. Common notices you may be familiar with include:
- Summary plan description detailing the benefits and how the plan works;
- Summary of material modification explaining changes to the benefits plan;
- COBRA insurance notices for benefits available after an employee leaves an employer;
- Periodic pension benefit statements; and
- Investment fee disclosures for retirement plans, such as a 401(k).
Employer-sponsored plans must comply with ERISA’s minimum standards for recordkeeping, fiduciary compliance, annual filing, and reporting requirements, among other things. For example, employers who offer a retirement plan must tell employees:
- When they are eligible to participate in the plan;
- How long it will take them to vest if the employer contributes to their plan;
- The length of time they can be away from their job without losing the benefit; and
- If the benefit passes to the employee’s spouse in the event of their death.
Importantly, under ERISA any person or business who administers, manages, and controls plan assets must comply with fiduciary responsibilities. These people and businesses must administer the plan in the best interest of the participants and beneficiaries, which includes paying out benefits and managing the plan’s administrative expenses. If a plan administrator violates their fiduciary duties, it can result in exposure to ERISA litigation, department of labor violations, and IRS penalties.
ERISA Violations and Litigation
Three common ERISA violations include:
- Breach of fiduciary duty, such as inconsistent account statements or excessive administrative fees;
- Improper denial of benefits to current and former employees; and
- Interference with employees’ rights, such as failing to provide plan notices and information.
Employees can bring civil actions for ERISA violations. But these actions are brought differently from most other disputes because ERISA has an exclusive set of remedies. However, because ERISA is a federal law, any claim relating to ERISA violations will most likely be pursued in a federal court.
John Robert Peace, PA has decades of experience litigating ERISA claims in federal courts and understands the different rules and procedures for ERISA claims. Reach out for knowledgeable advice on your potential ERISA claim.
Is ERISA Litigation Different from Traditional Litigation?
Yes, the ERISA litigation process is different from the state legal process for damages. One key difference is there are no jury trials for ERISA claims. Lawsuits for ERISA violations are typically argued through a process where both parties file motions to create an administrative record that generally consists of documents, information, and correspondence submitted and considered for the claim.
The court will review the administrative record and make a ruling. For instance, if the litigation is about the denial of benefits, the court will use the administrative record to determine whether the fiduciary’s decision to deny benefits was proper.
The process is restrictive and generally bars any discovery outside of the administrative record from being admissible.
Damages in ERISA Litigation
ERISA is designed with limited remedies. Claims under the act differ from traditional civil breach of contract, negligence, bad faith, or fraud claims under state law because employees are not allowed to receive noneconomic or punitive damages.
Generally, a plaintiff challenging a denial will be limited to recovering only the benefit amount due under the plan.
But at the court’s discretion, a successful plaintiff may be entitled to recover reasonable attorney fees and costs.Following the guidelines and complying with the necessary filing requirements can be easier said than done. That is why speaking with an experienced ERISA litigation attorney is imperative before proceeding with your claims.
ERISA Frequently Asked Questions
Who Can File an ERISA Claim?
If you are a plan participant or beneficiary, you have the right to file a claim. Plan administrators and managers, also known as fiduciaries, may also file ERISA litigation claims.
Who Do I Name in My ERISA Claim?
If you have been denied benefits through your plan, you can file a claim against the person or company that administers the benefit plan and the insurer that issued the plan, which is known as the claims administrator.
How Much Time Does the Plan Administrator Have to Review My Initial Claim?
ERISA requires plan administrators to provide an initial decision within 90 days of the claim being filed unless it is a disability claim, which must be decided within 45 days. For non-disability claims, ERISA allows the plan administrator a one-time extension of 90 days to provide the initial decision.
Disability claim decisions can be extended by 30 days no more than two times. In either case, the administrator must send a notice that explains why more time is needed and when the plan expects to reach a decision on your claim.
My Claim Was Denied, Can I File a Lawsuit Now?
No, if your initial benefit claim was denied, ERISA requires you to complete an appeal through the plan’s appeals process. This process should be explained in the summary plan description you received when you enrolled for the benefit.
No worries if you misplaced the summary; you can request another copy from the plan administrator. If the plan administrator still denies your claim after the first appeal is complete, you can usually proceed with ERISA litigation in federal court.
It is important to note that you can hire an experienced ERISA attorney to advise you on the plan’s appeal process. Insurance and benefit plans are extremely technical, and working with an attorney during the appeal can better prepare you if it turns out you need to file a lawsuit.
Can I File an ERISA Claim for Denied Benefits Under Medicare or Medicaid?
No, ERISA rules and procedures apply only to benefit plans that are offered by private-sector employers, which means employers not controlled by federal, state, or local governments. Claims for benefit denials by Medicare, Medicaid, or other government programs are governed by a different set of laws and procedures.
Does ERISA Cover Dental and Prescription Drug Plans?
Yes, the rules and procedures outlined in ERISA cover all employer-sponsored benefit plans that are offered to help employees to diagnose, cure, mitigate, treat, or prevent disease that impacts any part or function of a person’s body.
ERISA governs the claims process if you are denied benefits through a private-sector employer-sponsored prescription or dental plan.
Does ERISA Require My Employer to Provide Benefits?
No, ERISA does not require your employer to offer insurance or retirement benefits.
Recent Noteworthy ERISA Litigation
In 2022, the U.S. Supreme Court addressed an ERISA fiduciary duty dispute in Hughes v. Northwestern University. Petitioners alleged that plan fiduciaries breached their duty under ERISA by failing to monitor and control fees paid for record-keeping, offering more affordable investments, and offering too many investment options, causing “plan confusion.”
Initially, the U.S. Court of Appeals for the Seventh Circuit dismissed the petitioner’s complaint, reasoning that because plan participants ultimately had a choice over their investments, they could not complain about a few imprudent choices.
The Supreme Court found the Seventh Circuit erred in its finding and that the petitioners’ allegations rose to a plausible claim. It vacated the Seventh Circuit’s prior dismissal and remanded the case to the district court.
In its rationale, the Court reiterated the long-held standard that it is insufficient for a plan fiduciary to offer numerous investment options, of which some are prudent and some are not.
In other words, having the petitioners’ preferred type of investments available does not excuse the plan’s allegedly imprudent decisions. The plan fiduciary must prudently select and monitor every investment option.
Significantly, the Court did not explicitly address or clarify—as many had hoped—the requirements for a petitioner in an ERISA fiduciary duty case to survive a motion to dismiss.
South Carolina ERISA Litigation Lawyer
ERISA litigation can be complicated, intricate, and highly specialized. If you believe you have an ERISA claim for improperly denied benefits, breach of fiduciary duty, or interference with your rights, you would be wise to contact experienced ERISA legal counsel.
At John Robert Peace, PA, we have dedicated our practice to ERISA litigation and employee rights.For over 15 years, John Peace has been advising lawyers and non-lawyers on ERISA insurance issues and group benefits cases.
Don’t try to take on a claim by yourself. Let us use our skills and resources to handle it for you. Contact us today to schedule a convenient time for a consultation.