What Does an ERISA Attorney Do?
Have your ERISA benefits been denied or underpaid? Read on to understand the circumstances under which it might be in your best interest to consult with a qualified ERISA attorney about your claim. Contact ERISA attorney John Peace to schedule a free, fully confidential review of your case: (864) 485-6970
The Employee Retirement Income Security Act (ERISA) is a federal law that regulates many insurance plans and group welfare plans that are offered by private industry employers in the United States.
While the name suggests it’s rather limited in scope, ERISA actually covers many different types of benefits, such as retirement plans, severance plans, disability plans, health coverage, and 401(k).
ERISA is a federal law that is said to “supersede” state law. The practical implication of this characteristic is that if your benefit plan comes through your employer, it is highly likely that ERISA covers it.
Generally, the only exceptions to this rule are insurance plans offered through government agencies or church organizations, or individual disability insurance plans purchased outside of employer group plans.
ERISA offers many protections for participants and beneficiaries. It provides for mandatory disclosures and claims procedures that the employers’ benefit plans must follow. It mandates how a private employer must fund and manage your benefits.
It guarantees employee benefits even if the employer declares bankruptcy. It also grants participants and beneficiaries the right to bring a civil suit in federal court if the plan administrator fails to carry out their duties.
Additionally, ERISA provides a means to recover attorneys’ fees and litigation costs for successful cases.
However, while ERISA offers some very important legal protections for beneficiaries (workers and their family members), the law also stacks the deck in favor of the insurance companies. ERISA law has short deadlines and many technical rules that apply to the evidence in your case.
Unfortunately, in practice, many claimants have a hard time getting the full and fair ERISA benefits that they deserve.
If your benefits were denied or underpaid, you should reach out to an experienced ERISA claims attorney for help.
What Does an ERISA Disability Lawyer Do?
ERISA regulations are complex and challenging to understand. They do not offer much in the way of flexibility, and there is not much room for error.
It is imperative that your claim and appeal follow your summary plan description to the letter. Most attorneys tend to focus their practice on one or two general areas of law.
They do this because it’s a lot easier to understand a legal matter if you do a lot of work in that area. Of course, this makes perfect sense. We become better when we have more experience doing something. This is especially true of ERISA claims.
Not every attorney is qualified to handle ERISA claims. Claims arising from non-ERISA disability plans are handled in a completely different manner than ERISA claims.
These claims demand a high level of experience and a lot of time and effort. Someone dealing with a disability likely does not have the time or resources to parse the complicated regulations and deal with the insurance company.
The job of your ERISA disability attorney is to do this for you. Your ERISA attorney will stand up for you against the insurance company and protect your rights. They will protect you from being intimidated or forced to give up your benefits.
Your ERISA attorney can handle all aspects of your ERISA claim, whether you have not yet filed or you are appealing a denial. ERISA plans and insurers must be fair and objective in how they treat claims. An ERISA disability lawyer can review the claim file for any indication of bias or arbitrary treatment of your claim.
Your attorney will collect evidence, such as medical records and witness statements to support your claim or appeal. That includes working with your medical provider to put together a solid write-up to rebut your insurer’s arguments.
It is essential that your case is well-supported by documentary evidence. If you must go to trial, the federal judge likely will decide the outcome of your case based upon the documents that are already part of your claim and appeal.
Your attorney will represent you in communications with your plan administrator and put your appeal together. They will ensure that you have no weak spots in your administrative record and that you meet all of the necessary deadlines for your claim.
They will represent you in any mediations or settlement conferences with the insurance company. Your attorney will ensure that you get the best possible outcome for your situation. This includes filing any and all motions and litigating in court if necessary.
When to Hire an ERISA Lawyer
ERISA lawyers handle a wide range of different cases in which plan participants/beneficiaries are denied the full and fair benefits that were earned.
Specifically, you should hire an ERISA attorney if you find yourself facing any of the following scenarios:
- A plan administrator breached its fiduciary duty to the participants and the beneficiaries;
- Major investment losses were suffered in a pension/retirement plan;
- Your employer offered you a severance, and you worry that it might jeopardize other rights;
- Your ERISA disability claim was denied;
- You need a Qualified Domestic Relations Order (QDRO) in order to exercise your right to your ex-spouse’s retirement benefits;
- You submitted a QDRO for approval, but the insurer wrongly interpreted it;
- Your ERISA life insurance claim was denied;
- Your plan administrator incorrectly calculated your benefits;
- Your long-term care claim was denied; or
- You do not understand your rights under your plan.
Finally, if for any other reason, you believe that you were wrongly denied employee benefits or that you were offered less than you rightfully deserve, it is essential that you seek professional legal guidance as soon as possible.
You have a limited amount of time—180 days—to file appeals of claim denials. It is crucial that you act as quickly as possible to ensure that you have the best chance of success.
How ERISA Attorney John Peace Will Protect Your Rights
The ERISA claims process is highly technical and exceptionally complex.
You do not want to go up against the large insurance companies on your own. Insurance companies are businesses whose primary interest is their own bottom line. They do not want to pay out on claims, and their attorneys’ whole job is to ensure they retain as much profit as possible.
Insurers have a comprehensive understanding of ERISA rules and regulations — they have developed a range of strategies to protect their own profits and interests.
At the Peace Law Firm, our experienced South Carolina ERISA attorney is ready to protect your rights. Among other things, we are prepared to:
- Conduct a free, strictly confidential assessment of your ERISA case;
- Answer your questions and address your concerns;
- Conduct an in-depth investigation — obtaining additional evidence; and
- Take action to file an administrative appeal or an ERISA lawsuit.
With ERISA cases, there are strict deadlines, specialized evidentiary rules, and unique appeal procedures. It is crucial that you hire a top ERISA attorney who knows exactly how the law works in practice.
Our law firm will make sure that your claim is handled properly. We will protect your legal rights and financial interests at every stage of the claims process.
Get Immediate Help From ERISA Lawyer John Peace
At the Peace Law Firm, we have deep experience handling the full range of ERISA claims. Employers and insurance companies must be held accountable. We will fight for you every step of the way, and we are not afraid to litigate your case in court if necessary.
If you or your loved one is struggling to recover the full and fair ERISA benefits that you deserve, please do not hesitate to contact us today to get a free, confidential consultation or call (864) 485-6970
With an office in Greenville, SC, we handle ERISA claims throughout North Carolina and South Carolina.
ERISA Claim FAQ
You can find many answers about ERISA plans on the Department of Labor website. Your ERISA attorney can answer any other questions you might have about ERISA or your particular situation.
When Should I Hire an ERISA Attorney?
If your ERISA disability or life insurance claim was denied, it's a good idea to contact a lawyer. You should also reach out to an attorney if major losses were suffered to your long-term retirement plan. If you aren't sure whether or not you have a case, seek a free consultation.
Will an ERISA Lawyer Provide a Free Consultation?
At the Peace Law Firm, we offer free ERISA claim case reviews. During this consultation, attorney John Peace will examine the facts of your denial or issue and provide feedback for the best course of action.
How Can I Make a Claim for Benefits?
The law requires that all plans have a written procedure that details how your insurer must process claims and appeals. You can find this information in the Summary Plan Description (SPD). In a nutshell, once you file your claim, the plan administrator has up to 90 days to make a decision.
If they deny your claim, you have 60 days to request a review via your plan’s appeals procedure. Your administrator then has 60 days to review your appeal and decide whether to approve or deny your appeal. All of the administrator’s decisions must be detailed in writing, including their reasoning.
Can I Appeal a Denial without an ERISA Attorney?
You probably can, but it's not recommended. The fact is, insurance companies have endless budgets and attorneys of their own. An ERISA lawyer will best know how to negotiate with the insurance company and effectively defend your claim.
Who Decides ERISA Litigation?
If you must take your claim to trial, you will not have the right to a jury. There is only a federal judge to decide the final outcome of your claim. And the judge does not have much leeway to make their decision.
They can only decide if the insurance company acted reasonably in denying your claim. If there is any reasonable basis to uphold their decision, the judge must leave it alone.
Can I Submit New Evidence?
Generally, no. If the insurance company did not get to assess your evidence before their final denial, the judge likely will not be able to either. This is why it is so important to have a well-supported case before it gets to the point of a trial.