What is an ERISA Claim?

Reasons You Can Bring an ERISA Claim

Book about ERISA claims with money and a calculator

There are many claims that you can bring under the ERISA statute. Congress wanted to give the law teeth, so you might be able to bring a claim for the following reasons:

  • You want to enforce the terms of your plan after being unfairly denied benefits
  • You want to remedy a breach of fiduciary duties, which are duties the plan owes to plan participants and beneficiaries
  • You want to remedy any interference with your exercise of your ERISA rights

Type of ERISA Claims

There are many types of claims you can bring. Consider the following examples, which is not exhaustive:

  • An employee has a long-term disability plan which provides benefits if she is totally disabled. After suffering a serious fall at work, the employee struggles with a traumatic brain injury and other impairments. She submits a claim for disability benefits. However, the plan denies her claim, citing that she is not totally disabled based upon their review of the medical evidence. Because the employee wants to enforce the terms of her plan, she can bring a lawsuit.
  • An employee falls sick and goes to the doctor. The doctor performs several tests and decides that the employee needs to have surgery to address her condition. Her group health insurance plan will cover any medically necessary surgery, but to submit a claim she needs to pay a $100 filing fee with the insurance company. The employee believes this fee is hampering her ability to obtain benefits, so she sues to prevent having to pay for it.
  • An employee signs up for a life insurance policy. The plan administrator makes oral misrepresentations that the plan is worth much more than is stated on the plan document. The employee relies on these misrepresentations and signs up, only to realize later that the plan pays out far fewer benefits than he expected. In this situation, the plan administrator might have breached their fiduciary duty of honesty. The employee can often sue.
  • An employee has a 401k account. She is looking over the fees that she is charged and is surprised by how high they are. She suspects that the fees being charged are not reasonable or necessary, and she wants to challenge them. She might be able to bring a fiduciary claim against the plan.

Bringing an ERISA Claim

By bringing these lawsuits, employees are enforcing their rights under the benefit plans. They are also making sure that plan administrators and others are being prudent and honest in how they administer plans. ERISA allows plan participants and beneficiaries to get into federal court to bring these claims, otherwise they would have been stuck in state court with laws that do not provide the breadth of protection as ERISA does.

It is not always clear whether you have a valid ERISA claim. Rather than guess, or (even worse) simply assume that the law is too complicated to pursue, you can meet with a seasoned ERISA attorney to go over your complaints. You might find that other plan participants have similar complaints and that a lawsuit might be an effective way of changing the plan’s behavior.

If you need help with your ERISA claim, contact us today