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ERISA • Employment Law

Understanding the ERISA Claim Process

07 Jul 2020

When you or a loved one need to file a claim with your insurance providers, such as a disability or life insurance claim, you may come across a law known as ERISA. The Employee Retirement Income Security Act of 1974, or ERISA for short, is a federal law that sets forth requirements for a majority of employer-backed benefit plans throughout the country. ERISA claims can be complex, as larger insurance companies have spent the past few decades developing strategies that help them process claims in their own favor. If you’re new to the ERISA claims process, or your claim has been denied, you might not be sure what to do next. New Jersey ERISA attorney Adam Garner has helped many people navigate the claims process and can offer guidance on what to expect.

ERISA Benefit Claims

Under ERISA benefits law, some valid claims may include:

  • 401(k) benefits
  • Long-term disability (LTD) benefits
  • Pension benefits
  • Short-term disability (STD) benefits
  • Life insurance benefits
  • Accidental death and dismemberment (AD&D) benefits
  • Health insurance benefits
  • Other employee benefits

The Garner Firm, Ltd. represents employees, former employees, executives, plan participants, and their beneficiaries in all aspects of ERISA law and the aforementioned types of claims. 

How the ERISA Claim Process Works

The initial process for filing a claim will be determined by your insurance provider or the plan’s claim fiduciary. Just as there are regulations that insurers and other plan administrators must follow to comply with ERISA, beneficiaries must also follow the claims procedures required by their insurer. Failing to do so can reduce your ability to successfully obtain benefits.

Plan participants and their named beneficiaries are owed a full review of any claim for benefits. However, this does not always occur, which is one of many reasons why claimants might seek the help of an experienced ERISA lawyer. Having someone on your side who deeply understands ERISA regulations can help, as the same people who are reviewing your claim for benefits are often the same ones who pay the claims. This creates a conflict of interest and an incentive for them to deny your claim since it benefits their bottom line.

What to Do if Your ERISA Claim is Denied

If your benefits are denied, you must take specific steps to start the appeals process and ensure your rights are protected. If you do not handle it correctly, your appeal could be denied. That means you will have a hard time challenging the ruling in court, or you may even be barred from doing so.

Your appeal has to be filed quickly, as you only have 60-180 days at most, depending on the type of benefit claim. Failure to take action until after the deadline means your case could be dismissed automatically.

Sadly, you cannot rely on your employer to help with your ERISA claim or the subsequent appeal. When you work with a knowledgeable ERISA lawyer, you get the benefit of skilled representation from an attorney who has extensive experience handling these types of claims.

Let an Experienced ERISA Benefits Lawyer Help

At The Garner Firm, Ltd., our ERISA lawyers work to develop a unique strategy to help improve your chances of prevailing. No two situations or claims are identical, which is why we develop an individualized plan. If required, we can also work with you through the appeals process and help you pursue payment through the court.

If you need assistance with ERISA benefits, our New Jersey ERISA benefits attorney can help. Call The Garner Firm, Ltd., or contact us online today to schedule an initial consultation and free, no-obligation review of your ERISA claim.

Experienced Counsel

Mr. Garner is an ERISA employee benefits and employment attorney with over a decade of experience. The laws governing employee benefits, the employment relationship, and the workplace are complex.

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