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ERISA • Employment Law

What Is an ERISA Claim?

03 Jul 2021

Even among attorneys, ERISA is often misunderstood. There are few who can claim to really understand this complex and very-detailed law. As an employee, what you need to know is that this statute gives you the right to sue an employer.

Simply stated, ERISA exists to protect all of your employee benefits. However, the process that you need to follow when your benefits are denied is somewhat different from the traditional denial of an insurance claim. In some ways, the ERISA process is more direct, but it is also more complex, and you want the guidance of a Pennsylvania ERISA attorney.

Other Insurance Denials Mean an Immediate Lawsuit

When a regular insurance claim is denied, you will proceed directly to a lawsuit against the company. In this court action, you would have a pretty robust discovery process that would shine the spotlight on the insurance company. You can even question their witnesses. Essentially, you are taking on the insurance company in front of the judge. You have the full right to call as many witnesses as you need.

ERISA Requires an Administrative Appeal

The ERISA claims process introduces another step into the process. When your ERISA claim is denied, you need to file an appeal with the insurance company first. Here, you are trying to persuade the insurance company that they made a mistake in denying your claim. You must put on your full case because that will be the record that a judge will use to make a decision later on if you need to file suit. Anything that is not on the record as part of your appeal to the insurance company will not be considered by a judge when they review the decision. 

It is only after the administrative appeal that you can take the case to court. The time to get an attorney is when your claim is denied. You need legal representation during the appeal process to put on as strong a case as possible, even if there is not much of a chance of the insurance company reversing their decision. 

There is little denying that ERISA gives some built-in advantages to the insurance company, and they do not have the possible punishment of being sued for bad faith. This is why you need an attorney representing you in the process. 

The good news is that ERISA imposes a whole set of standards that insurance companies must follow in deciding your claim. The law plus an attorney who knows how to hold the insurance company’s feet to the fire could ensure that you have your say if your claim is denied. ERISA gives you a burden of proof to meet, but an attorney could help you put on the evidence that you need to ultimately get the payment to which you are legally entitled. 

Seek Legal Help from an ERISA Claims Attorney

For help with your ERISA claim, contact a Philadelphia long-term disability insurance attorney at The Garner Firm today. Contact us online to schedule your free initial consultation. The sooner you get legal counsel for your ERISA claim, the stronger of a message you can send to the insurance company. 

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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