Benefits Denial

 

The Employee Retirement Income Security Act (ERISA) applies to most cases where an employer (or an insurance company) has refused to pay benefits to an employee under a short or long term disability insurance policy or severance pay program. ERISA also applies when an employee’s pension benefits are unfairly denied or reduced.

 

ERISA claims include an administrative appeal process which requires the employee to first ask for review of the denial decision by the “administrator” of the particular plan or program. Because these administrators are often the same person or group that denied the benefits in the first place, employees sometimes do not take these appeal seriously. However, the administrative appeal is critical to a successful ERISA claim because the court in the subsequent lawsuit can generally only look at materials that were previously reviewed in the appeal, and not any additional documents or facts.

 

ERISA long term disability insurance claims, where the employer (or insurance company) has denied or discontinued benefits under a long term disability insurance policy are commonly filed ERISA lawsuits. These types of claims are common because the insurance company has the right to regularly require proof of the ongoing disability and can use that process as an excuse to discontinue benefits.