ERISA is a federal law that governs all claims for benefits from an “employee welfare benefit plan.” An employee welfare benefit plan is defined as ” any plan, fund, or program . . . established or maintained by an employer or by an employee organization” which provides employee benefits such as life, health or disability. 29 U.S.C. § 1002(1). As such, if your right to benefits was through a plan established by an employer or an employee organization (e.g., a labor union), then it is preempted by ERISA.
In most cases, when the employer buys life insurance for its employees, it is provided through an insurance company. If there is a plan and the plan was “established or maintained” by the employer (or employee organization), it is probably covered by ERISA. There are two exceptions to ERISA coverage:
- Plans sponsored by churches and church-related entities are not covered by ERISA, unless an election is made to have ERISA coverage.
- Plans established or maintained by government entities for their employees, or plans which are maintained solely to comply with workers’ compensation, unemployment, or disability laws are not covered by ERISA.
How Do I Know If My Benefit Plan is Controlled By ERISA?
If your Employer is engaged in any of the following activities, a Court will likely find that the employer “established or maintained” the Plan, mandating ERISA coverage.
- The employer is paying all or even part of the policy premiums;
- The employer is urging employees to join the plan;
- The employer is retaining some of the deducted premium to administer the plan;
- The employer is keeping track of who is in the plan;
- The employer is answering questions for the plan members about their coverage.
Has Your ERISA Claim Been Denied? We Will File An Appeal For You!
At Kadetskaya Law Firm, we handle various ERISA claim denials, including:
- Denial based on change in marital status
- Denial based on exclusions
- Denial based on employer non-payment of premium
- Denial based on failure to apply for waiver of premium
- Denial based on failure to provide insurability form
- Denial based on employer’s mistake
In most ERISA cases, an administrative appeal is a necessary step before the claim proceeds to court. If you decide to sue your insurance company without first exhausting administrative remedies, your court action may be barred. Therefore, you need to consult an experienced ERISA attorney who will file an appeal on your behalf.
Why Do I Need An Attorney?
ERISA allows for only one appeal. The deadline is usually 60 days from the date of the denial letter. It means that a beneficiary whose claim has been wrongfully denied has only sixty days to investigate the denial, draft an appeal, prepare supporting documents and submit the appeal before the deadline. Unfortunately, an appeal prepared without a legal brief is rarely winning. A beneficiary who lost a loved one may still be going through a grieving process and may not have the strength to review complex life insurance policies and perform a thorough investigation in order to submit a comprehensive brief. Further, an appeal based on the same set of documents is bound to be denied. When our life insurance attorney prepares an ERISA appeal, she drafts a legal brief based on ERISA law and the results of an independent investigation and research. This forces the insurance company to look at the case from a new perspective. At Kadetskaya Law Firm, we have a high success rate of recovering insurance proceeds on ERISA appeals and will make sure your ERISA appeal is handled professionally and competently.
No Legal Fees Unless We Win Your Case!
Our attorneys work on a contingent fee basis. It means that we do not charge legal fees unless we collect the life insurance proceeds for you. Only then will we charge a reasonable legal fee. We take pride in offering competitive contingent fee structures and will work with you to ensure you are comfortable with the fee. If your claim has been denied or delayed, call our life insurance lawyers for help. We have the experience you can trust.