If you have been denied benefits that you were entitled to under the Employee Retirement Income Security Act of 1974 (ERISA) you may have options to find relief.
The first step following a benefits claim denial is to file an appeal, followed by the option for filing an ERISA complaint in court. This process can be complex, but it’s often worth the effort.
Filing ERISA Complaint Topics Discussed Here hideERISA governs the minimum standards for employer-offered benefit programs and exists to ensure that employees receive the benefits they are dependent upon. Qualified plans are any plan that requires contributions by the employer or salary deductions from the employee.
Non-qualified plans that still fall under ERISA regulation include bonus plans and tax-deferred compensation. Some of the benefits that the ERISA may cover include:
Your employer is required to provide participants with information about the plan, including features and funding. If you are owed any of these benefits according to your benefits plan and have had a claim denied, you may be eligible to file an ERISA complaint.
Your benefits plan should include specific information about the initial claim process. You generally do not need legal counsel during the initial claim. Some reasons to file an ERISA claim include:
After submission, the claim can take anywhere from one to four months to be reviewed in its entirety.
The appeal process is the most important step to obtain the benefits you are entitled to. If your claim is denied, this is the last opportunity for you to submit substantial supporting documentation about your claim.
At this point, you should consider hiring an ERISA attorney to review your claim and conduct a thorough investigation. You have only a limited amount of time to file the appeal or the opportunity will be lost.
There are two purposes for appealing a decision. This first is to provide enough evidence that the denial is rescinded. The second is to gather information and establish a record that will carry over if you have to file an ERISA complaint.
An ERISA complaint lawsuit can be initiated only once the appeal is denied. If you have not already hired an experienced ERISA attorney, you should do so before pursuing additional legal action.
ERISA Section 502(e)(2) provides that legal action filed under ERISA may be brought in the district in which the plan is administered, where the breach took place, or where the defendant resides.
The plan may also specify the federal court or venue that the lawsuit must be filed in. This specification may also be listed in the correspondence for your claim denial or appeal.
The case will usually require filing an ERISA complaint and summons in the United States District Court. The defendant has 21-41 days to file an answer or counterclaim.
Each district court has a different method of handling ERISA cases. In South Carolina, there is no traditional trial for ERISA cases. Mediation is often the first option before asking the court to make a decision.
If mediation is unsuccessful, the court generally decides these cases based on the records presented and attorney briefs in support of their party’s position. This is why the appeals process and information gathering are so important.
Under ERISA, a successful ruling from the court or settlement in mediation will allow recovery of back benefits that are due. This may include reimbursement of attorney fees. Pain, suffering, and other non-economic compensation are not available in ERISA cases.
The Employee Benefits Security Administration is responsible for the enforcement of ERISA and compliance guidance.
As an ERISA employee, you may file an ERISA complaint with the EBSA, which may spark an investigation into your case. If an investigation does occur, the EBSA will follow up with a closing letter with recommendations that may include:
Benefit advisors handle EBSA complaints. Valid complaints may be resolved without a formal investigation, depending on the circumstances of the case. Filing an ERISA complaint with EBSA can be done via phone or mail. You will need to have the following information available:
The EBSA may take up to 180 days to respond to requests for interpretations of rulings, and all advice and opinions are to serve the purpose of facilitating ERISA compliance.
Though you may be able to handle the initial benefits claim on your own, once the claim is denied, you should seek the help of experienced legal counsel.
Negotiations with employers and insurance companies can become complicated quickly. Timing is important. The details of your claim are crucial. You need an advocate who understands the nuances of ERISA and will fight for the compensation you are entitled to.
The Peace Law Firm specializes in helping South Carolina employees find the relief they deserve. We understand that each case is unique and have successfully appealed numerous benefit denials. Contact us or call today for your free case consultation: (864) 485-6970
Who can file an ERISA complaint?If you are owed any benefits according to your employer's benefits plan and have had a claim denied, you may be eligible to file an ERISA complaint.
How do I appeal my ERISA claim?At this point, you should consider hiring an ERISA attorney to review your claim and conduct a thorough investigation. You have only a limited amount of time to file the appeal or the opportunity will be lost.
John Robert Peace, the founder of Peace Law Firm in Greenville, South Carolina, is a distinguished attorney with a rich educational and professional background. He earned his Juris Doctor from the University of South Carolina Law School in 1998, building upon a solid foundation with a Master's in Business Administration (1992) and a Bachelor of Science in Business Administration, majoring in Economics and Finance. Before law school, John honed his skills at Liberty Life Insurance Company, achieving the Fellow of the Life Management Institute designation in 1995. Since 2005, John has been an active member of the Board of Governors for the S.C. Association for Justice, providing expert advice in Group Benefits cases and ERISA and Insurance Issues for over 15 years.
