ERISA Is Complex. Don’t Give Up. We Can Help.


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Important Tips

Tip #6
Use privacy settings on your Social Media accounts and other online forums. Insurance companies monitor Facebook and other online accounts to and information about your activities. They use activity found there to argue you are not disabled and should be able to work. Avoid having to explain your posts by minimizing your use of Social Media and using privacy settings.

What is ERISA?

ERISA is the acronym for the “Employee Retirement Income Security Act of 1974.” It is a federal law that was enacted to protect participants in employee pension plans and other benefit plans offered by employers. ERISA covers employer-sponsored medical, disability, and other benefit programs. Under ERISA, plan participants and beneficiaries may seek relief for breaches of fiduciary responsibility, denial of benefits, or failure to provide adequate disclosures of plan terms or benefit changes.

Disability attorneys often think of ERISA as “Everything Rotten in Insurance Since Adam” because it has evolved over the decades to protect insurance companies much more than deserving claimants. Nothing is more heartbreaking than informing clients already enduring the stress of a disabling condition about the complexities of ERISA and how insurance companies truly operate.

ERISA has broad federal preemption, which means it replaces the consumer protections and remedies otherwise available to you under Arizona law. It is a complex federal statutory system that requires exceptional legal skills, medical knowledge and patience to successfully navigate. Don’t give up on benefits you rightfully deserve or let insurance companies mislead you into believing they are on your side. Their interest is always about their business.

Our highly experienced ERISA attorneys and staff know what it takes to get the STDI and LTDI benefits you deserve.

What You Need to Know About ERISA:

You are generally required to appeal before you can bring a lawsuit, and lawsuits under ERISA are largely limited to the evidence you provided on appeal. This is one reason why getting help as early as possible in the process is important. Even if your benefits were denied in bad faith, you have to appeal.

This is a key reason ERISA is rotten, because it requires you to appeal to the very entity that denied you in the first place. Even the strongest appeals are sometimes denied, because you are dealing with an insurance company that often has a financial conflict of interest to act against your best interests. This conflict exists when the insurance company is both paying your claim and making determinations about benefits. When this conflict exists, insurance companies will deny even valid claims, in the hopes claimants will get discouraged and abandon the process, thereby saving them money.

You generally do not have the right to a jury trial f you have to file a lawsuit. And, any lawsuit you bring is generally limited to the record you developed on appeal.

  • This discretion means that a federal judge reviewing your claim will use an “abuse of discretion” standard of review, giving deference to the insurance company’s decision and only overturning it if unreasonable. The analysis is complex, and having a skilled attorney is important to ensuring you get the most favorable standard of review possible.
  • Reasonableness is an easy standard for the insurance company to meet. Even if the insurance company’s denial is based on nothing more than a doctor conducting a paper review of your claim, in certain circumstances, that can be enough to defeat your claim. In ERISA, a federal judge does not have to defer to your treating providers’ opinions—they don’t even need to necessarily agree with the insurance company.

Rather than a jury of your peers reviewing the insurance company’s conduct, you only get a federal judge to review and make a decision, and their decision will be based solely on the evidence provided on appeal. You cannot submit new evidence to the judge, and you will not be able to testify about your medical conditions or any harm caused to you. Due to the importance the appeals process is to a potential lawsuit, it is imperative to consulting with an attorney focused exclusively on disability benefits law early on in an ERISA claim.

Rebuilding Justice.
One Case at a Time.

Winning a lawsuit is demanding due to the “standard of review” a judge will apply when considering the insurance company’s decision. The fact is a big insurance company knows it has a strong chance of winning a lawsuit you bring against them. This is in part because insurance companies often have “discretionary authority” to determine eligibility for disability benefits. This discretion means that a federal judge reviewing your claim will use an “abuse of discretion” standard of review, giving respect to the insurance company’s decision and only overturning it if unreasonable.

Reasonableness is an easy standard for the insurance company to meet. Even if the insurance company’s denial is based on nothing more than a doctor conducting a paper review of your claim. A federal judge could still uphold the denial as long as he or she finds that review to be “reasonable.” In ERISA, a federal judge does not have to defer to your treating providers’ opinions—they don’t even need to agree with the insurance company. Instead, he or she just has to find “any reasonable basis” for the insurance company’s decision.

Our ERISA lawyers know how to fight against their deference to the insurance company to establish a more favorable standard of review.

ERISA limits the relief you can hope to receive for the insurance company’s wrongdoing. There is no duty of good faith and fair dealing and no punitive damages. In most ERISA claims at litigation, the relief you will be able to secure is your past-due benefits with a remand to the insurance company for further claims handling. A court cannot accelerate future benefits to be paid immediately; instead, you have to continue to be “on claim” and meet the eligibility requirements under the policy. Without the prospect of punitive damages for its bad faith practices, insurance companies protected by ERISA have little incentive to pay valid claims.

In summary, ERISA has evolved over the decades to protect big business more than the disabled. A law meant to protect claimants sounds great, and insurance companies often try to present it to you this way, but the reality is that ERISA offers very little practical protection to those with disability benefits subject to the law.

DON’T GO AT IT ALONE AND DON’T GIVE UP ON BENEFITS YOU NEED AND DESERVE.

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