ERISA serves as a double-edged sword for employees who have employer-provided benefit programs. This is because, while ERISA provides a baseline for the terms and administration of these insurance programs, it also complicates the process for appealing any decision made by these program providers.
While most insurance programs purchased by individual citizens are simple contracts that Georgia courts have the power to enforce, ERISA-governed plans require the policyholder to first exhaust all insurance company appeals processes before asking a court to intervene. An Atlanta ERISA lawyer could help you better understand ERISA and how it interacts with your benefit plans. By helping you fully understand how ERISA affects your insurance policies, a knowledgeable insurance attorney can help you make sure you are doing everything possible to get the coverage you deserve.
ERISA is an acronym for the Employee Retirement Security Income Act. Because it is a federal law, ERISA controls all employer-provided benefits in Atlanta and everywhere else in the country. While it was originally intended to regulate retirement programs provided by employers, it has expanded to cover all employer-provided insurance programs including:
ERISA provides a baseline for how the administrators of these plans must act and the minimum protections that these policies must provide. However, it also states that a court can only hear a dispute over these cases if the policyholder exhausts all company internal appeals processes. This can significantly lengthen the time needed to obtain a ruling. An Atlanta ERISA lawyer could help policyholders understand whether ERISA controls a plan and to take the necessary steps under the law.
At their core, insurance plans and benefit packages are contracts. In exchange for the payment of a premium, an insurance company agrees to pay out if certain conditions are met. These conditions can include the policyholder dying, the policyholder contracting an illness, or the policyholder retiring after working for a set number of years.
In a privately purchased insurance policy, the policyholder can ask a civil court in Atlanta to require the insurance company to honor the terms of the policy. These cases allege a simple breach of contract.
ERISA disputes are more complex. This is because ERISA requires insurers to create an internal appeals process to handle these disputes. Sadly, these internal appeals processes are rarely beneficial to the policyholder since the same people who made the initial denial are likely to rule on the appeal.
These disputes can only go to an Atlanta court once the policyholder exhausts all possible appeals. This can take weeks if not months. Still, pursuing these appeals in a proper and timely manner could be the only way forward and an Atlanta ERISA lawyer could help with this process.
Few things are as frustrating as receiving a denial on an employer-provided benefit plan when difficulty or tragedy strikes. Many people rely on these plans in case of an illness, injury, or retirement. Sadly, insurance disputes over the scope and applicability of plans are common and a major source of breach of contract cases in civil courts.
However, if the plan in dispute is provided by an employer, ERISA laws control when a dispute can enter a courthouse. All policyholders who appeal a denial must fully exhaust all company appeals processes before filing a lawsuit. An Atlanta ERISA lawyer could help you understand this dynamic and to take the steps necessary to provide relief. To understand your options, call today.
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