Enacted in the mid-1970s, the Employee Retirement Income Security Act (ERISA) provides employees with various pension, insurance, and disability protections. It also requires employers to fairly administer the benefits they provide and employers who attempt to violate ERISA will have to face various punishments.
If you recently had a claim denied, you may be worried about your lack of insurance benefits will prevent you from maintaining your standard of living. This is understandable, but by working with a skilled Dallas ERISA lawyer, you may be able to get the benefits you deserve.
ERISA requires employers that provide their employees with pensions, health insurance, retirement, and disability benefits to adhere to certain regulations. According to ERISA, companies must provide their employees with important plan information and directions for using those plans. ERISA also allows workers to file suit against employers who attempt to withhold benefits or breach their fiduciary duties. Companies can generally be held responsible legally if they engage in any of the following prohibited actions:
If a plan beneficiary believes their employer engaged in any of the actions listed above, they have a right to file suit or take advantage of administrative remedies. They also have the right to file a complaint with the Employee Benefits Security Administration (EBSA).
As mentioned above, ERISA requires companies to behave in a certain manner in regards to the benefits they offer their employees. When a person files a health insurance, disability, or any other type of claim, the company has 90 days to tell the claimant if their benefits have been approved or denied. If the claim is denied, they must tell the beneficiary they have the right to a fair review and to file an appeal.
They must also include detailed steps for filing an appeal and inform the beneficiary they have at least 60 days to file their appeal. If a beneficiary elects to appeal, the company must provide a decision within 120 days. If the beneficiary still believes they are entitled to benefits, they do have a right to file suit. The appeals process can be confusing, but an experienced Dallas ERISA lawyer can be an effective guide.
Sometimes filing an appeal is necessary. Insurers and employers often attempt to deny workers benefits for absurd or obscure reasons and without extensive legal knowledge, it is simply impossible for employees to fight back. However, an experienced attorney may be able to help employees by finding flaws in the argument of the plan provider, bolstering the claim of the worker with testimony and opinions from doctors, nurses, and other medical professionals, and evaluating the criteria the policy-carrier uses to approve or deny claims.
An attorney can work with employees to level the playing field and hold policy-carriers accountable. Reach out to a Dallas ERISA lawyer today for additional information.
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