El Paso ERISA Lawyer
The Employee Retirement Income Security Act often referred to as ERISA, is a federal law passed by Congress in 1974. This legislation outlines specific rules and regulations for employers to follow in regards to employment benefits, as well as penalties for policy providers and insurance companies that fail to adhere to those regulations.
While following the rules outlined by ERISA is extremely important for employers, there are unfortunately still some companies and insurers that attempt to deny coverage to hardworking employees for no reason. There are even some who attempt to make unwise investments with the pensions of their employees.
This type of behavior is not only unfair, but illegal as well, and any company that behaves in this manner should be held liable for it. If you suffer mistreatment like this related to your ERISA-governed policy, get in touch with an El Paso ERISA lawyer to review your legal options. A determined ERISA attorney could advocate for you.
The Basics of ERISA
Employees who offer retirement, health insurance, and/or disability benefits are required to follow ERISA regulations and rules. According to these regulations, employers must provide their employees with an adequate amount of information about their insurance plans and benefits, or they can be held legally accountable for not doing so.
Employers also cannot deny benefits for no reason, breach their fiduciary duties, or change insurance benefits without notifying their employees. They must manage the pension and retirement funds of their employees responsibly, and their investment decisions should never be based solely on these plans.
If an employee suspects their employer is engaging in any of the acts listed above, they should contact the Employee Benefits Security Administration (EBSA). They may do so anonymously if they wish, or through an El Paso ERISA attorney.
Insurance Company Obligations
ERISA also requires third-party insurance companies contracted by employers to process claims in a timely manner and provide detailed information about submitted claims to claimants. They must adhere to the following regulations when processing claims:
- Insurance companies have 90 days to approve or deny claims related to disability, health, or life insurance
- If a claim is denied, the insurance company must provide the claimant with a reason for the denial and instructions for filing an appeal by within 60 days
- If a claimant elects to file an appeal, the insurer must issue a decision within 120 days
Beneficiaries also have a right to file an appeal if they do not agree with the decision of an insurance company.
What Happens When a Claim is Denied?
Insurance companies must consider a variety of factors when deciding to deny or approve a policyholder’s claim. Whether a claimant followed the proper steps when filing their claim can be very important, since insurance companies have the right to deny a claim if a claimant misses even a single one.
Claimants may also be asked to submit additional documentation from medical professionals such as physicians, therapists, and other healthcare practitioners. Unfortunately, even when a person submits additional documentation to bolder their claim, they can still be denied coverage.
When a person is denied coverage for no reason, they may be forced to return to work before they are fully healed. They may also have to use their own funds to pay for their expenses. Any employee who has their claim denied for no apparent reason should contact an ERISA lawyer in El Paso to see what options they might have to contest that decision.
Contacting an El Paso ERISA Attorney
The Employee Retirement Income Security Act was drafted in 1974 to protect honest and hardworking employees from dishonest employers and insurers. ERISA ensures employees have the opportunity to file an appeal if they do not agree with an insurer’s denial of their claim.
If you believe your insurer denied your insurance claim for no reason or your employer is not managing your pension or retirement funds properly, you have a right to take legal action. Reach out to an El Paso ERISA lawyer today for more information.