ERISA, which stands for the Employee Retirement Income Security Act, regulates the vast majority of employer-provided benefit plans in the private sector.
ERISA-covered benefit plans include short- and long-term disability insurance, health insurance, life insurance, retirement plans, and others.
The federal law provides protections for employees seeking benefits under ERISA-covered plans and imposes rules for fiduciaries.
Getting your ERISA-covered claim approved can be a complicated process, which is why it is essential to contact a Louisiana ERISA lawyer to seek guidance concerning your employer-sponsored benefit plan.
At J. Price McNamara ERISA Insurance Claim Attorney, our dedicated and results-driven firm has represented clients throughout Louisiana in different types of ERISA-related cases.
Our founding lawyer, J. Price McNamara, has provided residents of Louisiana with reliable and effective legal representation for several decades.
We commit to working on your ERISA case to ensure that your claim goes smoothly and help you at every stage of the claims and appeals process.
You have nothing to lose by calling now—we will evaluate your case for free, and since we typically work on contingency, if we cannot win your case, you won’t need to pay us anything.
What Benefit Plans Does ERISA Cover?
Most ERISA benefit plans provide long-term group disability insurance, life insurance, accidental death and dismemberment insurance benefits, and health insurance benefits for its employees.
29 U.S.C. § 1002 provides that the Employee Retirement Income Security Act (ERISA) governs employer-funded “employee welfare benefit plans” and “employee pension plans” in the private sector.
Under ERISA rules, employee welfare benefit plans refer to any plan or program that an employer sponsors to provide employees with:
- Medical and surgical benefits
- Hospital care
- Benefits for sickness and accidents
- Disability
- Death
- Vacation benefits
- Prepaid legal services
- Scholarship funds
- Holiday and severance pay
However, not all of these benefit plans may be subject to ERISA. It is essential to consult with a Louisiana ERISA lawyer to find which benefit plans are under ERISA guidance in your particular situation.
When ERISA applies to an employee benefit plan, the employer must comply with federal law’s minimum requirements.
In addition, ERISA sets fiduciary rules for insurance companies, plan administrators, and employers.
Which Benefit Plans Are Not Under ERISA Guidelines?
Not all employer-provided benefit plans fall under ERISA, as federal law excludes some plans.
A benefit plan is likely to not fall under ERISA if:
- The benefit payments only go to individual employees
- The employer does not make any employee contributions
- Employees receive the benefits as part of the employer’s payroll practice
- Employees receive the benefits from the employer’s general assets rather than pre-funded insurance policies or accounts
A knowledgeable lawyer will determine what ERISA does and doesn’t govern. Contact our Louisiana ERISA law firm to discuss your particular situation.
What Are the Administrative Requirements Under ERISA?
ERISA imposes many rules and requirements on participants, beneficiaries, and plan administrators.
When your employer-provided benefit plan involves an insurance company, the insurer is the plan administrator who must comply with:
- Reporting. Under ERISA, plan administrators must regularly report specific information to the U.S. Department of Labor and Internal Revenue Service (IRS). One of the documents that administrators must report to federal agencies is a Summary Plan Description (SPD), which clearly describes the participants’ and beneficiaries’ rights, benefits, and obligations.
- Disclosure. The second administrative requirement under ERISA is that plan administrators must share specific information about covered plans upon request. The plan administrator is required to disclose certain materials, including notices, reports, statements, and other plan-related documents (29 CFR § 2520.104b-1).
- Payment and denial. If a participant is seeking benefits under an ERISA-covered plan, the plan administrator must follow an established procedure to process the claim. The plan administrator may either approve or deny the participant’s claim. If the claim ends with a denial, the participant must receive notification of the reason for the denial.
In addition, there are other requirements for plan administrators depending on whether they handle welfare plans or retirement plans.
What Are the Common Types of ERISA Violations?
While plan administrators and insurance companies must comply with ERISA’s requirements, it does not mean that all of them do. ERISA cases often claim breaches of fiduciary duty.
Some of the most common types of ERISA violations encountered by participants and beneficiaries seeking benefits under employer-provided, ERISA-covered plans include:
- Failure to properly manage plan assets
- Delaying the claims process
- Not investigating a participant’s claim on time
- Discriminating against participants who exercise their ERISA-protected rights
- Lying about the benefits available to the participant
- Misinterpreting policy provisions in an attempt to deny the claim or pay as little as possible
- Failing to handle claims in the best interests of participants
- Using plan assets for the benefit of the plan administrator
If you believe that an insurance company or plan administrator committed an ERISA violation or breached any of the fiduciary duties they owed to you, do not hesitate to contact a Louisiana ERISA lawyer to discuss your options.
How to File an ERISA Claim in Louisiana?
Under 29 U.S.C. § 1024, participants and beneficiaries have the right to request specific plan materials, including a copy of the Summary Plan Description.
Request a copy of the SPD before you file your ERISA-based claim, as this document will provide such crucial information as:
- What benefits do you deserve
- What are the filing requirements
- The deadlines you should be aware of
- How you can appeal the denial of your claim
You should follow all of the requirements specified in the Summary Plan Description when preparing and filing your ERISA claim. If you do not comply with the requirements, the plan administrator is likely to deny your claim.
It is advisable to retain a Louisiana ERISA lawyer to help you file a claim properly and under all of the SPD requirements.
A Louisiana ERISA attorney will also collect all the evidence and documentation you need to ensure that your claim is successful.
After you file your ERISA claim, the plan administrator will either approve or deny your claim.
- If the plan administrator or insurer approves your claim, you will receive a notice and begin receiving your benefits shortly afterward.
- If the plan administrator or insurer denies your claim, you will get a denial letter that must specify the reason your claim was denied. The letter should also contain instructions on how to appeal the denial of your ERISA-based claim.
If you receive a claim denial, it is important to contact a lawyer right away. Your ERISA lawyer will help you appeal the plan administrator’s denial of your claim and do everything possible to achieve a favorable outcome in your case.
Under ERISA rules, participants whose claims end with a denial must exhaust their administrative remedies before filing a lawsuit.
Mistakes to Avoid When Filing Your ERISA Claim
Many participants don’t know the process of seeking benefits under an ERISA-covered plan.
Too often, people make avoidable mistakes when filing their ERISA claims. Often, participants turn to attorneys for help after making serious mistakes during the claims process.
While an attorney can fix some of the mistakes you made when filing your claim, you’re better off hiring an attorney before you make any of them.
Your Louisiana ERISA lawyer will help you avoid the following mistakes when pursuing benefits:
- Waiting too long to file an ERISA-based claim
- Not reading the terms of the plan
- Thinking that the plan administrator or insurance company is on your side
- Not gathering enough evidence to present a strong claim
- Doing things that could result in the loss of your right to seek the benefits
- Not appealing the denial of your claim on time
If you are not familiar with the ERISA claims process, it is critical to consult with a skilled attorney to make sure that you do not make any mistakes when filing your claim. Keep in mind that a mistake could cause you to lose your entitlement to benefits.
What You Need to Know About ERISA Litigation
While the government initially designed ERISA to protect employees and other participants and beneficiaries under ERISA-covered plans, insurers often use ERISA as an excuse to wrongfully deny valid claims. Many people do not realize this, but ERISA preempts all related state laws.
It means that ERISA litigation in federal courts is not the same as any other civil lawsuit in Louisiana.
Here’s what you need to know about ERISA litigation in federal courts:
- There is no jury trial.
- The judge decides without a jury.
- The plaintiff is not entitled to consequential or punitive damage.
- The parties cannot depose expert witnesses.
- The plaintiff cannot introduce any new evidence. The judge may only rule on the evidence submitted to the insurance company when filing a claim and in the administrative appeal.
As mentioned earlier, you cannot file a lawsuit against the insurance company before you have exhausted your administrative remedies. Consult with an attorney to find out what you can do to protect your rights during ERISA litigation and the claims process.
How a Louisiana ERISA Lawyer Can Help You Obtain Benefits
The process of seeking benefits under an ERISA-covered plan can be confusing and overwhelming. For this reason, it is advisable to contact an experienced lawyer to help obtain the benefits you deserve to receive under your employer-provided plan.
At J. Price McNamara ERISA Insurance Claim Attorney, we are committed to helping you during the claims process to ensure that you receive your benefits promptly.
Your Louisiana ERISA lawyer may:
- Review the Summary Plan Description to make sure that you understand the claims process.
- Collect medical records and other types of evidence to strengthen your claim before applying for ERISA-covered benefits.
- Negotiate with the insurance company or plan administrator to make sure that you receive the compensation to which you are entitled.
- Appeal the denial of your claim as soon as possible after you receive the denial letter from the plan administrator.
- If the appeal case is not successful, your lawyer will file a lawsuit in federal court and represent your best interests in front of a judge.
Contact J. Price McNamara ERISA Insurance Claim Attorneys Today
When you are looking for a Louisiana ERISA lawyer near you, look for an attorney who cares about the health and welfare of their clients.
J. Price McNamara ERISA Insurance Claim Attorney represents clients in ERISA-related matters throughout Louisiana.
We assist clients whose ERISA claims have been wrongfully denied or terminated by plan administrators or insurance companies.
We understand what you are going through if your coverage was denied. Our lawyer can shoulder all the burden and stress so that you can focus on your health and your family.
We will take the necessary steps to obtain ERISA-covered benefits on your behalf.
Mr. McNamara gives each case he handles the personalized attention it deserves to fight for the benefits to which his clients are entitled.
We have an enviable track record of success in representing residents of Louisiana in ERISA-related cases.
Our goal is to provide you with timely and practical advice and comprehensive legal representation.
We can answer all of your questions regarding your ERISA claim and employee benefits laws.
Schedule a free, no-obligation consultation with the team at J. Price McNamara ERISA Insurance Claim Attorney to discuss your case.
Call (504) 420-6962 or fill out this contact form to get your free case review with our results-driven and dedicated Louisiana ERISA attorneys.
