Orlando ERISA Lawyer
Often, one of the best arguments an employer can make for why a person should work for their company is the health plans, life insurance, and retirement benefits they offer to employees. These can serve as important non-salary benefits, as well as a means for a worker to more easily manage their finances while on the job.
Unfortunately, while workers have good reason to expect that a claim filed against these benefits will be successful, the truth is that denials of benefits are common. Because employers provide these plans, the Employee Retirement Income Security Act (ERISA) controls the appeal process associated with such denials.
An Orlando ERISA lawyer could help workers who need to appeal a plan denial issued by the administrator of an employer-provided insurance plan. With a dedicated insurance attorney by your side, you could work to exhaust all required administrative appeals and, if necessary, pursue a lawsuit in United States District Court demanding enforcement of your policy.
Pursuing an Appeal
The federal law known as ERISA controls and regulates all employer-provided benefit plans in the United States, including health insurance, pensions, and even life insurance. While this does create a series of baseline standards which all providers must adhere to, it also controls how a claimant must appeal a denial of coverage.
ERISA states that all plan administrators must create and adhere to an internal appeals process for handling beneficiary disputes. While this may appear to benefit a plan holder, in many cases the opposite effect occurs. Policyholders may ask a court to directly decide on a dispute over a policy they bought on their own, but ERISA plan holders must first go through this internal process.
This can delay the receipt of benefits for many months while policyholders make an often vain attempt to change an insurance company’s mind. Still, it is mandatory under ERISA regulations to endure this process before filing a court case, and an Orlando ERISA attorney could help perform this task quickly and properly.
Filing a Lawsuit
United States District Courts have jurisdiction to settle insurance disputes that arise over policies controlled by ERISA. For people living in Orlando, the courthouse is for the Middle District of Florida in Orlando. After exhausting internal appeals processes, people with ERISA-governed plans may petition this court to hear a case based on the legal cause of action known as breach of contract.
This is because an insurance plan is effectively a contract between the plan provider and the holder. As an exchange for the receipt of premium payments, the provider agrees to provide health coverage, death benefits, or retirement payments as dictated by the policy. A dispute over whether the provider should pay out for the policy is an example of a policy holder requesting performance of that contract.
Let an Orlando ERISA Attorney Help
Few things in life are more frustrating than hearing that a benefit plan’s administrator is refusing to pay out. Many people rely on these plans to pay for medical costs, provide payments upon death of a loved one, or provide income upon retirement. When an employer provides these plans, the federal law of ERISA controls all appeals processes.
An Orlando ERISA lawyer could explain the effect that ERISA has on your case and how to proceed accordingly, whether by filing appeals with the insurance company or eventually taking the case to a US District Court. Contact an attorney today to see how they could help you.