ERISA stands for the Employee Retirement Income Security Act of 1974. ERISA is a federal statute that was passed by Congress in order to help employees obtain the benefits which they deserve under an insurance contract. Most plans of insurance that are sponsored by an employer fall within the ambit of the ERISA statute, including employer-sponsored plans for life insurance, accidental death insurance, long-term disability, short-term disability, and medical insurance.
From time to time, however, disputes arise in the benefits process, and litigation through the court system sometimes becomes necessary. ERISA litigation begins when the individual who is making a claim for insurance benefits files a lawsuit against his or her insurance company in the federal court system. However, there are several prerequisites that need to be satisfied prior to filing such a lawsuit.
The experienced Texas ERISA litigation lawyers at the Law Offices of J. Price McNamara can help you navigate your way through the ERISA litigation process and help you to pursue the ERISA insurance benefits that you need.
Prerequisites to ERISA Litigation
Prior to starting ERISA litigation in the federal court system, there are several prerequisites that you must satisfy. First, you must read the denial letter which your insurance company sends you – and which explains why your benefits claim was denied in the first place.
Second, you must exhaust all of the administrative appeal remedies provided by your insurance company. An administrative appeal is an appeal that is handled in-house by the insurance company, and your insurance company is required to offer you at least one administrative appeal opportunity. At this level, you have the ability to supplement the administrative record with additional documentation in support of your ERISA claim.
What Happens During ERISA Litigation?
You can begin the ERISA litigation process once you have exhausted your administrative remedies with your insurance company. During ERISA litigation, you or your lawyer will do the following:
- File a formal legal complaint against your insurance company in the federal district court and have it served on legal counsel for the insurance company
- Take part in the discovery process, in which both sides to the dispute exchange documentation and other information pertaining to the case
- Attend a federal court hearing during which a federal judge will decide if you are entitled to ERISA benefits
If you have additional documentation, such as medical records that support your claim, it is important that you introduce those records at the administrative appeal level. Once your case has entered the federal court system, you will not be able to introduce new documentation. Instead, the federal judge handling your case can only rely on the administrative record.
Contact a Knowledgeable Texas ERISA Litigation Lawyer Today
At the Law Offices of J. Price McNamara, our legal team will carefully guide you through the ERISA litigation process. We can file the complaint against your insurance company on your behalf and represent you at all legal proceedings in court. To schedule a free case evaluation and legal consultation with a knowledgeable Texas ERISA litigation attorney, please contact us online today.