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Since you pay premiums for your disability insurance and other benefits, you expect them to be accessible to you should you need to utilize them. On the surface, it seems like a simple transaction. However, many people are unaware of how these benefits work as well as what rules are in place regarding their use.
If you have purchased disability insurance through your employer or another privatized insurance company, ERISA restrictions and limitations will apply. It is important to know what these restrictions are and how they affect your policy and your rights.
An accomplished attorney experienced in ERISA insurance laws may be able to help make your benefits easier to understand so that you can have fewer issues when you need to use them. They can sit with you and thoroughly explain ERISA restrictions and limitations.
ERISA is an acronym for the Employee Retirement Income Security Act. This law was established by the federal government in 1974 to protect the insured parties of most employee and voluntary insurance plans. While it is debatable as to whether ERISA benefits are for the protection of the insured, the fact still stands that there are ERISA restrictions and limitations.
For example, qualified ERISA plans are mandated to adhere to 26 U.S. Code § 415 regarding limits on benefits and contributions. ERISA plan administrators are required to keep those they insure updated about any changes to their policy and to provide information any restrictions or limitations that are in place.
One limitation of ERISA plans is time. For instance, after losing an appeal, or possibly even a second appeal, plan participants have a set amount of time to file a legal claim. Depending on the plan and the rulings of federal courts, this deadline could be one year, three years, or six years. If participants do not file in this time frame, the denial will stand.
At the same time, the ERISA insurance company is responsible for letting the insured know what their time limitations are. When they send a denial letter it must include any applicable deadlines for further action. Furthermore, if the insurance carrier fails to provide the insured information on the steps for pursuing further review of their denial, the time limit has not started until they do. These limitations can also be found in the summary plan description for the policy.
ERISA restrictions and limitations can be extremely frustrating if you are trying to use your disability or any other benefit. It is also preferential to the insurance company that you do not know your rights as the insured, and therefore, cannot act on them.
However, a passionate attorney believes you should be fully informed about ERISA laws, what your rights are, and what you can do to protect them. An experienced lawyer could establish and protect your rights with your insurance company. If you are not getting the benefits you deserve, contact an ERISA attorney today.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded J. Price McNamara ERISA Insurance Claim Attorney, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts