San Antonio ERISA Lawyer
The Employee Retirement Income Security Act (ERISA) is a collection of federal laws first passed by Congress in 1974. As the name suggests, the original intent of this Act was to regulate retirement benefit plans workplaces offered to their employees.
Over the years, ERISA has expanded to control all employer-provided benefit plans, including health insurance, pensions, and even life insurance. However, while ERISA does create a baseline of protection for all employer provided plans, it also regulates the means by which a policy holder may request court intervention in case of a dispute.
If you need to file an appeal following an ERISA-controlled plan administrator denying payment, a San Antonio ERISA lawyer could help. If necessary, your insurance attorney could work with you to exhaust all internal insurance company appeal processes and take the case to a United States District Court to demand enforcement of benefits.
When and How Does ERISA Control an Insurance Plan?
ERISA controls any insurance plan offered by workplaces to their employees. Many employees make their decisions on where to work based upon the availability of these plans. In fact, many workplaces offer such plans in lieu of a higher salary.
The fact that ERISA governs the administration of many insurance plans is key to understanding a policyholder’s rights. ERISA requires all employer-provided insurance plans to adhere to a minimum standard of professionalism and procedure. The Act also specifically addresses what to do in case of a dispute.
ERISA regulations state that plan administrators must create an internal appeal process to handle disputes. In fact, only once these appeals are exhausted and a dispute remains does a policy holder in San Antonio have standing to file a lawsuit in a US District Court. While these appeals often do not produce satisfactory results at first, they are usually a necessary step towards obtaining benefits.
Common Disputes in ERISA Plans
All the same disputes that may affect private citizens who obtain their own insurance policies may also damage the relationship between ERISA providers and their policyholders. In general, these disputes all concern whether an insurer should provide benefits under the terms of their policy. This could apply to:
- Health insurance, when a policy holder contracts an illness and a disagreement turns on whether a treatment is medically valid
- Life insurance, if a policy holder dies and there is a dispute as to the cause of death
- Pension benefit disputes, if an employee has worked long enough for the policy to mature
At their heart, these are all arguments over the contact between the insurer and the policy holder. Contractual disputes are a common cause of action for a plaintiff to take an insurance-related case to court, and ERISA polices are no exception.
However, as described above, a plaintiff must first exhaust all insurance company appeals before a court will hear the case. An ERISA lawyer in San Antonio could help to both pursue these appeals and file complaints in court.
Speak with a San Antonio ERISA Attorney Today
Insurance policies should provide their holders with peace of mind and financial stability. In exchange for the payment of premiums, policies should provide benefits in the form of medical bills, death benefits, and/or retirement income. However, insurance companies make profits by collecting premiums but denying claims, and they will often make every effort to do so.
When these denials come after making a claim on an ERISA plan, the process to demand reversal involves filing at least one appeal with the insurance company itself before asking a court to intervene. This could add significant time to a waiting period that may have a critical effect on your life. Contact a San Antonio ERISA lawyer today to learn how seasoned legal counsel could help you contest a claim denial and effectively pursue the benefits you have paid for.