Employee Benefit Disputes

Employee benefits are governed by the Employee Retirement Income Security Act of 1974 (ERISA). This legislation was enacted by Congress with the idea of providing economic security and stability to employees by protecting employer-provided benefits. These include pension plans, including 401(k) plans and other retirement plans and welfare benefit plans providing medical, health, accident, disability, or life insurance benefit coverage and other fringe benefits. While certain state law rights and remedies are limited by ERISA, ERISA requires certain disclosure and reporting to plan participants and their beneficiaries. Your rights under ERISA include:

The right to be furnished with the Summary Plan Description which described the terms and conditions of the plan, including the procedures for presenting a claim for benefits and your right to appeal any decision to deny benefits to you. The Summary Plan Description must also provide an identification of the persons responsible for administering the plan and the name, address and telephone number of the person responsible for reviewing your appeal of any denial of benefits.

The right, upon request, to be provided with copies of pertinent documents, including the Summary Plan Description, annual reportings on behalf of the plan, and copies of the claim file or other documentation pertaining to your benefit claim.

The right to receive a detailed explanation of the basis for denial of your claim for benefits, including the specific plan language or insurance policy language upon which the denial is based.

The right to a full and fair review by the plan fiduciary of any denial of your claim.

If any duty imposed by ERISA has been breached, an employee or beneficiary may bring suit in federal court to enforce your rights. It is most important for you to understand that, after you have requested an appeal or review of any denial of benefits, you may NOT provide additional information supporting your claim, at a later time. Therefore all of the necessary medical, legal, vocational and other specialized information must be provided before your appeal to your employer or the insurance company is conducted. Failure to provide this information prior to appeal may result in denial of an otherwise valid claim. This is because a court reviewing your ERISA benefit dispute is not likely to consider new evidence in most circumstances. We recommend you contact an attorney who regularly represents employees in ERISA claims before you submit your appeal.