Fort Lauderdale ERISA Claims Attorney

What Is ERISA?

ERISA stands for the "Employee Retirement Income Security Act" which aims to protect workers by regulating employee insurance policies and retirement plans. When you have short-term or long-term disability insurance and are unable to work as a result of an injury or illness, you will likely qualify for benefits that cover a percentage of your paycheck. However, your employer’s insurer may improperly deny your claim to avoid paying benefits. The United States Department of Labor enforces ERISA rules and oversees the conduct of plan administrators and fiduciaries.

What Happens if My Claim is Denied?

If your plan is covered by ERISA rules, you are entitled to certain rights when your claim is denied. Fort Lauderdale ERISA claims lawyer Martin J. Sperry can help you explore all of your legal options when an insurer acts in bad faith. Our firm has over 45 years of legal experience in this field and has recovered millions of dollars for our clients. We can assess whether your plan is covered by ERISA regulations, determine if you have a case, review potential remedies, and assist you in seeking the compensation you deserve.

If your insurance plan is covered by ERISA and your claim has been wrongfully denied, do not hesitate to call (954) 324-2340 or contact us online. We offer free initial consultations.

How ERISA Works 

Many employees procure life insurance, short-term disability insurance, and long-term disability insurance policies through their employer. ERISA sets and enforces minimum standards for many private employers that choose to offer these and other types of insurance and retirement plans. Under ERISA, most private employers that offer insurance and retirement plans must abide by rules governing:

• Disclosures. Private employers must regularly disclose policy benefits, means of obtaining benefits, rules, limitations, and changes.
• Accountability. Managers of company-offered policies and plans must make regular filings with the federal government to ensure no rules are being broken.
• Claims. Private employers must provide policyholders with a clear, written system for filing claims and appealing denied claims. ERISA also requires that claims and claims appeals must be adjudicated in a reasonably efficient manner.
• Conduct. Managers of plans and policies have legal fiduciary relationships with plan participants and policyholders under ERISA. Their conduct is strictly enforced.
• Plan Protection. ERISA quires managers of plans and policies to act in the best interests of the plan participants and policyholders.

ERISA rules require that policy administrators make timely decisions about approving or denying benefit claims. If your insurer denies your claim, they are required by law to provide a letter outlining the reasons for their decision. They must also disclose any evidence they used to make their decision and the identities of any experts whose expertise they relied upon during the adjudication process. When your ERISA-covered insurance claim is denied, your policy administrator must provide you with written instructions for how to appeal the decision.

Generally, you will have up to 6 months to file a formal appeal. Your appeal must be reviewed and adjudicated within a reasonable timeframe. If your appeal fails, you will likely have the opportunity to file a lawsuit against your insurer on the basis of your claim being wrongfully denied. These lawsuits are litigated in federal court.