What Does an ERISA Attorney Do?

Nearly 158 million workers and their dependents participate in employee benefit plans under the Employee Retirement Income Security Act of 1974 (ERISA). Congress instituted ERISA to protect the solvency of employee benefit plans and create a national framework for enforcing protections.

ERISA governs most voluntary benefit plans offered by private employers. These plans include retirement plans, health plans, and other benefit plans, such as life or disability insurance.

According to ERISA attorney Johnny Peace, when you receive employee benefits from an ERISA plan, the law provides you with certain rights. An ERISA attorney will help you understand and enforce your rights under the law.

How Does an ERISA Attorney Help with the Claims Process?

Once you join an ERISA plan, it is your right to receive coverage according to the plan’s terms. In many cases, you will need to file a claim for the plan to pay benefits.

Your plan administrator must promptly consider your claim and provide you with the information relating to the claim. If the plan administrator denies your claim, it must specify the reason for the denial. Finally, it must provide you with an opportunity for an appeal.

The law provides a limited time to appeal. To prepare your case, your ERISA attorney will review the denial and your plan’s terms and summary plan description (SPD).

Next, your attorney will draft an appeal letter. The letter will provide supporting evidence that the administrator should reverse the denial and grant or reinstate the benefits.

If the administrator denies your appeal, your attorney may file a lawsuit in federal court. The court will review the record and decide if the plan administrator's decision was biased or “arbitrary and capricious.” If so, the court can require the administrator to grant the benefits. Additionally, the court may award you with attorney's fees and costs.

How Can an ERISA Attorney Help with an ERISA Rights Violation?

ERISA sets the minimum standards for plan administrators. The law requires administrators to follow the plan's terms, notify members of changes to the plan and its funding status, report information to the government, implement fair claim procedures, and act as a fiduciary to plan beneficiaries.

If the plan administrator fails to meet the standard, ERISA allows for fines and penalties, including repayment of misused plan funds or barring the administrator from acting as a fiduciary.

In a case decided in January 2022, the Supreme Court ruled that courts should apply context-specific pleading standards when confronted with an ERISA violation.

Under this ruling, a complainant must allege sufficient facts for the court to draw a reasonable inference that the defendant is liable for the misconduct. An experienced ERISA attorney understands the evidence you will need to convince a judge of the validity of your claims.

How Can an ERISA Attorney Help Me?

Only an experienced ERISA attorney knows what records you will need to support your claim. They can work with your treatment providers to have them explain your medical condition in a way that refutes the plan's claim denial.

Your attorney may also assist you in arranging an independent medical exam to gather additional medical evidence. They will ensure that your appeal is strong and based on objective evidence sufficient to overcome the context-specific pleading requirements.

ERISA laws are complex, but you shouldn’t have to fight for the benefits you deserve. Instead, Congress intended ERISA to protect you and the value of your benefit plan.

It’s rare to find an ERISA attorney that represents only employees, not employers, insurance companies, or other large plan administrators. When you need to defend your rights, choose an attorney who will represent you and help you uphold your rights under the law.