The Employee Retirement Income Security Act of 1974 (ERISA) was intended to provide participants with an expedited resolution process through an administrative appeal process. Most Plans require a participant to exhaust her administrative remedies before bringing an action in federal court. Case precedent, judicial decisions deciding ERISA benefit claims, continuously develops. As a result, The Bushorn Firm remains updated on recent judicial decisions which impact the administrative appeals process as well as benefits litigation. At The Bushorn Firm, we litigate individual benefit claims after the plan sponsor or administrator has denied a claim for benefits, including claims for short or long term disability benefits, pension benefits, certain health benefits, and SERP/top-hat plan benefits. Issues we frequently address include the employer and/or insurer’s failure to issue decisions in accordance with the claim regulations, retention of biased and unfair third party medical reviewers, and procedural irregularities making it impossible to get a fair decision. When litigating a claim for benefits, we often bring claims under ERISA 29 U.S.C. § 1132(a)(1)(B), which provides a participant or beneficiary with the right to bring a civil action to “recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan”. Lawsuits brought under this section of ERISA allow a participant to recover, essentially, what they would have been entitled to had their benefit claim not been improperly denied. This may include past due benefits, reinstatement to the plan to receive future benefits, and interest. The insurer and/or employer may be required to pay your attorney’s fee should you prevail.
Litigating an ERISA benefit claim is very different from other areas of law. Claims for benefits are often decided by a court’s written order, as opposed to a jury decision following a trial. In addition, the court will look at the administrative record as evidence, i.e., the information submitted and created during the appeals process. You will likely not be asked to testify or sit for a deposition. If your claim for benefits has been denied, contact The Bushorn Firm for a free consultation to determine whether it is in your best interest to file a lawsuit to obtain the benefits you deserve.