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Employee Retirement Income Security Act
By Heidi Turner
The Employee Retirement Income Security Act of 1974 (ERISA) was designed to protect employees from private employers who might mismanage employee benefits plans. Among the items covered in ERISA laws are health benefits, pension plans, and employee stock ownership plans. In cases where ERISA protections are violated, employees can file a lawsuit to hold those responsible accountable for their actions and receive compensation for their losses.
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ERISA laws are federally enacted laws that set out the requirements for private employers who offer benefits to their employees. Such benefits frequently include health plans, pension plans, or employee stock ownership plans. Just because an employer offers these plans, however, does not mean the employer is free to run the plans how he or she sees fit.
Under ERISA laws, the fiduciaries responsible for overseeing benefits plans must act in the best interests of the plan, must provide plan participants with complete information about the plan—including how the plan operates, how benefits are calculated, and how benefits are paid—and must provide a process through which employees can appeal or grieve denials of their applications for benefits.
Among those who may be considered plan fiduciaries are trustees, administrators, employers, and anyone who sits on the investment committee. In addition to running the plan in the best interests of participants and beneficiaries, fiduciaries must avoid conflicts of interest when they run the plan.
Before employees are eligible to file a lawsuit under ERISA, they must exhaust the appeals process and must meet strict ERISA filing deadlines.
Health Benefit Plans
Group health benefits plans are frequently offered by employers as a benefit for employees. The plans ensure participants and their dependents have access to medical care either by providing that care directly, by providing insurance coverage for medical care, by reimbursing participants for expenses, or through other means.
If a group health insurance benefits plan has been mismanaged, employees may be able to file a lawsuit against the plan fiduciary, to ensure they have access to the medical care, insurance, or funding as set out in the plan agreement.
Meanwhile, if access to insurance benefits have been unreasonably denied by an insurance company, plan participants may be eligible to file a lawsuit under ERISA to have their insurance denial reversed. Before they can do so, however, they must first follow the insurance company’s appeals process.
There are situations in which employees can file ERISA lawsuits against a plan or its fiduciaries:
- To appeal a claim for benefits that was denied
- To recover missing benefits
- To prevent a plan from being managed in a way that violates ERISA laws
- To stop fiduciaries from mismanaging plans
In cases where ERISA plans have been mismanaged, legitimate claims for benefits have been denied, or plan administrators have breached their fiduciary duties, plan participants and their beneficiaries may be eligible to file an ERISA lawsuit.
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