Who Is Covered under ERISA?
Although the name suggests retirement plans are covered by ERISA, any employee welfare benefit plan is within the purview of the law, including, but not limited to, medical insurance, vacation plans, training and scholarships. To be clear, disability lawyers Augusta GA emphasize that ERISA does not require an employer to offer a plan, it merely establishes rules if benefits plans are offered. ERISA applies only to private employers; plans administered by government employers or religious organizations are not covered. Additionally, for a benefit plan to be covered by ERISA, it must be funded through an insurance policy or trust. Some employers will pay benefits from the general assets of the company, and such plans are not covered by ERISA.
Appealing a Denied Claim
If you file a claim, the plan must notify you in writing of its decision, typically within 90 days. ERISA requires the administrator of a covered plan to provide a detailed explanation as to why the claim was denied and how the claimant may appeal that denial. However, the rules governing appeals under ERISA are complicated and strongly favor the insurance company. For instance, unlike most adversarial proceedings, ERISA cases do not permit testimony and witnesses; the matter is typically determined by a judge who only reviews the paperwork that is included in the case file. This is true even if your claim exhausts all the administrative remedies provided by the plan and results in the filing of a lawsuit.
Contact Disability Lawyers Augusta GA for Legal Advice
If you have received a letter denying benefits that you believe you are entitled to, it is important to understand and protect your rights. To evaluate your options, call disability lawyers Augusta GA.