The Employee Retirement Income Security Act (ERISA) applies to much more than traditional pension/retirement benefits. ERISA sets standards for how an employer must run its 401(k) plan and ESOP plans, and its welfare-type plans, including health and disability benefit plans, severance plans, scholarship funds, employer-operated day care centers, death benefits, and plans providing prepaid legal services, just to name a few. ERISA is a comprehensive but exceedingly complex statutory enactment, and as such, is rife with the potential for disputes between plan participants/beneficiaries and plan sponsors/fiduciaries.
Both Sides of ERISA
Pridgen Bassett Law distinguishes itself by understanding both sides of ERISA. We have counseled both employers and employees about ERISA, as well as litigated on their behalf. We are very careful to avoid conflicts of interest, of course, that might arise by simultaneously representing an employer and one of its employees. We are also careful to avoid the potentiality for conflicts of interest, by maintaining other internal and external checks on our representations that we undertake. However, our comprehensive approach to ERISA litigation ultimately benefits our clients because it both enhances our ability to see a case from all sides and requires us to stay up to date on all of the latest legal developments in ERISA disputes.
ERISA’s Administrative Process
Under ERISA, an employee or plan beneficiary may bring a lawsuit in federal court against an employer or plan administrator only after he or she has exhausted the administrative remedies provided under the ERISA plan. In addition to exhaustion of remedies being a prerequisite to filing a case, there are specific procedural and substantive requirements, both for plan fiduciaries and participants/beneficiaries, that must be met in order to preserve one’s arguments in any resulting litigation.
Complying With Procedural Requirements
ERISA comes into play regarding the timing and processing of benefit determinations. ERISA’s claims regulations specify the time periods required for the handling of the various types of plan benefits, e.g., health, disability, pension claims, when such claims are made under a plan. Such regulations also dictate how the adverse benefit determination must be handled, how many appeals may be mandated, and the substantive and procedural requirements applicable to each. It is imperative, whether you are a plan fiduciary or a plan participant/beneficiary, to have an experienced ERISA attorney helping you navigate through the claims/appeals process and understanding how the ERISA regulations impact the process.
Direct Answers to Your Questions
We understand that litigants will likely have many questions both before and during ERISA disputes. One of the most important services we provide to our clients is education. Employers approach us about their obligations under ERISA, such as how they must respond to employee benefit claims and appeals during the administrative process. Employees, in turn, may have questions about their rights under ERISA. We are here to answer your questions.