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Does ERISA Protect My Right to Receive Benefits Under My Medical Or Disability Plan?

Erisa

The Employee Retirement Income Security Act of 1974 (ERISA) is ostensibly designed to protect employment benefits from mismanagement or unfair practices. Specifically, the law covers procedures related to claims and appeals for private employer-provided benefits. In the eyes of the employee, however, the protection offered by this federal statute is minimal, at best.

Unfortunately, ERISA is heavily slanted in favor of the employer and any associated insurance companies. As a result, little protection may be provided for employees who make claims for individual benefits.

Doesn't ERISA protect my right to receive benefits under my medical or disability plan?

How Does ERISA Protect Employees?

ERISA does not actually require employers to provide benefits. Rather, under ERISA, employers and insurance companies must provide plan participants with information regarding each plan's setup and how it is funded. This information is critical, as it allows employees to make informed decisions regarding their benefits — and whether they intend to remain with the employer providing those benefits.

Beyond plan information, ERISA mandates that employers provide participants with a grievance and appeals process — which is crucial for those who believe they have been wrongfully denied. Under ERISA, participants also have the right to sue for benefits or for breaches of fiduciary duty.

Overcoming the Heightened Potential For Claim Rejection

ERISA may mandate detailed plan information and the provision of an appeals process, but these elements often do little good for employees desperate to avoid claim rejections in the first place. Unfortunately, employers and insurers currently have the power to reject claims for almost any reason imaginable. While the cards may seem stacked against employees, legal representation can make a huge difference.

If you're struggling to make sense of ERISA or are worried about the possibility of a claim denial, you'll want to move forward with an experienced attorney by your side. Contact us today to learn more.

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