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The federal Employee Retirement Income Security Act (ERISA) protects a worker’s access to benefits a private employer offers and ensures the benefit plans are administered fairly.
ERISA determines the procedures you use to dispute a benefits administrator’s decision. It is critical to work with an ERISA attorney who focuses on this area of law, like the lawyers at Cody Allison & Associates. They can provide an overview of ERISA in Nashville so that you fully understand the process and can advocate aggressively to ensure you receive the benefits you need and deserve.
ERISA establishes general principles that Nashville employers offering disability benefits must abide by. The law contains definitions of terms that may be important in a specific case. The details are mostly left to the discretion of the employer offering the benefits or the insurance company that administers it.
The law requires the plan to provide each participant with a summary of the plan, including what it covers and the rules for obtaining benefits. The plan must inform participants whenever it makes changes to its coverage or procedures. Plans must offer participants at least one level of internal review to appeal decisions.
When your disability claim is denied or your benefits are terminated, the plan must explain the reason for its decision. The letter announcing the denial of benefits must also explain the procedure for seeking a reconsideration of the decision. There is normally a short window of just a few weeks to file an appeal, so contact our firm of experienced ERISA attorneys as soon as you receive the letter denying benefits.
If the original denial cites a failure to make a timely claim or some other procedural flaw, our Nashville ERISA attorneys would investigate whether the plan gave you proper notice of its procedures. If the plan cites a medical reason for its denial, we could compile extensive medical documentation and question whether the medical information the plan relied on was biased or outdated. If the plan asserts that your disability should not prevent you from working, we can submit vocational assessments refuting the plan’s position.
Filing a comprehensive, well-researched, and compelling appeal is essential. If the appeal fails and you must take the issue to court, the record compiled for the appeal is usually the only evidence the judge will review. We work with disabled clients nationwide to appeal unfavorable decisions and always focus on building a substantial record in case court proceedings are necessary.
If you must appeal a plan’s decision in court, the matter will be decided by a judge without a jury, and the judge will not hear witnesses or review evidence other than the record of the internal appeal. It is not impossible to persuade a judge to overturn a plan’s decision, but it is challenging.
If the benefit plan allows the plan administrator discretion to determine coverage or implement policy, the judge can overturn a plan’s decision only if it was arbitrary and capricious. That means our lawyers in Nashville must prove the plan administrator abused their discretion when handling your ERISA claim. If the plan does not give the administrator this discretion, or if it does but we can demonstrate that the administrator has a conflict of interest, the judge can consider the record on its merits.
An overview of ERISA in Nashville reveals that these cases are complex and require legal knowledge and experience. The lawyers at Cody Allison & Associates devote their professional lives to helping disabled people win ERISA benefits. Contact us immediately if an ERISA plan has denied your claim.