Frequently Asked Questions

Before filing a lawsuit, a claimant must exhaust the available remedies under the plan, so long as the plan’s procedures are reasonable. This typically means a claimant must apply for benefits in accordance with the plan’s application procedures. If the claim is denied, the claimant must appeal under the plan’s appeal procedures. A claimant is required to “exhaust” his or her administrative remedies before filing an action in court.

It is crucial to understand that the record closes when the insurance company or ERISA administrator issues its final decision.  Claimants must submit all the evidence they want to be considered during the administrative appeal process, and may not submit new evidence regarding the merits of their claim once the case is in court.

In other words, the basic rule is that the record closes when the administrator or insurance company makes its final denial, and it is often impossible to submit new evidence in litigation that was not sent to the insurance company before it denied the claim. This typically leads to extremely curtailed records requests and reviews by insurers. Willful blindness helps them later on in court.

From December 1, 2012, to December 8, 2017, there were 380 cases coded in Pacer as 791 (ERISA) in Alabama’s three federal districts. Excluding government actions, actions brought by the insurer, and class action cases which were not individual ERISA benefits cases, only 20 cases (5.26%) out of 380 cases coded as 791 (ERISA) in CM/ECF went the distance to a final decision in all three of Alabama’s districts. Remember, there are no jury trials under ERISA, so this typically meant it was decided via dispositive briefing.

Of the 20 cases that went to a final decision, only four resulted favorably for the plaintiff. Out of 380 ERISA cases, the individual won 4 times.  Improving your client’s odds of winning requires an understanding of the importance of ERISA’s administrative remedies.

ERISA divides employee benefits into two broad categories: pension benefits and welfare benefits. Long-term disability benefits, health insurance, life insurance, dental insurance, and similar benefits fall under “ERISA welfare benefits.” If an ERISA plan participant or beneficiary is denied those benefits, the person must go through the ERISA plan’s required appeal procedures. If the claim is still denied, the person can then bring an action under ERISA § 502(a)(1)(B) (29 U.S.C. § 1132(a)(1)(B)).

Because ERISA preempts any state law remedies, a plaintiff may only obtain those remedies available under the ERISA statute and case law. Usually, this is a remedy to obtain the benefits that should have been paid under the plan, plus possibly attorneys’ fees, and interest. Other remedies, such as punitive damages, make-whole damages, bad faith damages, or similar remedies are preempted.

Additionally, when reviewing the limited record, courts usually review the decision under an arbitrary and capricious (abuse of discretion) standard of review that is deferential to the decision made by the plan administrator. According to the Supreme Court in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), the rule is that courts should review denials of ERISA benefits de novo, but that same decision held that if the parties agree to a deferential standard of review, then courts should apply that standard.  Id. at 115. As a result, most ERISA plans and group insurance policies contain language conferring the deferential standard of review, and that exception has virtually swallowed the default rule.

ERISA applies to almost all disputes over employee benefits offered by private employers.  Any state law claims, such as breach of contract or bad faith, do not apply because the rules under ERISA “shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan . . . .” 29 U.S.C. § 1144(a).

This means almost all employee benefit plans that provide health insurance, life insurance, long-term disability insurance, or similar benefits are governed by federal ERISA law; however, plans sponsored by governmental employers and churches are not usually governed by ERISA.  29 U.S.C. § 1004(b). If ERISA applies, most claims should be filed in federal court (except for claims that are limited to benefits over which state courts have concurrent jurisdiction), and if a plaintiff files a claim that is properly preempted by ERISA, the defendant may remove the claim to federal court without regard to the well-pled complaint rule (29 U.S.C. § 1132(e)); therefore, ERISA claims are rarely litigated in state court.

In addition to receiving pension payments, when you reach the age of 65, you may qualify for additional benefit programs supported by the government. As with many other benefit programs, your qualifications for these programs will depend on your individual financial situation and the availability of programs in your area. Here is a short list of benefit programs that may benefit you and your family. Our team is always here to help you maximize these benefits and ensure long-lasting security.

• Veterans Health Administration (VHA): Established to fulfill the healthcare needs of those who have served in the U.S. armed forces, the VHA operates a vast network of medical centers, clinics, and other healthcare facilities nationwide. Veterans enrolled in the VHA program have access to a wide range of medical services, including primary care, specialized care, mental health services, rehabilitation, and more.
• Social Security Disability Insurance (SSDI): Social Security Disability Insurance is a federal program designed to provide financial assistance to individuals who are unable to work due to a qualifying disability. To qualify, you must meet the Social Security Administration’s definition of a disability, which generally involves having a condition expected to last at least one year or result in death. The amount of SSDI benefits is based on your work history and earnings and may also qualify you to receive Medicare.

Supplemental Security Income (SSI): Supplemental Security Income is a federal assistance that provides financial support to elderly, blind, or disabled individuals with limited income and resources. Eligibility for SSI is determined by factors such as your income, assets, and disability status. If you qualify for SSI, you will receive monthly cash payments to help cover basic living expenses, including food, shelter, and clothing.

The benefits provided by a state pension plan can vary based on each state’s specific plan and its rules. State pension plans typically offer retirement benefits to eligible employees, and the benefits can include:

Disability Benefits: In the event of a disability preventing you from working, some pension plans may provide disability benefits.

Survivor Benefits: Pension plans often offer benefits to surviving spouses or dependents in the event of the participant’s death.

Cost-of-Living Adjustments (COLA): Some plans provide adjustments to your pension payments to account for inflation and rising living costs.

Healthcare Benefits: Some state pension plans may offer healthcare benefits or have provisions for health insurance coverage during retirement.

Deferred Retirement Option Program (DROP): Some plans have a DROP that allows employees to work for a specified period after becoming eligible for retirement while their pension benefits accumulate.

Please note that pension plan details can change, and it’s essential to verify information with the relevant parties or the plan administrators to ensure you have the latest and most accurate details about the benefits you may be eligible to claim.

Claiming your pension benefits is a multi-step process that can vary based on your employer, type of pension plan, location, and individual finances. Here is a general guide to give you an idea of what this process looks like. However, we recommend contacting your employer for the most accurate information. Additionally, this guide is meant to provide insight into single-employer pension plans, not multiemployer pension plans.

1. Contact Your Pension Plan Administrator:

If your workplace offers a pension plan, contact your HR department or the pension plan administrator. They should be able to provide information on eligibility, required documents, and the specific process for making a claim.

2. Gather Necessary Documents:

Collect any required documents such as identification, proof of age, marriage certificates (if applicable), and any other documents requested by the pension plan.

3. Fill Out the Application Form:

Obtain the pension application form from your employer or pension plan administrator. Fill it out completely and accurately, providing all the necessary information.

4. Submit the Application:

Submit the completed application form along with any required documents to the designated address or office. Some plans may allow online submission, so check for electronic options.

5. Wait for Processing:

The pension plan administrator will review your application. The processing time can vary, so it’s important to be patient. If you have questions during this period, contact your administrator for updates.

6. Receive Confirmation and Information:

Once your application is approved, you will receive confirmation of your pension benefits. This document will outline the amount you will receive, the frequency of payments, and any other relevant details.

7. Choose Payment Method:

Determine how you want to receive your pension payments. Options may include direct deposit to your bank account or receiving a check in the mail.

8. Understand Tax Implications:

Be aware of the tax implications of your pension benefits. Some pension income may be taxable, and you may need to plan for this when filing your tax returns.

9. Keep Your Contact Information Updated:

Ensure that the pension plan administrator has your current contact information. This is crucial for receiving important updates and documentation related to your pension benefits.

Remember, this process may vary, and it’s essential to follow the specific guidelines provided by your pension plan. If you have any doubts or questions, consult your employer’s HR department or contact the pension plan administrator directly for personalized assistance.

The short answer to this question is yes, you can claim unemployment benefits while receiving a pension. However, unemployment can significantly impact pension benefits, creating a complex relationship between the retirement account and the financial support system. If you receive any pension payments where a base period employer made the primary contributions, you will see a dollar-for-dollar reduction in your unemployment benefits. This is also the case even if you partially contributed to your pension, meaning you will still see the 100% dollar match in reduction on your unemployment benefits. However, in cases where you were the sole contributor to your pension plan, your unemployment benefits should not be impacted.

It is important to note that while pension benefits can impact your take-home amount from unemployment benefits, you may still qualify for unemployment benefits even if you are retired from a job and receiving pension payments if you are actively looking for a job.

This would depend on the state laws governing the life insurance policy.

Yes. Proving death is not always dependent on having the body.

Yes. Insurance companies do not make money paying claims. They make money collecting premiums. They save money by denying claims.

Often, the insurance policy will lapse due to nonpayment of premiums. Without notice of a claim, no life insurance benefit will ever be paid.