Most people don’t learn about ERISA until it’s too late. That’s where an ERISA attorney comes in. At Sinclair Law Firm, we won’t just tell you what ERISA is, but when and why you should speak to a lawyer for help.
An ERISA lawyer is well-versed in the specific processes, deadlines, and documentation required to pursue ERISA claims effectively. Without the help of an ERISA attorney, it’s easy for you as a plaintiff to make costly mistakes that jeopardize your right to the employee benefits you’ve worked hard for.
Let’s look at five of the most common and compelling reasons to seek out and hire an ERISA lawyer. We’ll also look at why ERIA claims can be so complicated and frustrating. To get a free claim review from a trusted Alabama ERISA attorney, contact our Birmingham law firm today. You can also reach our office by phone at (877) 249-0091.
Key Takeaways
- ERISA attorneys help protect your employee benefits if your disability, retirement, or healthcare claim is delayed or denied.
- Filing an ERISA appeal without help from an ERISA attorney could ruin your chances of recovering denied benefits.
- An ERISA lawyer can help you uncover and prove fiduciary misconduct by your employer or plan administrator.
- An ERIA attorney builds a legal foundation during the appeals process that is geared toward the difficult legal standard to overrule the denial of a claim.
What Is ERISA?
Let’s quickly cover the basics. The Employee Retirement Income Security Act (ERISA) is a federal law that governs most employer-sponsored plans, including long-term disability, health insurance, pensions, and other retirement plans. It was signed into law in 1974.
Although ERISA was originally designed to protect employees, it has since become a tool to deny employee benefits and make the appeals process far more difficult. Figuring out complex ERISA regulations can be overwhelming, especially when you’re already concerned with your benefits being wrongfully denied or delayed.
When You Might Need an ERISA Attorney
Here are five specific situations when you should contact an ERISA lawyer. We also mention why having an attorney is crucial in these circumstances.
1. Your Workplace Benefits Claim Was Denied
People often hire an ERISA attorney when a plan administrator denies their claim for disability, life insurance, or health benefits. Even though this can feel like a dead end, it’s actually just the beginning of a long process.
Under ERISA, you can appeal a denied claim, but there’s a catch.
Why You Need an ERISA Lawyer for a Denied Claim
The administrative appeal process for ERISA can be rigid, giving plaintiffs just one chance to get it right. If you don’t include the proper evidence, miss a deadline, or fail to follow the plan’s procedures, your appeal could be thrown out entirely. And these plans aren’t written in layman’s terms. On top of having no flexibility, they are also hard to understand. In fact, insurers often rely on vague policy language or alleged pre-existing conditions to deny claims.
A skilled ERISA lawyer knows how to challenge the reasons given for denial and gather the necessary medical or vocational evidence to strengthen your appeal. Like we said, a denial isn’t the end. It’s just your sign that you need an ERISA expert who knows how to fight back.
2. You Are Filing an ERISA Administrative Appeal
Even if your claim has not been denied yet, hiring an attorney with experience in ERISA law during the appeals process can drastically improve your chances of a successful outcome.
Under normal circumstances, once you submit your appeal, you can’t add new evidence later in court. So what you submit during this appeal stage is of the utmost importance.
Why You Need an ERISA Lawyer for Administrative Appeals
An experienced ERISA lawyer will know exactly what a judge is going to look for if your case goes to litigation. We can help you build a comprehensive administrative record, collect expert opinions, and draft persuasive arguments based on ERISA regulations.
Think of the ERISA appeal stage as your legal foundation. An expertly crafted appeal by an ERISA attorney can be the difference between approval and further delay of much-needed resources.
3. There Are Fiduciary Breach Red Flags
Suppose your employer or plan administrator is abusing plan funds, showing favoritism towards other employees, or failing to act in your best interests. In that case, you may be dealing with a fiduciary breach.
Your employer and plan administrator are legally required to manage your plan prudently and do right by you. Yet, sometimes they cut corners by lying or failing to disclose important plan details.
Why You Need an ERISA Lawyer for Fiduciary Breach
A seasoned ERISA attorney can investigate whether fiduciary duties were breached and pursue legal remedies on your behalf. These breaches can result in significant losses, not just to you, but to the plan as a whole.
Fiduciary misconduct can be subtle but still devastating, and an ERISA lawyer can help reveal misconduct (if any), protect your interests, and potentially hold your employer accountable.
4. You Are Facing a Complex Disability Claim
Disability claims under ERISA can be especially taxing on you as a plaintiff. Insurance companies are known to delay, underpay, or deny valid disability claims flat-out by using vague language and narrow definitions to avoid having to pay out.
Why You Need an ERISA Lawyer for Complex Disability Claims
ERISA lawyers understand these tactics and can see them coming from a mile away. More importantly, we know how to gain the advantage. We’ll communicate directly with the insurer, gather the necessary documentation, and ensure your claim meets the plan’s requirements.
If your condition makes it difficult to manage your claim on your own, hiring an ERISA attorney can take the pressure off and increase your chances of approval.
When your livelihood is on the line, expert legal support becomes a necessity.
5. You Are Preparing for ERISA Litigation
Sometimes, even the best-prepared appeals are denied. Without a strong appeal foundation, a strong case doesn’t really stand a chance.
It’s worth noting that litigation under ERISA is governed by strict rules, limited evidence, and extremely specific procedures, even more so than standard insurance litigation.
Why You Need an ERISA Lawyer for Litigation
An ERISA attorney will have ensured your appeal includes every piece of evidence and argument needed to hold up if your claim goes all the way to federal court.
At Sinclair Law Firm, our team knows what it takes to prepare a compelling legal argument and stand up to insurance companies and employers who don’t play fair. Increase your chances of success when filing a lawsuit by hiring a specialized advocate who knows ERISA.
Additional Reasons Why You Might Need an ERISA Attorney
There are other reasons why you need an ERISA lawyer, and many of these involve creating that strong legal foundation during the ERISA appeals process. Ultimately, you should speak with an attorney any time you have a question about ERISA or when something you’ve read or heard about your claim seems vague or unclear.
ERISA Cases Are Not Like Bad Faith Insurance Claims
ERISA claims are entirely separate from non-ERISA claims, meaning you will not be able to file a bad faith insurance claim. You need to go through the appeal process, exhaust those administrative options, and then go to federal court for the ERISA case.
An ERISA lawyer can help build your case during the appeal stage so it’s ready to go to court. Your lawyer will help explain this unique process and framework to you so that you are not caught off guard.
There Are No Juries in ERISA Cases
On the note of going to court, ERISA cases are heard before a federal judge once administrative remedies have been exhausted. The case is not heard before a jury of one’s peers.
Again, this is where having an experienced ERISA attorney is so helpful in building a strong foundation. Your lawyer will lay out your case and the evidence in a way that can compel a judge based on some rather difficult criteria.
There Is a Difficult Standard to Overrule a Denied Claim
Here’s another frustrating hurdle in ERISA cases when they go to court. The federal law is such that there is an abuse of discretion standard to overrule a denied claim. “Abuse of discretion” means that the evidence presented to the judge must show that the insurance company’s decision to deny your claim was arbitrary, capricious, or unreasonable.
An ERISA lawyer can identify evidence that helps demonstrate an abuse of discretion by the insurance company. While this is a difficult and somewhat ambiguous standard to meet, our team will help build a case with this standard in mind, noting the language of your policy and the details of your situation.
You Can’t Receive Additional Damages for ERISA Claims
Perhaps the most frustrating aspect of ERISA claims is that success has its limits. If you are successful during the appeals process or a judge rules in your favor, you can only obtain the benefits you were denied. You will not receive any additional compensation for lost wages, emotional distress, or pain and suffering, nor can you receive punitive damages.
Your ERISA lawyer will let you know this from the outset so that you can have realistic expectations about the path ahead. When you have an honest and trusted legal team on your side, you’ll get straight answers about the entire process.
How Sinclair Law Firm Can Help with Your ERISA Claim
You don’t have to face the system alone when your benefits are denied, delayed, or mishandled. The team at Sinclair Law Firm has the expertise, tenacity, and compassion to help you win back what’s rightfully yours.
We understand how personal these kinds of cases can get, and we treat them and you with the respect you deserve.
We Know How Insurance Companies Operate
Before becoming an ERISA lawyer, Tom Sinclair began his legal career representing insurance companies and automakers. He realized that his true calling was helping everyday people who were let down and mistreated by the system.
Our team knows how insurance companies operate, as well as the tactics they use to deny claims, delay payments, and frustrate policyholders into accepting defeat.
We Have Access to Trusted Experts
Insurance companies have experts they consult to justify denying employee benefits. Sinclair Law Firm also has a team of experts we can trust when building your legal foundation in the appeals process.
As we collaborate with these experts, we always keep the abuse of discretion standard in mind, focusing on the type of evidence that demonstrates your initial denial was arbitrary, unreasonable, or capricious.
Insurance Companies Know Our Law Firm by Name
We know for a fact that some insurance companies flag Tom Sinclair’s name whenever it shows up in a file. That’s something that pleases us greatly. It means we have a reputation for holding powerful interests accountable and fighting for the underdog.
Sinclair Law Firm has decades of experience working on ERISA claims, and we will exhaust administrative remedies and go to court for your benefits. Your employer or plan administrator may have done you wrong, but we will always do right by you.
We Offer Free Claim Reviews
We know you were counting on those work benefits, and the last thing you need right now is another bill. That’s why Sinclair Law Firm offers free claim reviews. As you’ve noticed, ERISA is complicated. You don’t have to pay us a dime to be heard and to get sound legal counsel about what steps you ought to take next.
We Will Work with Your Financial Situation
Sinclair Law Firm works with people all over Alabama, from blue-collar workers to founders and executives. Each person who comes to us faces a different financial reality. When you work with our team, we can work out a payment arrangement that makes sense given your current means and circumstances.
Protect Your Benefits: Contact an ERISA Attorney from Sinclair Law Firm
You know who we are, what ERISA is, when and why you need an ERISA attorney, and how we can help. No matter where you live in Alabama, you can count on us. To request a free claim review with an experienced ERISA lawyer, contact our Birmingham, AL law office today. You can also reach Sinclair Law Firm by phone at (877) 249-0091.