ERISA Attorney in Birmingham, AL

Back in 1974, Congress enacted a law that was originally intended to prevent unscrupulous employers from taking away pensions, stock ownership plans, and health benefits. That law is the Employee Retirement Income Security Act of 1974, commonly referred to as ERISA.

Despite the best of intentions, ERISA did not protect employees. Insurance providers and underhanded companies figured out how to deny employee benefits and then use ERISA to make the appeals process more difficult. When the system fails workers like this, everyday people need advocates who are ready to take on powerful insurance companies and will not back down.If you’ve been denied disability or retirement benefits, Alabama ERISA lawyer Tom Sinclair can help identify the best way to fight back. To request a free claim review with a proven and trusted ERISA attorney, contact our Birmingham, AL law office today. You can also reach us by phone at (877) 249-0091. This is a David and Goliath situation, and we’re eager to help.

What Is ERISA?

ERISA is a federal law that covers essentially all employee benefit plans provided by an employer to its employees. This typically includes insurance and retirement benefits. By design, ERISA was meant to protect the employees and their benefits, but it has become a law that protects the employer and insurance company.

ERISA is complex in nature and requires an attorney who regularly handles employee benefits litigation. The most important first question about ERISA is this: Was the denied benefit offered by your employer or your spouse’s employer? If so, you may be facing a frustrating uphill battle in the appeals process.

How Long Do I Have to Appeal a Denied ERISA Claim?

This depends on the type of benefits as well as the specific details of your plan. Generally speaking, many people will face these administrative deadlines:

• 180 days to appeal the denial of life and disability insurance benefits
• 60 days to appeal the denial of pension and retirement benefits

If you miss the deadline to appeal, you may not be able to have your eligibility for these benefits reviewed or to pursue litigation in federal court.

Time Is of the Essence with ERISA Claims

As soon as your claim is denied, the clock is ticking. We encourage you to check your plan documents for any deadlines to file an appeal as well as any other applicable information related to your workplace’s insurance policy.

It’s in your best interests to contact an ERISA attorney here in Alabama to discuss your claim and to begin the appeal process immediately. Our Birmingham law office can help you gather all of the necessary information and documentation to get the appeal process underway.

What Makes ERISA Claims So Challenging?

ERISA is not used to deny employee benefits per se, but the nature of the law creates obstacles in the appeals process that make it difficult to obtain benefits once they are denied.

Even if you are eligible for the benefits you were denied, ERISA will require you to undergo a lengthy and complicated appeals process. The obstacles in the appeal process include:

• Administrative Deadlines and Rules: When disputing a denied ERISA claim, you need to go through an internal appeals process with the insurance company. If you miss any administrative deadlines during this process, you may lose your right to pursue legal action.
• There Are No Juries in ERISA Trials: If ERISA applies to your case, you are not entitled to a jury trial based on how courts have interpreted the law. ERISA cases are heard before a federal judge instead of a jury of your peers. 
• Limits to New Evidence in Court: If you sue for benefits after a failed appeal, the court will often look at the evidence the insurance company had when it denied your claim. New evidence may not be admissible in your ERISA case.
• Difficult Standard to Overrule a Denied Claim: A court may not overturn a denied ERISA claim because evidence must show that the insurer was clearly unreasonable (the abuse of discretion standard). Despite the merits of your claim, the denial may still stand if the decision was not considered an abuse of discretion.
• You Can Only Recover Denied Benefits: Even if the federal court rules in your favor, you are only able to receive denied benefits under ERISA. You will not be able to seek additional compensation for lost wages, pain and suffering, or punitive damages.

Numbers That Put ERISA Denials Into Perspective

In 2017, we analyzed all of the ERISA claims filed during a five-year period in Alabama federal courts. There were 360 ERISA claims during that timeframe.

The plaintiff/insured employee only won a dispositive ruling four times. Read that again: 4 in 360. That’s just a 1 percent success rate in a five-year period.

Why You Need an ERISA Attorney

You can see how the odds are stacked against you with ERISA claims. As we mentioned before, this is a David and Goliath situation, with insurance companies exploiting a loophole in the law to make things harder for working people who are eligible for benefits.

Due to their complexity, few plaintiff lawyers are well-versed in this kind of employee benefits litigation. In ERISA cases, there is an escalated urgency during the time before a claims adjuster formulates a decision.

For these reasons, you should seek legal counsel from an experienced ERISA attorney at the first indication that your benefits will be terminated or a claim denied. Going it alone during the appeals process puts you at a severe disadvantage—it means going up against a team of insurance company lawyers and all the people behind the scenes at the claims department.

Why Choose Sinclair Law Firm for ERISA Cases in Alabama

Sinclair Law Firm is willing to take on insurance companies through internal remedies and in federal court so you can get the benefits you deserve. There are five key reasons why people all over Alabama trust our team to assist with appealing their ERISA claim denials.

We Have Decades of Experience with ERISA Cases

Attorney Tom Sinclair started his legal career representing automakers and insurance companies, but after a change of heart, he shifted to representing clients in ERISA claims. He still remembers cases in which regular working people were let down by the system. The desire to support the underdog continues to fuel his work as a lawyer.

We’re a Known Quantity to Insurance Companies

At Sinclair Law Firm, we know for a fact that some insurance companies flag Tom Sinclair’s name when it shows up in a file. That pleases us greatly. Insurance companies know we mean business, that we have experience with ERISA claims, and that we’re willing to exhaust internal remedies and go to federal court if necessary.

We Offer Free Consultations and Claim Reviews

At Sinclair Law Firm, case reviews are free. We know how complicated ERISA claims are, and we want to make sure people here in Birmingham and all over Alabama have access to sound legal advice when so much is on the line.

We’ll Work with You and Your Financial Situation

We know that money can be tight if you were counting on your pension or disability benefits. During the consultation process, we can discuss payment arrangements that make sense given your financial situation and current circumstances.

We’re Here to Help Everyone, Whoever You Are

Tom believes that justice and the law should apply equally and uniformly to everyone, regardless of class or politics. He’s built his legal practice on this core principle and strives to be a guardian for others when they are in need of legal help.

Request a Free Claim Review from a Trusted Birmingham ERISA Attorney

ERISA claims are complicated matters, and you have no time to delay once you receive that denial letter. Alabamians deserve a lawyer who will fight for them every step of the way, leveling the playing field with insurance companies. That’s why Sinclair Law Firm is here. To request a free claim review with a trusted ERISA attorney in Birmingham, AL, contact our law office today.

How ERISA Was Originally Envisioned

ERISA was enacted to protect employees from employers who may seek to tamper with or otherwise damage workers’ benefits. Originally, ERISA was designed just to protect pension accounts, but at the last minute, it was broadened by Congress to cover all employee benefits.

The Original Good Intentions Behind ERISA

The original reason for ERISA came from an employer (one of several) using their stronger bargaining power (employers can fire you, after all) to tell workers to give up the money in the employee pension accounts.

At its heart, ERISA tried to make up for this difference in bargaining power between employers and employees. ERISA was designed as a way for employees to know their health care, retirement plans, and insurance coverage obtained through their employment would provide the crucial safety net in their time of need and couldn’t be arbitrarily taken away.

Unfortunately, that is no longer the case, and many employees are not sure about their legal rights when it comes to ERISA. The fact is, most people haven’t even heard of ERISA until their benefits get denied.

Who Is Subject to ERISA?

ERISA likely applies if your health insurance, pension or 401(k), deferred compensation plans, disability, or life insurance comes from your status as an employee. Forget most of your understanding of your state’s various laws. ERISA “preempts” those laws, and ERISA governs your rights to those employee benefits.

ERISA Does Not Apply to State Government Entities or the Chruch

The only exceptions to the ERISA preemptions noted above are if your employer is a state governmental entity or a church.

These two exceptions come from the Constitution itself—think separation of powers and church and state. We don’t want the federal government to have power over state employee benefits, and we do not want governments to have control over clergy benefits.

Here is a tip. If you are not certain whether ERISA applies, ask this question: Do I need a federal statute to help protect the account/insurance product at issue from my employer’s interference? If the answer is no because my employer has no connection to or control over that account/product, then ERISA probably does not apply.

How ERISA Denials Differ from Bad Faith Insurance Claims

Most people are familiar with the phrases “bad faith insurance denial” or “breach of contract” when talking about the claims that an individual would assert against an insurance company for not providing insurance benefits. Those terms refer to state law claims. For example, in Alabama, the claims would normally be governed by Alabama law.

ERISA is a federal statute enacted by Congress that “preempts” your state law claims in cases where your benefits are provided by your employer. As such, you can’t seek a jury trial for a bad faith claim when ERISA is involved.

As an example, if you had a group disability policy provided as part of your employee benefits package, your insurance rights would be governed by ERISA. Because of this, ERISA would preempt all your state law claims that would typically apply otherwise. This preemption means you would have to sue under the federal statute and assert an ERISA claim against that insurance carrier, and you normally cannot sue under any of the numerous state laws that would apply to the same conduct.

What Is Needed for an ERISA Administrative Appeal?

If your ERISA benefits have been denied, you’ll want to prepare some key documents while trying to appeal the decision.

• The Denial Letter: Keep the denial letter and make a copy of it for your records. The denial letter will typically include the reason(s) your benefits were denied, the provisions in your plan that were used to deny your claim, and information on how to appeal this decision.
• Your Insurance Policy/Plan Documents: Your insurance policy and plan documents will be crucial to review. Be sure to obtain a copy of your insurance policy and any other plan documents that may be relevant to your claim.
• Any Supporting Documentation: If you have any medical records, letters from doctors, statements from your employer or co-workers, or any other documentation that would support your claim, be sure to compile all of this information.

The above material may not be all you need to file a persuasive administrative appeal, but it’s a good starting point to build your case.

Get in Touch with an ERISA Lawyer as Soon as Possible

Getting records together and reviewing your policy and other documents can take time. While you may have up to 180 days to submit an appeal, time is not on your side once you get that denial letter.

It’s best to get in touch with our Birmingham law office to speak with an ERISA attorney ASAP. We can review your denial letter and your policy and start the administrative appeals process promptly.

Contact an Experienced ERISA Attorney in Birmingham, AL

Once you receive that denial letter, you have no time to delay. Sinclair Law Firm is here to listen and to help you get the employee benefits you were denied. We’re ready and willing to be your advocate when the odds seem stacked against you. To request a free case review from an experienced ERISA lawyer, contact our Birmingham, AL law office today. You can also reach Sinclair Law Firm by calling (877) 249-0091.

ERISA FAQs

ERISA claims are complex, which is why we’ve compiled a list of some common questions we’ve received from clients in the past. If you have a question about ERISA not answered here, reach out to our Birmingham law office for more information. We’ll be happy to get you the information you need.

Are IRAs Subject to ERISA?

Probably not. As we mentioned before, ERISA applies to your pension and employee benefits that you have as a result of your status as an employee. “Individual” Retirement Accounts are likely outside of that employment relationship.

Are 403B Plans Subject to ERISA?

Maybe. It depends on who your employer is. If it is a governmental entity, then no. If it is a private charitable entity? Then likely, yes.

Are 401K Plans Subject to ERISA?

Yes. Employer-sponsored 401k plans are subject to ERISA.

Are 457B Plans Subject to ERISA?

No. If your employer is a governmental entity, then ERISA would not apply. However, if you find yourself participating in a 457b plan because of your status as a contractor for government agencies, the answer can be less clear.

Are Cash Balance Plans Subject to ERISA?

Yes. Assuming you have a private employer.

What Plans Are Not Covered by ERISA?

If your benefits are provided through a state governmental agency or through a church, ERISA will not apply.

Just the Facts: What You Should Know About ERISA Claims

Under ERISA, you can only seek what the insurance company should have been paid to begin with through the date of the court’s verdict. You cannot seek compensation for future benefits, emotional damages, bad faith damages, or punitive damages. In addition, it is entirely possible and often the case in ERISA that the disability insurance carrier may try to deny your claim again, even after you litigate and win your case.

Under ERISA, courts have interpreted the statute to mean that you have lost your right to a jury trial. This means a federal judge, not a jury, will be the one deciding your claim.

Sinclair Law Firm practices in all the federal courthouses in the state of Alabama. From Huntsville and Muscle Shoals to Tuscaloosa, Birmingham, Anniston, Mobile, and Dothan, we’re on your side.

In 2017, we analyzed 360 ERISA claims filed in a five-year period in Alabama federal courts. The plaintiff/insured employee only won a dispositive ruling four times. That’s roughly 1 percent success in that five-year period. This illustrates the importance of hiring an experienced Alabama ERISA lawyer for the best possible outcome.