Sunday, March 9, 2014

DENIAL OF BENEFITS UNDER AN ERISA HEALTH INSURANCE PLAN?

Have you been denied health, disability or life insurance benefits through your employer-sponsored health plan?  Have you been to told you have an ERISA plan and must follow the claim and appeal procedures in your ERISA policy?  If so, you may need a Knoxville ERISA lawyer to help you understand the ERISA claim and appeal process.

ERISA stands for the Employee Retirement Income Security Act of 1974.  It was designed to protect the interests of employees/participants and their beneficiaries who depend on benefits from private employee benefit plans.  Unfortunately the law is often used to successfully deny needed health insurance benefits.   ERISA sets rules and standards for how insurance companies and/or businesses administer ERISA-based health, disability and life insurance plans.  These standards include clearly written rules and procedures for denial of claims or benefits and an appeal process to challenge such denials. 

If you are denied health insurance or other benefits, your ERISA plan administrator must give you the reason for denial in writing and in a manner you can understand.  It also must give you a reasonable opportunity for a fair and full review of the decision.  An employee or plan member must exhaust the appeal process before any lawsuit can be filed for benefit denial.  Generally any such suit must be filed in federal court following a complex procedure to prepare the case for judicial review. 

If you believe you have been improperly denied benefits under an ERISA policy or plan, how you build the record during the ERISA appeal process is key to whether you win the appeal and to whether you  win an ERISA lawsuit.  The Law Office of Stephen A. Burroughs handles ERISA appeals and suits and can give you advice on how to proceed during the appeal phase.  You may also want to view the following for information on your ERISA plan and the appeal and lawsuit process.
   http://www.michbar.org/younglawyers/pdfs/erisa_materials.pdf

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