What is ERISA?

ERISA is an acronym of the Employee Retirement Income Security Act of 1974, the law that governs most employee benefits disputes (except benefits for government and church employees and other special circumstances). While state courts technically share jurisdiction with the federal courts over some ERISA cases almost all ERISA cases are ultimately decided in federal district court.

There are several aspects of ERISA litigation that can make it more difficult to pursue than other types of civil cases in state and federal court. First, benefits cases are decided on a paper record developed for the most part before filing suit. Witnesses seldom, if ever, testify in court in an ERISA case. Second, the issue presented in an ERISA case is often not whether the employee meets the terms of the plan (policy) entitling him or her to benefits but whether he or she can show whether the defendant acted “arbitrarily and capriciously”. This is a very significant additional hurdle in many cases. Third, the federal court is empowered to award past benefits and can place the plaintiff back in the plan but the court cannot award a lump sum of future benefits. This means that the defendant (typically an insurance company) has the opportunity to cut the benefits off again in the future.

We know, and make, everyone we represent aware of, these risk factors. Nonetheless, we have often been of significant service to our clients either by court outcome or by settlement.

What types of benefits cases does your firm handle? How do you charge for your time?

Our firm typically handles long-term disability (“LTD”), medical benefits and long-term care insurance cases. Although there is no hard and fast rule, we prefer to handle cases with a gross value of at least $100,000 in value. In an initial case evaluation we can help you determine the value of your case. We typically do not get involved in cases involving only short-term disability benefits unless those benefits are tied to LTD benefits. In any case we will have to look at medical and vocational records and if there is little supporting evidence we will most likely have to decline your case.

If there is evidence to support your case but the amount of the benefits does not approach or exceed $100,000 in issue, we still may be able to take your case on an hourly or mixed hourly/contingency fee basis. Please give our office a call and give us the basic facts. We will be glad to schedule a free consult if we think we can be of assistance.

On a final note, we sometime get calls where the issue is simply that the potential client has been receiving LTD benefits and then receives a large Social Security disability award. Invariably, the LTD insurance carrier wants to be paid back for an alleged overpayment. Usually the insurance company has the right to demand this based upon the terms of the plan (insurance policy) or based upon another signed document. Unless there are unusual circumstances, we are not able to help and usually decline such cases.

What type of service does your firm provide?

We have been involved in all phases of the claim process and have made a difference for the client at each stage. We have provided pre-claim consulting that has helped clients present their claim in the best possible light. We have gotten involved in the initial claim process and help clients properly fill out insurance documentation. We have made a substantial impact on cases at the pre-suit appeal level and have been able to restore benefits to clients in many instances. We have substantial experience handling ERISA cases in federal court, both at the federal district court and circuit court of appeal level. Please see our “results” page for more information.

When should I schedule a consult?

We urge you to contact an attorney as early as possible in the claim process. If nothing else, please resist the temptation to draft your own pre-suit appeal without first contacting an attorney. It is usually very difficult to add additional evidence to the record once the pre-suit appeal process is complete. We have handled many pre-suit appeals and are familiar with both the legal and medical issues in ERISA cases.