Once all administrative remedies have been exhausted, including a mandatory administrative appeal, the Employee Retirement Income Security Act (ERISA) claim has now entered the litigation phase. A case will either be filed in state or federal court. Although not all ERISA claims end up in litigation, having an attorney who has extensive experience and is prepared to take the claim through the district court, circuit court of appeals level and beyond is essential to seeking the benefits you deserve.
Attorney Myron Allenstein has more than 20 years of ERISA experience, including representing individuals throughout North Alabama in ERISA litigation cases. If you have an employment-related insurance claim, schedule a free initial consultation with our highly skilled North Alabama ERISA litigation attorney. At Allenstein & Allenstein we are one of the few law firms in our area that can provide comprehensive ERISA litigation services. Contact us today.
Primary Issues in ERISA Litigation
In an ERISA lawsuit, the standard of review is either de novo or abuse of discretion. The court will consider whether the decision to deny or terminate benefits was wrong and if there is a conflict of interest. Discovery is allowed under some circumstances.
The 11th Circuit Court in Williams v. BellSouth Telecommunications, 373 F.3d 1132, 1138 (11th Cir. 2004) explained the issues on an ERISA claim:
- "(1) Apply the de novo standard to determine whether the claim administrator's benefits denial decision is 'wrong' (i.e., the court disagrees with the administrator's decision); if it is not, then end the inquiry and affirm the decision.
- (2) If the administrator's decision in fact is 'de novo wrong' then determine whether he was vested with discretion in reviewing claims; if not, end judicial inquiry and reverse the decision.
- (3) If the administrator's decision is 'de novo wrong' and he was vested with discretion in reviewing claims, then determine whether 'reasonable' grounds supported it (hence, review his decision under the more deferential arbitrary and capricious standard).
- (4) If no reasonable grounds exist, then end the inquiry and reverse the administrator's decision; if reasonable grounds do exist, then determine if he operated under a conflict of interest.
- (5) If there is no conflict of interest, then end the inquiry and affirm the decision.
- (6) If there is a conflict of interest, then apply the heightened arbitrary and capricious review to the decision to affirm or deny it."
The sixth step analysis maybe changed by Metropolitan v. Glenn. We also take a proactive approach by filing a motion for judgment. This is a dispositive motion that seeks to convince the judge you should win. We also look for settlement opportunities in situations where:
- Defendant has started paying attorney's fees
- After a motion for judgment: when it becomes evident you will should win
- Attitude of the judge is important
After the lawsuit is filed we will:
- Have a planning meeting — usually by phone
- Provide initial disclosures — usually just correspondence (defendant already has medicals in claim file)
- File any motions for judgment
- If the case is lost, we will appeal if appropriate
ERISA and Social Security Disability
An award for Social Security Disability (SSD) is persuasive evidence of a disability in ERISA litigation. Both the insurance company and the court have to consider an SSD award as part of the evidence. Attorney Rose Allenstein has more than a decade of legal experience and can assist with any Social Security Disability claims.
Contact Us for an Experienced Attorney Who Handles ERISA Cases in North Alabama Including Huntsville
To schedule a free initial consultation with an experienced employee benefits lawyer, contact Allenstein & Allenstein. You can also call our office toll free at 1-866-546-6314.
