ERISA Primer — Allenstein & Allenstein
Experience Matters
Filing an Employee Retirement Income Security Act (ERISA) claim is a complicated process that can be done effectively if one has experienced, thorough and skilled legal representation. At Allenstein & Allenstein, attorney Myron Allenstein has more than 20 years of experience assisting individuals and families throughout North Alabama with their ERISA claims. He is there for his clients throughout the entire ERISA process and more than prepared at every step of the way.
We understand that you likely have many questions and concerns regarding your ERISA claim. Please schedule a free initial consultation at our Gadsden, Alabama, law firm, and contact us today to discuss your case.
Common Questions and the ERISA Claims Process
1. What is an ERISA case?
- Medical insurance claims when insurance was through employer
- Short- (STD) or long-term disability (LTD) benefits when insurance was through employer
2. What law gives authority for ERISA claims?
Statutory authority for claims — 29 USC §1132 — Preemption — Federal Court
3. Why do I need an ERISA attorney?
The typical case:
Employee injured back and had back surgery. Employee drew STD benefits and then LTD benefits for 24 months. The insurance company terminated benefits after 24 months of LTD benefits because the definition of disability changed from "own" occupation to "any" occupation. Employee just won Social Security Disability (SSD) disability benefits. The insurance company or employer demands $10,000 of LTD back benefits, claiming overpayments due to offset. Employee's attorney does not handle ERISA cases. Employee now requires assistance from an ERISA attorney.
4. What will an ERISA attorney do?
The ERISA attorney will:
- Obtain accurate statements from client
- Determine whether the insurance company has been provided with complete medical records including an opinion regarding disability
- Determine whether or not the insurance company was sent the SSD award
- Review the ERISA plan, summary plan description and/or insurance policy
- File an administrative appeal. Employee must exhaust administrative remedies.
- On appeal, will explain why benefits should be continued based on medical records
- Request the claim file. The attorney must have the claim file on which the case will be tried.
- Determine if more evidence of disability is required
- Determine if an expert is needed for reviewing the claim file
- Be familiar with deadlines and the number of administrative appeals required
- Summarize the claim file with a table of contents
- Begin to prepare a motion for judgment, considering if the case is strong enough to convince a federal judge that the insurance company made the wrongful decision
- Add evidence of disability if necessary, i.e., medical opinion, recent treatment, psychological evaluation, vocational evaluation
5. What happens after an administrative appeal?
After an administrative appeal, file the ERISA lawsuit:
- State court or federal court?
- Claim: Benefits, attorney's fees and interest
6. What about mediation?
Mediation: Generally a waste of time and money unless a judge or magistrate conducts mediation
7. Are benefits taxable?
Yes, if the employer paid the premiums or provided coverage. No, if purchased by employee
8. Current case law:
The recent case of Metropolitan v. Glenn (554 U.S.105 (2008)) is still being interpreted by the 11th Circuit Court. Attorneys should review 11th Circuit Court opinions which interpret the MetLife case.
Contact Us for Experienced Huntsville ERISA Assistance Attorneys
For more information about the ERISA claims process and how Allenstein & Allenstein can assist you, please contact us online for an experienced ERISA assistance lawyer. You can also call our office toll free at 1-866-546-6314.
