It can seem unfair when the benefits you have paid for through your employer suddenly become unavailable to you when you make a claim. However, the Employee Retirement Income Security Act of 1974, or ERISA, was passed to require fiduciary responsibility of employers and plan sponsor. The act also provides employees with rights in the event a claim they make on a benefit plan covered by ERISA is handled fairly.

The Kimsey Law Firm, P.A., represents Florida employees with accounts covered by ERISA, and we provide one-on-one attention so you can be sure your conflict in this specialized area of benefits law will be handled aggressively, efficiently and successfully.

ERISA Frequently Asked Questions

Here are answers to a few of the most commonly asked questions our firm receives about ERISA and how it operates.

What Is ERISA?

The laws included in ERISA set minimum standards for employers who choose to offer health insurance, pension/retirement accounts and other types of employee benefits. Employers are required to abide by many organizational and administrative regulations, including:

  • Producing summary plan disclosures for employees
  • Submitting detailed reports to the federal government related to plan administration
  • Providing notice to pension plan enrollees if a plan is going to be amended or eliminated
  • To pay a portion of the company's unfunded vested benefits if it intends to withdraw from a retirement plan

How Do I Know If My Benefit Plan Is Governed By ERISA?

Most private sector employees are covered by this act. If you work for a public sector employer, especially a government entity, your benefit plans are not covered by ERISA. Also, some small businesses that have concerns about meeting ERISA's requirements may choose not to offer benefit plans that are covered by the act.

What Should I Do If A Claim Covered By ERISA Is Denied?

The timeline for appeals begins the moment you file a claim for the first time. After that, in general:

  1. The claim administrator has 30-45 days (with extensions possible) to approve or deny your claim.
  2. You (the claimant) then have 180 days after the date of denial to appeal your claim.
  3. The administrator then has 45-60 days (plus possible extensions) to approve or deny your appeal.
  4. If your appeal is denied during an internal review, you have the option of filing a lawsuit to obtain your benefits.

Why Do I Need A Lawyer To Help Me Reverse An ERISA Claim Denial?

The internal review process is bound by strict deadlines, and the plan administrator uses their knowledge of ERISA and how it works against you if it intends to deny your claim. An experienced ERISA attorney can help you meet tight submission deadlines, gather relevant medical evidence, attend independent medical examinations with you and create a compelling administrative record during the internal review period. This record is often the strongest part of your litigation if you file a lawsuit, and can mean the difference between winning and losing your case.

More ERISA Questions? Bring Them To Us.

Our attorneys are experienced with ERISA's complex set of guidelines and procedures. We can help you access the benefits you have paid for and deserve. Call us at our Tampa office at 813-867-2179 or email us to set up a free introductory appointment. We serve clients across the Tampa Bay area.