ERISA Information

ERISA (the Employee Retirement Income Security Act of 1974) is a complicated federal statute that governs employee benefits such as pensions, health insurance, and long-term disability insurance. Just about any benefit obtained by an employee from a private, non-church employer is covered by ERISA. Several aspects of ERISA, as interpreted by the courts, favor insurers and employers over employees. For example, most benefit plans confer discretionary authority on the employer. This means that if the employer self-insures the benefit at issue, a court can only overturn a claim denial if the employee proves that the employer or its administrator abused its discretion. In essence, the employee must prove that the employer’s decision was unreasonable. Second, the courts usually review only that evidence, which was before the insurance company or employer at the time it rendered its final decision on the claim. The record at trial cannot be supplemented, and discovery is severely truncated. For this reason it is essential that claimants do a very thorough job in demonstrating that they qualify for benefits while the claim is being processed. It is Mr. Chabre’s opinion that most claimants should have have help from a lawyer during the administrative appeal process.