ERISA Appeals

The ERISA appeals process is a significant part of the firm’s Long Term Disability insurance practice.

In 1974, Congress passed the Employee Retirement Income Security Act (ERISA). The law was created to address concerns that private pension funds were being mismanaged by businesses. ERISA has been changed over time to address retirement and health care needs of employees and their families. It requires that employers providing employee benefit plans provide employees with information about their plans, and must meet certain standards of conduct in their role as fiduciaries – meaning they have a responsibility to their employees to act in their employees’ best interest.

Somewhere along the line it was discovered that employee disability benefits were covered by the ERISA umbrella. While the original intent of the law was to protect employees, it was turned on its purpose and transformed into a tool that is used by disability insurance companies to control and strictly limit the ability of a policy owner to fight back when a claim is denied or when benefits are cut off.

The rules for an ERISA appeal are extremely strict, and there is no deviation during the course of an ERISA appeal. Lawyers who do not practice this specific area of the law are not likely to be familiar with the restrictions and what is permitted and what is not allowed.

An ERISA appeal is akin to a trial on paper where the insurance company you are fighting is the judge and jury. During an appeal, the claimant must present factual, medical, legal and vocational evidence as to how and why the claimant is disabled and entitled to benefits under the plan. If that does not sound fair to you, you are right. The entire process is stacked against the claimant. Courts reviewing ERISA lawsuits often act as a rubber stamp of the claim termination or denial. The appeal is the only opportunity to create a record for litigation, with the hope that the Court will be receptive to the demonstration of wrongful conduct by the insurer.

That is why Frankel & Newfield uses the symbol of a see-saw, weighed on one side with heavy metal spheres. We think this best illustrates how it feels to be on the receiving end of a termination or denial of disability benefits. It just doesn’t seem fair that at the same time that you are struggling with an illness or injury that is so debilitating that you cannot work, you must also contend with the challenge of fighting a huge and hugely powerful disability insurance company in a highly restrictive administrative appeals process.

This is one battle you don’t want to fight alone- and with Frankel & Newfield, you don’t have to.