Medicare and Medicaid are two different government programs for healthcare. It is important to understand…
ERISA stands for the Employee Retirement Income Security Act of 1974, a federal law that sets minimum standards for insurance companies who provide health or disability insurance benefits as part of an employee benefit package. In other words, if you have health or disability insurance through your employer, then your insurer must abide by ERISA standards and regulations.
Under ERISA, your employer and the insurance company must be transparent with plan information and they also owe you a fiduciary duty, which means they must act in your best interests. If your employer or the insurance company fails to meet ERISA standards, such as denying you benefits to which you are entitled, the law also gives you the right to sue for benefits and breaches.
Suing for Benefits You Didn’t Receive
If you file an insurance claim, your insurance company must review the claim promptly, and if valid, award your benefits promptly. If your insurer denies your claim, the company must provide a written and reasonable justification for the denial. This means that the denial must be justified according to both your insurance policy (a.k.a. your insurance contract) and state and federal insurance law. If the denial was based on an error made by your employer, your employer also has an obligation to correct it so the claim can be approved.
If your claim is denied and you believe the denial was not justified under the law and your insurance contract, you also have the right to appeal. Most people don’t appeal insurance claim denials, which can be costly to your health and finances, especially since appeals are often successful. When people do appeal their insurance claim denials, they often recruit attorneys because some appeals progress into lawsuits that must be handled in federal court. In addition to appealing claim denials, ERISA also provides the option of filing a lawsuit against your insurance company for delaying approval or processing of your claim, requesting unreasonable amounts of information, and other unsavory tactics.
Put more simply, you can sue your employer-based insurance company any time you don’t receive the benefits you are entitled to under your policy or when your insurance company otherwise fails to act in your best interests.
Paying Your Attorneys’ Fees
When you’re faced with medical debt and/or are unable to work, the thought of filing a lawsuit may sound too expensive. If you file a valid legal claim under ERISA, however, and the courts decide your insurance company or employer is at fault, your insurance company or your employer will be responsible for your attorneys’ fees.
An attorney can evaluate the strengths and weaknesses of your case and help you take the best course of action, legally.
At Norton Health Law, P.C., we offer free initial consultations, and we never want you to feel like you can’t afford to talk to a lawyer.
Get Started Today
Norton Health Law, P.C. has special experience handling health insurance claims and disability insurance claims. Our founding attorney, Beth Norton, worked as a nurse and as a corporate healthcare attorney before opening her own practice to help patients and health care consumers like you.
If you believe your insurance company or employer is treating you unfairly, don’t wait to seek legal help. Instead, give us a call at (434) 978-3100 or contact us online to schedule a free case review.