Protecting the Rights of Employees under Managed Care and ERISA Plans

If you have been denied benefits provided through an employer-sponsored plan, your claim will generally fall under the Employee Retirement Income Security Act (ERISA).  ERISA is a federal law that governs most employee benefit plans.  While ERISA was originally enacted to safeguard employees’ retirement and pension benefits, the protections afforded under ERISA have been expanded over the years. 

Although ERISA is designed to provide certain safeguards to employees, insurance companies often use ERISA as a shield to unfairly deny valid claims.  When a claim is governed by ERISA it preempts state law.  This preemption leads to a number of consequences that can give the insurance company an unfair advantage.  These include:

  • No jury trial
  • No trial in state court
  • No consequential damages
  • No punitive damages
  • No right to depose expert witnesses
  • No right to depose insurance company witnesses
  • No right to testify on your behalf

In addition, before an employee can take any legal action against the insurance company, he or she must meet all administrative requirements under the plan.  The attorneys at Berg Plummer Johnson & Raval, LLP are very familiar with the procedures that need to be followed when a claim is covered under an employer sponsored benefit plan.  We are experienced ERISA lawyers who are highly skilled in handling all types of disability, life insurance, accidental death and dismemberment and health insurance claims governed by this complicated federal law. 

In most situations, when an ERISA claim is denied the plan will usually allow for at least one appeal.  During the appeals process, a managed care or ERISA attorney at our firm will act quickly to submit additional records and evidence in support of your claim.  We know the type of information that is necessary to get a claim approved or a denial reversed and will work diligently to present the strongest possible case to the insurance company. 

Why Hire an Attorney for Managed Care and ERISA Challenges?

It is necessary to have an experienced attorney working on your behalf throughout the claims process. In most cases, you will you not be permitted to submit any additional information if you file a lawsuit later down the line – the court will only review the information that was already in the record at the conclusion of the appeals process. 

When an appeal is unsuccessful and all administrative remedies provided for under a plan have been exhausted, our legal team is fully prepared to protect your rights in court.  Unlike most civil cases, in an ERISA suit, the courts will generally use a standard of review that gives deference to the insurance company.  This means that the insurance company’s decision to deny your benefits will only be overturned if the court finds that the company abused its discretion when making its determination.

Additional ERISA-Related Cases

Beyond representing individual employees who have been denied disability and other benefits under an employer-sponsored plan, our lawyers also handle a variety of other ERISA-related matters, including:

  • ERISA Class Actions
  • Fiduciary Nondisclosure and Misrepresentation Claims

Contact Berg Plummer Johnson & Raval, LLP to Discuss Your ERISA Claim

If you have been denied ERISA benefits, the attorneys at Berg Plummer Johnson & Raval, LLP can help you file a case and recover the compensation you deserve. For more information on filing an ERISA claim, call our firm today to schedule a consultation. Our lawyers offer unique, cost-effective fee arrangements and will fight for your rights throughout the entire duration of your case.

Contact Us

Berg Plummer Johnson & Raval, LLP
Berg Plummer Johnson & Raval, LLP Logo 4203 Montrose Boulevard, Suite 260, Houston, TX 77006
Phone: 713-526-0200 - Fax: 832-615-2665