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Insurance Company Denies Your ERISA Claim

Kantor & Kantor is a one of the most experienced and highly respected law firms dealing with the prosecution of claims against insurance companies. Our firm has extensive experience with the complex appeals procedure and Federal Court litigation of ERISA matters.

Insurance companies make every effort to avoid making pay outs, attempting to minimize their loses. They are notorious for denying ERISA claims. The reason for the lack of fairness and proper payment of claims in ERISA cases is that when an insurance company denies an ERISA claim, it knows that even if it is wrong in denying the claim, the most the court can force the insurance company to pay is the claim it should have paid in the first place. If that is all the insurance company can be liable for, what is the incentive for the insurer to pay the claim?

All ERISA claims have several things in common. They are most frequently litigated in Federal Court, a court in which most lawyers are uncomfortable. Before getting to court there is an administrative appeal that you must follow. It is imperative that this appeal procedure is followed. If it is not, you will in all likelihood lose your right to sue the insurance company. If you wish a brief summary of the appeal process and what you must do to make sure the appeal is properly prosecuted, e-mail us and we will send you one.

If you, or anyone you know, has questions about claims against their insurance company involving ERISA, contact an experienced California ERISA claims attorney at Kantor & Kantor toll free at 866-384-1126 to set up a free consultation.

What is the Employee Retirement Income Security Act (ERISA)?

The U.S. Congress, out of concern over corporate mismanagement of worker's retirement funds, passed erisa in 1974. The Act establishes detailed regulations effecting employee welfare and pension benefits, and it enforces certain rights for employees and responsibilities for employers concerning benefit plans that were created after January 1, 1975. erisa federalizes all disputes over employment related benefits, and preempts all state law for cases involving businesses engaged in interstate commerce.

The U.S. Congress, out of concern over corporate mismanagement of worker's retirement funds, passed erisa in 1974. The Act establishes detailed regulations effecting employee welfare and pension benefits, and it enforces certain rights for employees and responsibilities for employers concerning benefit plans that were created after January 1, 1975. erisa federalizes all disputes over employment related benefits, and preempts all state law for cases involving businesses engaged in interstate commerce.

ERISA requires employers to provide detailed descriptions of their benefit plans, and it requires that a percentage of an employee's benefit contribution be vested at a certain point in a worker's employment history at a certain age. erisa also requires that pension plans provide survivor's benefits for each qualified worker, and the administrators of these plans must conduct themselves within specific fiduciary criteria. erisa set guidelines for employers to follow to assure they adequately fund their pension plans, and erisa requires that employers purchase insurance to protect their pension plans through the Pension Benefit Guaranty Corporation (PBGC).

Two governmental agencies share most of the responsibility to enforce erisa rules and regulations. The IRS is responsible for enforcing the vesting and funding requirements by removing tax-exempt status for those employers who violate these regulations. The U.S. Labor Department enforces the provisions associated with rules of disclosure, reporting, and the fiduciary responsibilities of an employer.

ERISA regulates an employee's right to carry-over their benefits from job to job. The Health Insurance Portability and Accountability Act (HIPAA) amended erisa to endure the portability of an employee's health care plan by preventing exclusions in a new employers plan due to preexisting conditions.

Who is covered by the Employee Retirement Income Security Act?
Any employee benefit plan established or maintained by any employer or organization representing employees engaged in commerce, or in any industry or activity affecting commerce, is covered by erisa. erisa does not apply to government plans or tax-exempt church plans as defined by the Act. Also exempt are plans maintained solely for the purpose of complying with workers compensation, unemployment, or disability insurance laws, or those maintained outside of the U.S. primarily for the benefit of persons who are nonresident aliens.

Any employee benefit plan established or maintained by any employer or organization representing employees engaged in commerce, or in any industry or activity affecting commerce, is covered by erisa. erisa does not apply to government plans or tax-exempt church plans as defined by the Act. Also exempt are plans maintained solely for the purpose of complying with workers compensation, unemployment, or disability insurance laws, or those maintained outside of the U.S. primarily for the benefit of persons who are nonresident aliens.

What administrative body may impose remedies for a violation of the Employee Retirement Income Security Act?
ERISA has designated the Secretary of Labor broad powers to investigate and determine violations and impose remedies. The Secretary of Labor, plan participants, beneficiaries or fiduciaries, can bring erisa actions to U.S. District Courts. Criminal prosecutions may be brought against persons who willfully violate the Act.

ERISA has designated the Secretary of Labor broad powers to investigate and determine violations and impose remedies. The Secretary of Labor, plan participants, beneficiaries or fiduciaries, can bring erisa actions to U.S. District Courts. Criminal prosecutions may be brought against persons who willfully violate the Act.

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