Philadelphia ERISA Claim Denial Attorneys Guiding Clients Through the ERISA Denied Claim Appeal Process in PA
A large number of American workers are enrolled in health and retirement benefits through their employers. ERISA is an important federal law that provides some protection for employees and their beneficiaries who participate in health, retirement, and/or wellness plans sponsored by their employer. Learn how ERISA works and what to do if your claim has been denied.
What does ERISA mean?
ERISA is the Employee Retirement Income Security Act. Created in 1974, the act protects the interests of current and former employees and their beneficiaries when they opt to participate in benefit plans through an employer. It can be thought of as a federal law that imposes certain standards that must be followed by health and retirement plans provided by the private sector.
Some of those standards include the need to provide enough information about plan features, changes in the plans, and establishing fiduciary duties to financial professionals and other individuals that may be in charge of managing plan assets. ERISA also contains rules concerning how transactions associated with employee benefit plans may impact federal income taxes.
Why Can ERISA Claims Be Denied?
It is an unfortunate fact that life insurance companies may frequently try to deny the payment of benefits to a beneficiary of a deceased employee who was a policyholder. Most employees believe that just paying their premiums every year is enough to guarantee that their loved ones will receive death benefit payment when the time comes, but things are not always that simple. Payment can be denied if the insurer alleges that the policyholder engaged in misrepresentation or that somehow the injury that led to the policyholder’s death was self-inflicted and thus does not qualify for coverage.
In other cases, insurance companies may sometimes retroactively cancel a policy, a practice that can be rather unfair to beneficiaries and prevents them from receiving the payment of a claim. They may also try to find other ways to deny a claim because it is not in their best interest to be offering generous payouts, and they would rather protect their profits. Being blindsided by a claim denial at a time when you are not only grieving but also need the extra money to cover financial needs can feel like a dead end. If you are in this situation, consult an attorney experienced in handling ERISA denials, as there may well be a feasible option to turn the situation around and get you the death benefits you are entitled to.
How Long Does a Beneficiary Have to Appeal a Denied ERISA Claim?
After being notified that their claim was denied, many beneficiaries tend to wait for a long time before taking action and speaking to an ERISA claims denial attorney like the ones at the Boonswang Law Firm. However, it is important to understand that once you receive a denial letter, the clock starts ticking. Beneficiaries may have only 180 days to file an appeal, and sometimes as little as 60 days. Your appeal should be done in writing. In some cases, it may be possible to gain more time by seeing an expert (such as an attorney) so as to gain new information regarding your claim.
It is quite common to see denials occurring during the contestability period included in almost all life insurance policies, which is a 2-year period in which the insurance company is allowed to investigate any death claims that take place during that time with the goal of uncovering if the policyholder engaged in any fraud or misrepresentation. In this case, the burden of proof lies with the insurance company. It is up to them to present evidence to support their reasons for denying coverage, which is often a challenging process and leaves an opportunity for a seasoned attorney to help revert the situation. If your claim was denied, it may be in your best interest to seek the help of an attorney shortly after receiving your denial letter.
How Can an ERISA Claim Denials Lawyer Help?
Understanding all the rules surrounding benefit plans under ERISA is a complex task, but being able to rely on someone with a deep knowledge of ERISA who can identify the frequent errors made by insurance companies, insurance agents or even the insured’s employee is crucial for the success of your case. The Boonswang Law Firm has been successful in representing beneficiaries in these cases as well as in cases involving employers that do not fulfill their duties to their current or former employees once they leave their jobs. Our attorneys have repeatedly made significant recoveries for our clients in Philadelphia, PA, and surrounding areas.
For example, our legal team has been able to recover several six and seven-figure claims for our clients, including $1,000,000 from ING Insurance Company; $750,000 from New York Life Insurance Company; $500,000 from AIG American General Life Insurance Co.; $300,000 from Liberty Mutual Insurance Company; and $250,000 from AAA Life Insurance Company, Household Life Insurance Company, Transamerica, and Prudential Life Insurance Company.
While it is important to highlight that each case is different and results may vary, your chances of success are maximized when you let an ERISA claims denial attorney handle your case on your behalf. Dealing with endless forms and paperwork for the insurance company while grieving the loss of a loved one is an incredible burden, especially when you end up lying awake at night worrying about how the family will get by without the life insurance money you were counting on. The attorneys at the Boonswang Law Firm can deal with the insurance company for you, and take your case to court if necessary. Reach out to our Philadelphia office by calling 215-940-8900 and requesting a free consultation to talk about your case and learn your options.