Is Your Employer Denying You Benefits?

Allen Employment Lawyers Handling Employee Benefits / ERISA Claims

Dallas employment lawyers explain ERISA benefits and how to file a claim against an employer or insurer when benefits are denied. Employee benefits law is complex. Most employers do not have to offer health care or pension benefits. However, if they do, they must follow the requirements of federal law. But, sometimes companies will violate employee rights regarding employment benefits. If such a thing happens to you, you should discuss it with our Collin County employment lawyers.

The Employee Retirement Income Security Act (ERISA) was enacted in 1974 to make sure that employer-sponsored benefit plans are administered fairly and are kept on a solid financial footing. ERISA covers employee benefits such as health insurance, short- and long-term disability insurance, pensions, 401(k) retirement plans and life insurance. If your employer-sponsored benefit plan denies a valid claim, you can file a lawsuit for ERISA violations after exhausting internal appeals.

Are All Employers in Collin County Subject to ERISA Laws?

Depending on your job, federal ERISA law may or may not be cover you. The law requires private sector employers as well as some non-profit organizations with 50 or more employees to comply with ERISA if they wish to provide health care plans. The following employers do not have to comply with ERISA:

  • Governmental entities
  • Religious organizations such as churches
  • Small businesses with under 50 employees, unless they provide small benefit group coverage through insurance.

Private sector small businesses with between 20 and 50 employees are required to provide COBRA coverage under ERISA.

What is the Process of Filing an ERISA Claim in Texas?

Filing an ERISA claim can be intimidating. Here is a short breakdown of the ERISA claims and appeals process.

  1. Ask your insurance provider or employer for the claims procedure in writing.
  2. Following the procedure, you file a benefits claim based on type: urgent care, preservice, post-service or disability.
  3. Depending on the type of benefits claim you file, the insurance company has a certain time frame to respond. Within this time frame, you will receive an approval or a denial.
  4. If you receive a denial, you then file an appeal within the deadline set forth in your denial notice.
  5. The insurance company reviews your appeal and either approves or denies it.
  6. If you are denied once more, you can appeal through the U.S. Department of Labor.

The process seems straightforward, but there is potential for any number of problems to occur. ERISA is a complex and ever-changing set of laws and regulations that require extraordinary attention to detail when employee benefits are denied. Your best chance of having your appeal go through smoothly is by discussing your case with an ERISA attorney.

What Do I Do if I Am Denied Employee Benefits in Texas?

After a denial of your employee benefits, you have two choices. You can either accept the denial, or you can request the reversal of the denial through an administrative appeal. When filing an appeal, your goal is to collect evidence to add to your administrative record proving that you should receive benefits through ERISA. This can be a difficult task, one made much easier by speaking to an employment lawyer about your case.

It is important to act quickly when an employer or insurer denies your employee benefits. ERISA claims are different from the typical civil claim. Because ERISA claims involve federal law, it is best to file your claim as soon as possible in order to speed up the process and meet deadlines.

Here are common reasons for ERISA claims:

  • Failure to pay plan benefits – when your valid claim is denied
  • Breach of fiduciary duty – when an employer-sponsored benefits provider fails to honor its obligation to act in the employee’s best interest
  • Wrongful termination – when your employer terminates your employment in order to avoid paying benefits protected under ERISA

Involved in a Dispute over ERISA Benefits? Do Not Delay – Call Our Allen Employment Law Firm

Our North Dallas employment lawyers can help protect your rights under ERISA. Our attorney has been practicing employment law for more than 25 years. We know how insurance companies work and are prepared to aggressively negotiate for a fair settlement. As an experienced trial lawyer, Dan Atkerson is willing to go to court to fight for your rights. If you are in a dispute about employee benefits, then contact us at (214) 383-3606 for a confidential initial consultation or fill out our online contact form. Our consultations come at no cost to you. Additionally, our firm works on contingency fees. This means that, should we take your case, you will only owe us attorney fees if we are successful in obtaining ERISA benefits for you. We have clients throughout North Texas, including in McKinney, Plano, Allen, Irving, Grapevine and Frisco.