ERISA Claims

Many New York employers voluntarily provide their employees with benefits, such as pension benefits, disability insurance, and life insurance. Such plans often provide employees with peace of mind that they will be financially taken care of when they retire or if they develop debilitating health issues that prevent them from working. ERISA (Employee Retirement Income Security Act of 1974) applies to several employer-funded benefits plans; as such, employees seeking benefits under such plans will typically file an ERISA claim. ERISA claims can be challenging to navigate, however, as they involve strict deadlines and procedures. As such, it is critical that if you are pursuing an ERISA claim, you should seek the assistance of an attorney. Valerie Crown of The Law Firm of Valerie J. Crown, Attorney at Law, P.C., is a knowledgeable Rockland County ERISA lawyer who can guide you through the process of seeking disability benefits you may be owed. Ms. Crown represents people with disability ERISA claims in Rockland, Orange, Westchester, Dutchess, and Ulster Counties, as well as the greater metropolitan area.

ERISA is a federal law that governs the process for individuals seeking benefits from private-sector employee benefit plans, including pension plans, health insurance, disability insurance, and other welfare benefits.

Pursuant to ERISA, a request for benefits is considered a claim. People typically file ERISA claims on account of disability or death. Notably, ERISA claims differ from workers’ compensation claims in that workers’ compensation benefits are only available to employees who suffer work-related harm, while ERISA claims provide benefits to people who suffer illnesses or injuries outside of the scope of employment.

The ERISA claims process consists of several stages. It begins with the claimant filing a formal claim with the plan administrator or insurance company responsible for administering the benefits. If you are an ERISA claimant, it is essential that you provide all relevant documentation and evidence supporting your claim for benefits, which may include financial records as well as medical records and statements from treating physicians.

Once your claim is submitted, the plan administrator conducts an initial review to determine your eligibility for the requested benefits according to the terms of the plan. The administrator is required to respond with a written decision, regardless of whether there is an approval or denial of your claim. The decision may take up to 105 days. If the claim is denied, the claimant has the right to appeal the decision within 180 days.

If you appeal, you should offer any additional documentation that may support your claim and set forth legal arguments demonstrating the denial of your claim was improper. It is important to have an attorney assist you. Parties from the insurance company, who were not involved in the initial decision, will conduct a comprehensive review of the claim and consider any evidence and arguments offered by the claimant/claimant’s attorney. The plan administrator will then issue a written decision on the appeal, typically within 60 days. Most plans offer a voluntary second appeal.

After appeals are complete, the plan administrator will issue a final decision on the claim. This decision is binding; however, if it is adverse, a claimant has the option of initiating legal action in federal court to challenge the denial of benefits.

Many people who are no longer able to work, due to disabling medical conditions, can recover benefits from their employer, but the ERISA claims process can be complicated, and delays and mistakes can result in a denial of benefits. If you are unable to work due to non-work-related illness or injury, you should speak to an attorney about your rights. Valerie Crown of The Law Firm of Valerie J. Crown, Attorney at Law, P.C., is a dedicated Rockland County ERISA claims attorney who is adept at handling complex claims, and if you engage her services, she will fight to help you seek a just outcome. Ms. Crown’s office is located in New York, and she represents people in ERISA claims in Rockland, Orange, Westchester, Dutchess, and Ulster Counties, as well as the greater metropolitan area. You can contact Ms. Crown by calling 845.708.5900 (office number) or 845.598.8253 (Valerie’s direct cellphone 24/7) or via the form online.