The basics of erisa --- a federal statute governing employee benefits

 
 

ERISA is a complicated law and regulatory scheme that involves many issues not typically found in other cases.  These can include:

  1. Filing An Administrative Appeal

  2. The Insurance Company’s “Discretionary Authority” to Deny Claims

  3. The Insurance Company’s “Conflict of Interest”

  4. Exceptions to ERISA like the “Safe Harbor”

  5. ERISA’s Prohibition on “Bad Faith” Damages


General Background on ERISA:

Congress passed the ERISA law to bring uniformity to state laws governing pension and benefit plans, saying its purpose was to “promote the interest of employees and their beneficiaries in employment benefit plans.”  The effects of ERISA, however, include shielding insurance companies from state laws --- including prohibiting bad faith punitive damages to punish them for their wrongful conduct --- and giving insurance companies “discretionary authority” to shield them from close scrutiny of their denials.


ERISA does not require employers to provide any particular benefits.  But, if an employer provides benefits like a pension plan, health insurance, or disability insurance, unless the plan is exempt from ERISA under one of its exceptions, ERISA will regulate that plan and apply to claims for benefits.   


Many health insurance and disability plans are subject to ERISA.  If you got disability insurance through work, and the insurance company denied your claim, chances are your claim will be subject to ERISA. 


Frequently, the insurance company will tell you about “your rights under ERISA” when denying your claim.  Your rights include the right to file an administrative appeal, and the  right to file a lawsuit if your administrative appeal is denied.  Patrick is an Arizona lawyer who can answer questions about how you can protect your rights under an ERISA disability insurance policy or file a lawsuit if your benefits have been wrongly denied. 

ERISA --- the Employee Retirement Income Security Act of 1974, 29 U.S.C. ß 1001 et seq. 

ERISA applies to many long term disability claims, and other claims for employee benefits.  ERISA has specific rules and procedures that are not applicable to other insurance claims, and that are not familiar to most attorneys.


Patrick focuses his practice on ERISA and non-ERISA benefit claims.  If you questions about your claim that you would like to ask a lawyer, or if you need help with your ERISA administrative appeal, contact Patrick for a free consultation

The information on this website is intended to be informational only and does not establish an attorney/client

relationship, nor is it meant to give or be legal advice for a specific matter.  Please do not email or fax information to

Patrick Mause without first speaking or meeting with him because the information will not establish an attorney/client

relationship and may not be kept confidential. Patrick Mause is a lawyer admitted to practice only in Arizona, the Arizona

District Courts, and the Ninth Circuit Court of Appeals.  His office is located at 290 North Meyer, Tucson, Arizona 85701.