Understanding ERISA Law

Protecting Employee Benefits and Ensuring Financial Security

The Employee Retirement Income Security Act, commonly known as ERISA, was introduced in 1974. ERISA is a federal law that was designed to protect the rights and interests of employees who take advantage of their employer-provided benefit plans. Today, ERISA encompasses a broad range of employee benefits provided by employers and employee organizations, including  pensions and retirement and health and welfare plans.  While the purpose of the legislation was to protect employees, it has instead become a complicated regulatory jumble that, unless your employer or insurance company is held to the rules, favors the decision making of companies that are not concerned about your benefits or your best interest.

Why hire an ERISA attorney?

Navigating ERISA: Most benefits received through an employer are governed by ERISA, which has complex procedural rules. Attorneys experienced in ERISA cases can guide claimants through these rules and procedures effectively.

Fighting Insurance Companies: Insurance companies (who are concerned about profits, not your best interests) are skilled at using the rules to their advantage, often to the detriment of claimants. Legal representation helps level the playing field and increases the chances of a favorable outcome.

Legal teams like Davis Olszeski specialize in advocating for individuals facing disabilities  ensuring their stories are heard and their rights protected throughout the claims process.

How an ERISA Attorney Can Help:

Attorneys review the policy and denial letter to understand the reasons for denial and identify any loopholes that could benefit the policyholder.

Attorneys gather necessary evidence, such as medical records and witness statements, to support the claim and refute the reason for denial.

Attorneys negotiate with the insurance company on behalf of policyholders, offering additional evidence or addressing concerns raised by the insurer.

If negotiation fails, attorneys can file a lawsuit, leveraging their knowledge of applicable laws and regulations to present a solid legal argument in court.

Attorneys may also explore alternative mechanisms for settlement, such as arbitration or mediation, to resolve the conflict outside of court.

What Are The Key Components of ERISA

  • ERISA covers claims related to most employer-provided pension, severance, health, and welfare benefit plans, including disability, life, accidental death, and dismemberment, and pension benefits.
  • It typically applies to benefit plans established by private sector employers and does not apply to plans offered by churches or government entities.
  • Large employers may self-fund these benefit plans, but benefits are usually paid with insurance policy funds.
  • ERISA preempts all other state laws, meaning the rights and remedies available to claimants are determined under ERISA.
  • Under ERISA, insurance carriers or benefit plan administrators decide whether a claimant meets the requirements for benefits based on the terms set forth in the insurance policy or benefit plan document.
  • Claimants must exhaust their administrative remedies by submitting a request for review or appeal to the administrator before filing a lawsuit for benefits.
  • Courts are typically limited to the claims record that exists at the time of the final denial.

Individuals typically have 180 days after receiving the denial letter to submit a written request for review of the claim denial. However, due to COVID and regulatory changes, this time frame may vary. It's crucial to contact legal assistance promptly upon receiving the denial letter to ensure timely action.

The appeal is a critical aspect of an ERISA benefits claim, as the information submitted or generated during the appeals process forms the Administrative Record. This record is often the only evidence considered by a reviewing court when determining entitlement to benefits.

Therefore, the appeal is vital in presenting a comprehensive and thorough case to support the claim for benefits.

  • Analyzing the reasons for the denial outlined in the denial letter.
  • Requesting the claim file from the claims administrator to fully assess the basis for the denial.
  • Obtaining, analyzing, and summarizing medical records to support the disability claim.
  • Obtaining medical assessments and addressing any surveillance evidence.
  • Obtaining independent medical and vocational evaluations.
  • Gathering third-party statements supporting the disability claim.
  • Preparing a detailed appeal letter that effectively presents all the evidence supporting the disability claim.

ERISA Appeals Process

One of the crucial aspects of ERISA is the provision for appealing denied benefit claims. When a participant’s claim for benefits is denied, ERISA ensures that individuals have the right to appeal the decision through a structured process. This process includes several steps:

Internal Appeal

Participants submit an internal appeal to the plan administrator, providing additional evidence or clarifications to support their claim.

Internal Review

If the internal appeal is unsuccessful, ERISA allows for an independent external review of the claim by a third-party reviewer.


If the external review also results in an adverse decision, participants 
have the right to file a lawsuit to challenge the denial of benefits.

The appeals process is designed to ensure fairness and transparency, serving as a mechanism for individuals to challenge unfavorable decisions made by plan administrators.

When you are going through one of the most stressful and scary times in your life, the last thing you want to worry about is fighting for the benefits you expect and are owed. Our mission is to guide you through claims, litigate inappropriate denials to get you your promised benefits, and hold insurance companies accountable to the law. You do not have to fight alone. 

Navigating ERISA Law with Confidence: Your Trusted Partner in Employee Benefits Law and ERISA Appeals

We specialize in providing comprehensive expertise in both Employee Benefits Law and

ERISA Appeals, ensuring that your rights are upheld, and your financial security is protected.

Understanding your rights concerning your employee benefits is crucial. When you are going through a difficult time, the last thing you want to deal with is insurance agencies giving you the run around about what you are rightfully owed. Our team is there every step of the way to guide you through the claims process, handle appeals, and represent you effectively in a courtroom setting.

Why Choose Davis Olszeski Disability Law?

We are experts in employee benefits law and ERISA appeals and are equipped to guide you through the entire process. With a history of successful outcomes, we’re committed to achieving the best possible results for your unique case. Our personalized approach ensures we are able to address your specific needs and concerns with clear communication at every stage.

If you’re facing challenges within employee benefits law or seeking guidance for an ERISA appeal, our team is here to provide the expertise and support you need. Contact us today to schedule a consultation, and let us be your partner in securing your rights and financial future.