How Do ERISA Lawsuits Work?
If you have employee benefits sponsored by your employer and are insured under a group
insurance plan, you are entitled to certain benefits. Many of these benefits, such as pensions,
healthcare, accidental death and dismemberment benefits or disability benefits, are protected by
federal law through ERISA. However, employers or insurance companies will often attempt to
deny your right to benefits. When this happens, ERISA litigation is a means of recovering the
benefits to which you are entitled.
ERISA lawsuits are most often the result of insurance companies, also known in ERISA as
“claim fiduciaries,” denying life, health, accidental death or disability benefits. If you have
submitted a claim under your group insurance policy and your insurer has denied it, your next
step is to contact an ERISA litigation attorney and, possibly, file suit to recover your benefits.
ERISA claims can often be resolved with the threat of litigation without ever going to court.
Litigation is time-consuming and expensive, so it is in everyone’s best interest to resolve an
issue before a lawsuit is filed. However, there are times when employers or insurance
companies dig in their heels and force you to take them to court to access the benefits you need
Who Can File An ERISA Lawsuit?
There are only four groups of people who can sue under ERISA: insurance plan participants,
plan beneficiaries, plan fiduciaries, and the Secretary of Labor. Most often, suits are brought by
employees or former employees against their insurance company and/or employer.
If you belong to a group that can sue under ERISA, you will have to know when and how to file
your lawsuit. Beyond the other resources available to you, it is best to consult an experienced
ERISA lawyer and keep in communication with your lawyer while you consider a lawsuit.
Is There A Time Limit To File An ERISA Lawsuit?
There is no specific statute of limitations for most ERISA claims involving recovery of unpaid
benefits, so the courts have determined that the applicable statute of limitations is taken from a
state’s statute of limitations for breach of contract. However, there is another deadline that is
equally important, if not more so: the contractual limitations period determined by each
insurance policy, which may be shorter than the applicable state statute of limitations. You
should carefully read through your plan’s deadlines for filing ERISA claims, appeals, or litigation.
It is vital to take timely action, because if you miss the policy’s deadline to file, there is likely
nothing else you can do. It is critical to consult with an ERISA litigation lawyer who knows how
to interpret these provisions, as they are very complicated and can be easily missed.
If you previously filed an ERISA claim that was denied, there is a mandatory administrative
review process you must go through before filing a lawsuit. Once your claim is denied, you
should consult with your attorney as soon as possible to understand your new timeline for filing
How Do I File An ERISA Lawsuit?
Once you have exhausted any available administrative remedies and the insurance company
still refuses to pay your benefits, you can file a lawsuit under ERISA.
The first step to start the ERISA litigation process is having your lawyer file a summons and
complaint in a federal court, which then triggers a time within which the insurance company or
employer is to respond to the complaint, typically 21 days. The insurance company may reach
out at any time with a settlement offer, which can eliminate the need to continue with litigation, if
you accept the offer. However, if no settlement is reached, your case will most likely be decided
with a bench trial before the trial court judge (generally on the “Administrative Record”) without
witnesses. There are no jury trials in ERISA matters. Your case can be decided in your favor, in
the insurance company’s favor, or be sent back to the insurance company to be re-evaluated,
known as a remand.
What Happens in the ERISA Litigation Process?
If litigation becomes your only option to get your benefits paid, federal court litigation will
typically consist of the following:
- You first file a formal legal complaint against your employer or insurance company (the
entities responsible for denial of your benefits) in the appropriate federal district court,
and then serve the summons and complaint on the insurance company.
- The employer and the insurance company then hire their own attorneys and file a
response to the complaint, with an answer or motion to dismiss the complaint.
- The parties go through the FRCP 26 process and share information with each other and
- The parties go through the discovery process. This is where both sides of the case
request and exchange relevant documentation and any other information relevant to the
- The parties engage in alternative dispute resolution, such as mediation, in an attempt to
settle the dispute.
- The parties file special cross-motions for judgment and attend a federal court hearing,
where a judge will determine whether you are entitled to receive benefits.
To give your case the best chance of success, you should obtain all the relevant evidence as
quickly as possible and always cooperate with your attorney.
How Can An Insurance Attorney Help Me?
ERISA litigation can be complicated. If you need help deciding whether you have a valid claim
to sue under ERISA, you should consult with a knowledgeable ERISA life and disability
At McKennon Law Group PC, your first consultation is free. Get the advice and professional
representation you need with the trusted ERISA lawyers at McKennon Law Group PC