What is an ERISA De Novo Review?

Employer-provided group insurance plans are governed by the federal Employee Retirement Income Security Act of 1974 – ERISA. If you file a claim for disability benefits through an ERISA-governed insurance plan, and if that claim is denied, can you take steps to have the denial reversed? It’s possible, but your first step should be obtaining the advice and services of a California disability claims attorney at the McKennon Law Group.

Before you can bring a lawsuit against an insurance company for the denial of your disability claim under ERISA, you will have to file at least one “administrative” appeal with the insurance company. If your appeal does not prevail, your attorney may recommend bringing a lawsuit against the insurance company. U.S. District Courts have jurisdiction in all ERISA-related legal matters.

What Are the “Standards of Review” When You Sue an Insurance Company Under ERISA?

ERISA itself provides some guidelines for how these cases are handled. You may not seek punitive damages or bad faith damages when you sue an insurance company under ERISA, and you will not have a jury. The court will apply one of these two “standards of review” when it considers your lawsuit:

1. Abuse-of-discretion: To prevail with your lawsuit under the abuse-of-discretion standard of review, the judge must not only be persuaded that the insurance company wrongly denied your claim, but the judge must also find that the insurance company abused its discretion when it denied the claim.

2. De novo review: Under the de novo standard of review, the judge simply determines if the insurance company was wrong or right when it denied your claim.

Which Standard of Review Applies in California?

The abuse-of-discretion standard requires a court to adhere to the insurance company’s finding in the prior administrative appeal – unless the insurance company abused its discretion when it decided the administrative appeal.

Insurance companies prefer the abuse-of-discretion standard of review, but California law now prohibits the inclusion of clauses in life and disability insurance policies that require the abuse-of-discretion standard. If you are seeking ERISA disability benefits in California, you will receive a de novo review of your claim if you and your attorney take the case to a U.S. District Court.

How Will a McKennon Law Group Attorney Help You?

Even under the more favorable de novo standard of review, you and your attorney still must establish that you are entitled to the ERISA disability benefits you are claiming. However, a de novo review allows the court to make an independent decision about your eligibility for ERISA disability benefits, without regard to the result of a previous administrative appeal.

The McKennon Law Group has decades of experience fighting for the rights of disabled workers in California. If you have been temporarily or permanently disabled and you cannot work, discuss your options for compensation and benefits with one of our attorneys. Meeting with a McKennon Law Group attorney will not cost you anything or obligate you to anything.

If your claim for disability benefits through an ERISA plan has been denied, we will handle an appeal and/or a lawsuit on your behalf. You can contact us to learn more – or to schedule a review of your case – by calling the McKennon Law Group now at (800) 682-4137 or by completing the contact form on this website.