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Washington D.C. Benefits Law Blog

Important changes to ERISA benefits plans

A number of changes have been made to the procedures involved with ERISA benefits claims that may affect workers and employers in the Washington, D.C., metropolitan area. It is important for workers and their employers to be aware of these changes because they could impact the way in which disability claims are handled.

The U.S. Department of Labor issued rules that impact long-term disability plans. The rules also have an impact on other ERISA benefits, including tax-deferred retirement plans, defined benefit pensions and certain deferred compensation plans for executives.

ERISA issues litigated in federal Fifth Circuit

For workers in Washington, D.C. and across the country, employee benefits can be a critical part of their compensation and their preparation for the future. The Employee Retirement Income Security Act (ERISA) aims to protect workers' pensions, insurance plans and other benefits from being squandered. However, the procedures for filing ERISA benefits claims can be complex.

In one case before the U.S. Court of Appeals for the Fifth Circuit, some complex issues related to ERISA claims were raised. These claims can also be brought by workers who are denied benefits by an insurance plan provided through the workplace, as in the case considered. A former employee of Turner Industries sued the company as well as the insurer, Prudential, for denying his claim for long-term disability benefits. He also challenged the insurer's demand for repayment of short-term disability benefits it provided. Much of the case hinged on the proper section of the law under which an employee can bring a claim. While one section of ERISA covers benefits claims, another addresses other breaches of fiduciary duty.

Benefit denials hit workers when they are most vulnerable

Workers within the federal and public service sectors in Washington D.C. focus their careers on community-oriented goals. As a reward for serving social needs like teaching, you earn extensive benefits that include retirement savings, health insurance and disability insurance. You work hard with the expectation of falling back on these generous programs in your time of need, and a benefits denial hits especially hard when you have given years of service to an organization. You might need outside legal advice to get clear information about the appeals process that would not be forthcoming from your employer.

Your financial security during a medical crisis or retirement depends on getting fair consideration from your benefits administrator. The terms that govern your plan benefits will vary depending on whether you work in a public or private setting. An attorney knowledgeable about benefits programs could review your situation and provide insights about your rights to coverage and compensation.

Common civil and criminal ERISA benefits violations

The basic purpose of the Employee Retirement Income Security Act, or ERISA, is to set minimum standards for voluntary pension and health plans. It's a piece of legislation meant to protect the interests of plan participants in Washington, D.C., and other states and their designated beneficiaries. However, there are times when certain benefit plans are not set up in a way that keeps the best interests of participants in mind.

In some cases, civil or criminal ERISA benefits claims litigation is necessary because of benefits violations. Many of the common ERISA violations are civil in nature. For instance, a plan may not be operated prudently or in the best interests of participants. There have been instances where plan assets were used to benefit the plan administrator and other specific parties. Employers are also not permitted to take adverse actions like termination or issuing fines because employees exercise their rights under a specific plan.

How ERISA protects pensions for private sector workers

While public sector employees in Washington, D.C. may have some degree of security when it comes to pensions, this isn't always true for private sector workers. This is why the Employee Retirement Income Security Act (ERISA) was passed in the early 1970s. Initially, the purpose of ERISA was to protect pensions for private sector employees in the United States. Today, the act has been expanded to cover many other types of employee benefits, including long-term care, various medical insurance plans, and dental, prescription, and vision plans.

ERISA protection applies to all types of employees, from individuals working for large private corporations and non-profits to people performing paid duties at small businesses and two-person set-ups. Even though this act provides comprehensive safeguards, there are still times when ERISA benefits claims appeals may need to be filed. Also, if benefits aren't provided by a private employer in a timely manner, an appeal must be filed within a specific period of time to make an attempt to receive those distributions.

ERISA plan regulations protect disability claimants

In April 2018, new procedures for processing disability claims went into place for ERISA benefits plans. These changes, developed by the federal Department of Labor, are designed to provide additional protections for workers dealing with insurers or plan fiduciaries who deny disability benefits claims. The reforms mandate that employee benefit plans must provide a reason for a denied claim as quickly as possible. This reason must be provided in enough time before the appeal deadline to allow the plan member to respond adequately.

In addition, the rule changes require that people who make a disability claim to their ERISA benefits plan must receive a complete explanation of why their claim was denied. They must also receive information about how they can appeal the decision and respond to the plan's claims. They mandate that plan claims adjudicators cannot be hired, fired, penalized or rewarded for their claim denial practices.

ERISA benefits case not subject to arbitration

Employees in Washington, D.C., may be interested in the outcome of an ongoing case in which a group of ERISA plan participants are pursuing claims for a breach of fiduciary duty. The Court of Appeals for the Ninth Circuit upheld a ruling that the participants were not required to go to arbitration despite the existence of employment agreements requiring arbitration of disputes. The court said that the claimants were not representing their own interests but those of the ERISA plan itself.

Nine current and former employees of the University of Southern California are pursuing a claim against the university, its retirement plan and one fellow member of the Retirement Plan Oversight Committee. They accuse them of failing to live up to their responsibilities to reduce the fees and expense of the plan; they also accuse those parties of failing to use good judgment in selecting investments for the plan. In their lawsuit, the claimants are seeking both monetary compensation and equitable actions that can benefit the plan as a whole.

Man denied disability benefits pursues legal action

People in Washington, D.C., may face unexpected and unpleasant results when they seek to file a claim on their disability benefits in the workplace. In one case, a man is suing his former employer as well as the insurance company involved, alleging that they are violating his rights by denying his long-term disability benefits. The man says that the companies' actions violate the protections for workers found in the federal Employee Retirement Income Security Act, or ERISA.

In 2006, the man suffered a foot injury in which three of his toes required amputation. Other surgeries were needed to repair the damage to his foot. After he could not return to work, he alleges that the company he worked for fired him. In addition, when he filed a long-term disability claim with the benefits provider, Metropolitan Life Insurance, he said that the company claimed that he had a pre-existing condition. The man is seeking damages for the unpaid disability benefits, and he is hoping to have his case heard before a jury.

Appealing benefits denials for public sector workers

It can be particularly important for public and federal sector workers in the District of Columbia to understand the protections and rights attached to employee benefits. Since benefits packages for public employees can often be quite valuable, they are a major incentive convincing people to prefer a government job to a corporate alternative. The dedication to community -- and, at times, lower salaries -- of government workers are rewarded with secure, generous benefits that include health insurance, disability protection and extensive retirement plans.

Because these benefits programs can be significantly different than those in the private sector, you may need to know more about government programs to successfully appeal a denied benefits claim. When you're struggling to pay medical bills, being denied treatment can be a serious blow. However, it is possible to successfully appeal benefits denials and receive the compensation or coverage that is rightfully yours.

Appeals court sides with workers in benefits dispute

Some people in Washington, D.C., may be aware of a number of recent lawsuits brought by college and university employees against their employers regarding retirement plan mismanagement. In a case involving the University of California, a federal appeals court ruled on July 24 that investors could not be forced to settle their claims in arbitration.

The workers sued the university two years ago, and this ruling represents a win. The U.S. Court of Appeals for the 9th Circuit said that the claim cannot be forced to arbitration because the parties consented to arbitrate claims brought on their own behalf. However, in this case, the claims were on the plans' behalf. This is the 9th Circuit's first time examining the effects of employment arbitration clauses on claims under the Employee Retirement Income Security Act.


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