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Washington D.C. Benefits Law Blog

Public workers face complex benefits system

Many District of Columbia residents have built their careers in the public sector. One thing that can make these jobs so appealing is the exceptional benefits they offer, often significantly superior to those available to workers in the private sector. Government and other public service employees often have strong insurance packages that include disability, retirement and health benefits. However, even people who believe they can rely on great benefits may be shocked by an unjust denial or a dismissed benefits claim.

When you are denied benefits as a federal or public employee, the process you go through is also different than that for employees of private companies. However, the costs can be massive, and many workers cannot afford to let a denial of a claim stand. People may find themselves unable to make ends meet or cover the costs for necessary health care. If you are nearing retirement age, it may be particularly important to protect your rights under your benefits plan.

Supreme Court petitioned on ERISA benefits issue

The nation's highest court may rule in Washington, D.C., on which party is responsible for proving loss causation when a dispute over the management of defined contribution benefit plans goes to court. One company currently involved in such a case appealed to the Supreme Court to settle the disparate approaches taken among federal appeals courts about who must prove losses when plan members file suit over fiduciary breaches of the Employment Retirement Income Security Act (ERISA), which protects employee benefits from misuse or fraud.

One company involved in an ERISA benefits dispute has requested that the Supreme Court rule on the issue to provide a definitive national framework for assessing loss causation. In six appellate courts, plaintiffs suing the fiduciaries of these plans have the burden of proof to show that losses were caused by fiduciary breaches of duty. On the other hand, four courts have ruled that the defendants must show that losses were not caused by any breaches of fiduciary duty. The petition noted that the high court is well-placed to resolve this fundamental divide that can mean similar cases are treated substantially differently, even under a uniform national law.

Actual knowledge in ERISA claims

When ERISA claims are filed in Washington, D.C., the plan fiduciaries commonly claim that the statute of limitations bars the claims. ERISA claims have a three-year statute of limitations, which means that claims must be filed within that period of time, or they will be time-barred.

The Employee Retirement Income Security Act is a federal law that sets standards for health and retirement plans that are voluntarily established by private companies. When people become aware that their plans' fiduciaries took actions that violated the provisions of ERISA, they may file lawsuits. In some cases, the workers may be unaware that they can file claims until the statute of limitations has run.

Employee lawsuit questions hospital's exemption from ERISA

Governmental agencies employ many workers in Washington D.C. These organizations generally qualify for the government exemption to operational rules for pension and benefit plans imposed by the Employee Retirement Income Security Act. A brewing class action lawsuit brought by a group of current and former hospital employees has challenged the health care organization's assertion that ERISA rules do not apply to its health plan because it is a governmental entity.

The lawsuit maintains that the hospital has no recognizable basis for declaring itself exempt from ERISA regulations that normally apply to private employers. If the hospital had followed ERISA rules, then it would not have allegedly engaged in self-dealing transactions with affiliates and vendors that unnecessarily increased health care costs for plan participants.

Insurance company is being sued for underpayment

Metropolitan Life Insurance is being sued by participants of its retirement plans for alleged underpayment. The plaintiffs claim that the company's benefits committee purposefully used outdated mortality rates to pay out less money. MetLife, which has customers in Washington D.C. and other parts of the country, faces this lawsuit in New York federal court.

Language in this lawsuit claims that the insurance company did not pay alternative benefits in accordance to regulations established by the Employee Retirement Income Security Act of 1974. Plaintiffs are demanding that their plans comply with ERISA and that they receive all previously withheld benefits. They also want MetLife to recalculate the already-paid benefits and present accounting information to determine what the actual errors were.

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.

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