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Washington D.C. Benefits Law Blog

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.

Rule change promotes creation of Association Health Plans

The Department of Labor has changed a rule about health benefits that could affect workers in the District of Columbia and across the country, particularly those who work for small businesses. The rule change was prompted by a 2017 executive order by President Trump and is intended to promote the creation of Association Health Plans or AHPs. These plans are designed to provide a form of group health insurance for small employers who come together to form an association. Because they can be considered large group policies rather than small group or individual policies, they are exempt from some of the provisions of the Affordable Care Act.

This means that AHPs may be a more affordable benefits option for some small businesses, self-employed people and related individuals, but members of the plan may lack some of the consumer protections provided for in the ACA. The Department of Labor's new rule eliminated certain restrictions on the formation of AHPs that were in place by promulgating a new understanding of the definition of "employer" under the Employee Retirement Income Security Act. ARPs are considered a form of joint employee welfare benefit plan shared among multiple employers.

What to do when an ERISA claim is denied

If a District of Columbia resident files a claim for disability benefits under an ERISA plan, that claim may be denied. If it is, the exact reasons for the denial will be sent to the applicant. This will be done either electronically or in writing, and electronic notices will be provided in a way that conforms with the law. In addition to the reason for the denial, a notice will include information as to what information may be needed to overturn it.

Applicants generally have the right to appeal a denial, and the notice should tell them how to do so. They should also be told how long they have to appeal if they choose to do so. A request to review the denied claim must be made no more than 180 days after learning of the denied application. The person who reviews the appeal will not be the same person who made the original determination.

About the ERISA preemption

There are many laws that protect workers' rights with regard to pensions and healthcare benefit plans. However, workers in Washington, D.C., should be aware of the Employee Retirement Security Act of 1974 and how the ERISA preemption can affect certain protections provided by local and state laws.

ERISA is a complicated federal law that is intended to prevent mismanagement and fraud in private health and pension plans. However, because the regulations take priority over any similar or conflicting local and state laws, individuals may find that the protections they have against unfair claim denials in the state in which they reside might not be applied.

ERISA: Protecting your benefits under federal law

If you work in Washington, D.C., you may be concerned about how to handle improper actions taken by your employer when they affect your benefits. There is a law, the Employee Retirement Income Security Act, or ERISA, that is designed to protect the interests of workers in their retirement accounts as well as other key benefits provided on the job. While ERISA is best known as protective legislation to prevent unethical behavior with employee pensions, it also applies to medical insurance, health reimbursement accounts, additional health plans, disability insurance and severance agreements.

ERISA guidelines apply to the vast majority of private employers across the country, including nonprofit organizations and small businesses. Even a "mom-and-pop" company is likely subject to ERISA's provisions. However, you may be unclear about how exactly you can make use of the protections under the law and how you can protect your rights as a worker. There are a number of specific provisions under the law that guide how a complaint should be made.

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