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ERISA

What is ERISA?

ERISA is the Employment Retirement Income Security Act passed by Congress in 1974. It was enacted to protect employees’ pension plan assets, but has been given an expansive interpretation by the United States Supreme Court to cover nearly all claims submitted under insurance policies provided to employees by their employers, primarily health, disability, and life (including accidental death) insurance.
 
Though created to help employees, as it has been interpreted, it is not a consumer-friendly law. Instead, it has become a haven for unscrupulous insurance companies to deny valid claims with no accountability for their actions. This is so because ERISA preempts (i.e., trumps) nearly all state laws that would otherwise be available to an insurance consumer who is wrongly denied benefits, including the ability of the employee to sue the insurance company for bad faith. It allows for the employee to recover only the benefits denied, and perhaps attorneys fees at the judge’s discretion if the case is won at trial. That is, the insurance company is not required to pay any damages caused to the insured as a consequence or result of denying the claim. 
 
Additionally, ERISA requires that an internal administrative appeals process occur, under short time requirements, before a lawsuit may be filed, and if such a lawsuit results, it is a review of only the documents exchanged in that administrative process, with very few exceptions allowing the submission of new evidence. 
 
It is, thus, a process fraught with peril for the employee, and requires the assistance of skilled counsel to overcome the insurance company’s built-in advantages in order to obtain the benefits that have been wrongly denied. (See Jeff's article recently published in "The Gavel" of the Orange County Trial Lawyers Association.)
 
The Law Offices of Jeffrey C. Metzger has the skill, experience, expertise, and track record to take on insurance companies such as Unum, Hartford, Aetna, Prudential, Met Life, Blue Cross, Anthem, Blue Shield who routinely deny and terminate legitimate claims.
 
We do not let insurance companies take advantage of you!