In this video Marc Whitehead, a board certified disability attorney, explains why ” Your Remedies” are limited under ERISA Law.
Another way that ERISA Law actually favors Insurance Companies over individual policy holders is the fact that your remedies are limited. This basically means, when your insurance comes through your employer there’s not much that you can do to punish your insurance company if they treat you poorly or otherwise violate the terms of your policy or even the law.
For example: Someone who buys their own individual policy on the free market could then take their insurer to court if they believe they were abused in some way and sue them for all the damages that they sustained because of the wrongful denial of benefits.
Private policies hold insurance companies much more responsible for their violations.
For example: What if they refused your benefits alleging a preexisting condition when, in fact, you didn’t have one? You could take them to court and ask for pain and suffering or mental anguish damages, if you had an individual policy. If your policy was not governed under ERISA Law and you could show that the insurance company acted in bad faith, they could be sued for bad faith or punitive damages. Perhaps pay for your painful back injury was delayed and now you need multiple surgeries that could have been avoided. That could be extremely expensive.
Of course, nothing is guaranteed but at least with an individual policy you have the option to bring a lawsuit. Not so much with policies that fall under ERISA Law.
Under Federal ERISA Law, you only have the right to enforce the terms of the policy. Meaning they only have to pay you your monthly benefits and your back benefits.
Another unfortunate result of ERISA is that it is incredibly difficult to force your insurance company to pay your legal fees if you have to sue them. In most cases this is considered par for the course when the winning party in the claim goes to court, but not under ERISA. While some people have been able to make this happen, it’s not automatic.
This is just a few of the ways that gaining disability insurance benefits is made more difficult under ERISA Law but it is a big reason why reform is needed. Though it seems that ERISA Law is only enacted to protect Insurance Companies and their denial of your benefits, their are ways to use ERISA Law to get you the benefits that you deserve.
Marc Whitehead & Associates have over 20 years of experience in ERISA based claims and we can help you win your benefits.
