ERISA – Will It Change?

Lawyers who handle Employee Retirement Income Security Act (ERISA) claims will tell that insurance claims made on an individual policy and claims made on an ERISA plan are remarkably different.  ERISA requires that the insurer or third-party claims administrator engage in a dialogue with the claimant about the claim and the reasons for denial, allowing the claimant an opportunity to rebut the reasons for denial and compelling a fiduciary review of a denied claim.  The downside of that review is that if the claimant asks for judicial review of a denied appeal, the federal court will probably have to defer to the claim fiduciary’s decision and the evidence will be limited to the contents of the claim file. There is no monetary remedy within ERISA for a violation of claims procedures nor does ERISA allow for consequential damages.  The remedies for claims violations are potentially (1) a remand to the claims fiduciary for another try, or (2) forfeiture of…

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