Understanding ERISA


The Employee Retirement Income Security Act  (ERISA) applies to much more than traditional pension/retirement  benefits. ERISA sets standards for how an employer must run its 401(k)  plan and ESOP plans, and its welfare-type plans, including health and  disability benefit plans, severance plans, scholarship funds,  employer-operated day care centers, death benefits, and plans providing  prepaid legal services, just to name a few.  ERISA is a comprehensive  but exceedingly complex statutory enactment, and as such, is rife with  the potential for disputes between plan participants/beneficiaries and  plan sponsors/fiduciaries.

Staying Current on Legal Developments

Despite its broad impact, ERISA is considered a specific focus within our general employment law practice.  Indeed, ERISA litigation is a highly complex and unique area of law. In  addition to knowing the federal statute, its voluminous regulations and  all of the case law that has been interpreted, a practitioner must also  know how the tax code impacts the analysis in a particular case. ERISA  also preempts general tort theories and many general defenses and  requires a claimant to exhaust his or her administrative remedies prior to bringing a case to court. And sometimes unique legal arguments  are indicated under ERISA, such as estoppel or breach of fiduciary  duty, and it is important to know when such arguments can and should be  raised. For these reasons, Pridgen Law receives many ERISA referrals  from other attorneys and even other employment law firms.

Understanding Both Sides of ERISA

Pridgen Law distinguishes itself by understanding both sides of ERISA. We have counseled both employers and employees about ERISA, as well as litigated on their behalf. We are very careful  to avoid conflicts of interest, of course, that might arise by  simultaneously representing an employer and one of its employees. We are  also careful to avoid the potentiality for conflicts of interest, by  maintaining other internal and external checks on our representations  that we undertake. However, our comprehensive approach to ERISA  litigation ultimately benefits our clients because it both enhances our  ability to see a case from all sides, and requires us to stay up to date  on all of the latest legal developments in ERISA disputes.

 ERISA's Administrative Process                 

Under ERISA, an employee or plan beneficiary may bring a lawsuit in federal court against an employer  or plan administrator only after he or she has exhausted the  administrative remedies provided under the ERISA plan.  In addition to  being a prerequisite to filing a case, there are specific procedural and  substantive requirements, both for plan fiduciaries and  participants/beneficiaries, that must be met in order to preserve one's  arguments in any resulting litigation.

Complying With Procedural Requirements

ERISA  comes into play regarding the timing and processing of benefit  determinations. ERISA's claims regulations specify the time periods  required for the various types of plan benefits, e.g., health,  disability, pension claims, when such claims are made under a plan.   Such regulations also dictate how the adverse benefit determination must  be handled, how many appeals may be mandated, and the timing and  requirements applicable to each. It is imperative, whether you are a  plan fiduciary or a plan participant/beneficiary, to have an experienced  ERISA attorney to help you navigate through the claims/appeals process,  understanding how the ERISA regulations impact the process.

Protecting Your Administrative Arguments

Additionally,  ERISA has unique substantive laws that generally do not apply outside  of ERISA. These may not be familiar to the general practitioner or even  an employment lawyer who has not spent adequate time practicing in ERISA  litigation. There are circumstances when failure to raise certain ERISA  arguments at a particular time can act as a waiver of such arguments  later on in the process, and this applies equally to plan fiduciaries  and plan participants/beneficiaries. This is why it is essential that  you contact an experienced ERISA attorney even during the administrative  process.

Direct Answers To Your Questions

We  understand that litigants will likely have many questions both before  and during ERISA disputes. One of the most important services we provide  to our clients is educational. Employers approach us about their  obligations under ERISA, such as how they must respond to employee  benefit claims and appeals during the administrative process. Employees,  in turn, may have questions about their rights under ERISA. We are here  to answer your questions.

Learn More About How ERISA Impacts You

We  are thoroughly familiar with the administrative requirements of ERISA,  governing how plan sponsors and plan fiduciaries communicate plan  benefits and claim outcomes to their plan participants and  beneficiaries. We have the experience to evaluate the litigation  potential of a disputed employee benefit claim or practice. This is why  Pridgen Law has earned the respect of our peers in Atlanta and  elsewhere. Schedule your free initial consultation today.