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.
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.
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.
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.
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.
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.
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.