ERISA And the 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.

Contact a Skilled ERISA Litigation Attorney

Put your claim in the hands of an experienced attorney and schedule your free initial consultation with Pridgen Law today. You may call us at 404-465-2730 or complete our online contact form.