ERISA stands for Employee Retirement Income Security Act, a federal law that governs private (non-government) employers with 25 or more employees. Employers who choose to provide pension plans, retirement plans, and other plans must comply with ERISA standards.
What Does ERISA Do?
ERISA provides standards related to:
- How the people financially responsible for administrating the various plans carry out that administration (fiduciary duties);
- Disclosures of plan information to the participants;
- Procedures for employee grievances about plans; and
- Policies on how to file claims and appeals.
Enforcing Your Claim For Benefits
When you file a claim for benefits under one of the plans, the insurance company may deny your claim. If that happens, you will need to file an appeal. Appeals must follow established appeals procedures, set out in your employer’s required Summary Plan Description (SPD). Our knowledgeable South Carolina ERISA attorney will ensure that your appeal complies with these procedures.
If your appeal is denied, you can appeal a second time, either through the insurance company or a regional EBSA office. Your employer’s insurance company’s established procedure will determine which process to follow. EBSA stands for Employee Benefits Security Administration (EBSA), a division of the Department of Labor (DOL), and is the governing body responsible for administering and enforcing ERISA.
Enforcing Your Employer’s Failure to Adhere to ERISA Standards
Employers who fail to adhere to ERISA requirements can face civil and criminal penalties. Once you have exhausted all the administrative options required by the particular plan, you can then file your ERISA legal claims in Federal Court.
Damages are assessed on a case-by-case basis since ERISA does not set out penalties based on specific violations. ERISA allows employees to recover these sorts of damages:
- Benefits that were denied improperly;
- Interest that accrued while benefits were withheld or denied; and
- Attorneys’ fees.