PLEASE NOTE: To protect your safety in response to the threats of COVID-19, we are offering our clients the ability to meet with us in person or by telephone. Please call our office to discuss your options. We expect to remain open during regular business hours subject to further directives from federal, state and/or local officials.

Insurance companies must abide by ERISA rules

On Behalf of | Mar 28, 2019 | ERISA |

A Employee Retirement Income Security Act of 1974 court ruling may allow Texas residents greater access to insurance coverage for substance abuse and mental health treatment. The ruling was made by a California judge in Wit v. United Behavioral Health. The case involved 11 plaintiffs who took legal action on behalf of more than 50,000 people who said that their claims were denied because of improper review criteria.

In its ruling, the court found that UBH had created unreasonable standards for accepting such claims. Ultimately, it was found to have acted in its own financial interest as opposed to the evidence regarding best practices related to mental health and substance abuse treatment. This ruling could have an impact on employers who choose to offer medical care to their employees. It could also make it easier for individuals who suffer from anxiety, depression or alcohol abuse to get the help that they need.

Under the terms of ERISA, plan providers are supposed to act in the best interests of policyholders. In the Wit case, it was held that UBH did not act in a fiduciary capacity. It is widely believed that UBH is not the only company that has acted in such a manner, which is why employers should review their current insurance plans for compliance with ERISA regulations.

Offering employee benefits may attract quality talent to an organization. However, it is important that benefits are administered in a manner that complies with federal and other laws. An employee who has had their ERISA rights violated may wish to speak with an attorney about their case. It may be possible to take an employer or plan administrator to court. This could result in a cash settlement.


FindLaw Network