ERISA Archives

The potential consequences of an ERISA violation

The Employee Retirement Income Security Act provides several protections for those who receive benefits from their employers. For example, Houston companies that are covered by ERISA must tell employees how a retirement plan or pension is funded or what its key features are. They must also create a system that allows employees to submit grievances or appeal any decision that is not in their favor. Finally, employers subject to ERISA must act in a fiduciary capacity toward plan participants.

Insurance companies must abide by ERISA rules

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.

Court Lowers Bar to Collect Benefits

The standard of review utilized by a district court in a denial of benefits case can be outcome determinative. Either the court will examine the administrative record and make its own determination as to a participant's eligibility for benefits (the de novo standard) or simply assure itself that the plan administrator's decision to deny benefits "falls somewhere on a continuum of reasonableness" (the abuse of discretion standard). Corry v. Liberty Life Assurance Co. of Boston, 499 F.3d 389, 398 (5th Cir. 2007). Needless to say, a plan administrator's decision to deny benefits is given great deference, and routinely upheld, under the abuse of discretion standard.
Recently, the Fifth Circuit Court of Appeals overruled its longstanding precedent to reject the notion that plan administrators are inherently entitled to discretion. Ariana M. v. Human Health Plan of Tex., 884 F.3d 246, 255 (5th Cir. 2018). As a result, courts must now apply the de novo standard of review unless the benefit plan itself expressly delegates discretion to the plan administrator.

ERISA - New Regulations

The Department of Labor recently strengthened the procedural safeguards governing claims for disability benefits provided by employee benefit plans. The new regulations are designed to ensure that all claims and appeals for disability benefits are given a full and fair review. For example, an adverse benefit determination must include: (1) an explanation of the basis for the decision; (2) an explanation of the scientific or clinical judgment underlying the adverse determination or an offer to provide such explanation free of charge; (3) the rules, guidelines or other criteria within the benefit plan relied upon to deny benefits; (4) a statement that the claimant is entitled to receive upon request and free of charge copies of all records, documents and other information relevant to the claim for benefits; and (5) a description of the applicable appeal procedures. A failure to comply with these disclosure requirements may result in the claimant's right to seek immediate relief in federal court.

Appealing a denied disability benefits claim

If you have a non-worked related injury and can no longer work, you'll need long-term disability benefits. It's not an easy process and it can be more stressful when your employer or insurance company denies your claim. You may feel at a loss, but remember that you have protections under the law.

Over $1 billion recovered for workers in 2017

During fiscal year 2017, the Employee Benefits Security Administration, or EBSA, closed 1,707 civil cases. Furthermore, there were 1,303 applications to take part in the Voluntary Fiduciary Correction Program. The Abandoned Plan Program was able to return $27.9 million to participants in 586 plans that had been terminated. Overall, more than $1.1 billion was put back into worker health care, retirement and other Employee Retirement Income Security Act, or ERISA, plans.

GE accused of making millions off 401(k) participants' loss

Many workers in Texas invest for retirement through their employer-sponsored 401(k) plans. A possible class-action lawsuit emerging against General Electric Co. illustrates the harm caused when plan managers ignore fiduciary duties. Participants in GE's plan, which is one of the largest in the country with over $28 billion in assets, have filed a lawsuit based on violations of the Employee Retirement Income Security Act (ERISA).

DOL backs employee seeking retirement benefits

Texas auto workers may be interested to learn that, on July 28, the Department of Labor filed an amicus brief that supported a Chrysler Group LLC retiree who was seeking to recover enhanced early retirement benefits. According to the court documents, the retiree was seeking the right to pursue equitable claims against his plan after being denied benefits due to undisclosed plan terms.

Supreme Court decision could affect church hospital employees

Catholic hospitals and other employers in Houston and around the nation are paying close attention to a case involving retirement plans that's scheduled to be heard before the United States Supreme Court. Pension plans affiliated with church hospitals are regularly exempt from the Employee Retirement Income Security Act of 1974; however, the Supreme Court will soon be ruling on three cases that challenged that exemption.

Wells Fargo sued for ERISA violations

Wells Fargo employees in the Houston area may have lost money in their retirement plans after stock prices in the bank declined. Employees who allege that Wells Fargo violated the Employee Retirement Income Security Act have filed several complaints against the bank. The plaintiffs are seeking class action status for their ERISA claims.

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