The Employee Retirement Income Security Act (ERISA)

Steve Kunkle has handled ERISA matters since the mid-1980s. He is one of a handful of attorneys in the Philadelphia suburbs who handle these matters on behalf of employees.

What Is ERISA?

Enacted by Congress in the early 1970s, the Employee Retirement Income Security Act, also known as ERISA, was designed to encourage employers to offer retirement and other benefits to employees and to protect employees’ rights to such benefits under employer-sponsored benefit plans.

ERISA has expanded to cover almost all group insurance benefits offered by employers, including short-term and long-term disability benefits, as well as health insurance benefits, ERISA also covers certain noninsured benefits offered to employees on a group basis, such as severance benefits, change in control benefits, and retention bonus plan benefits.

If an employee believes that an employer has not followed through on its obligations under a plan providing for the payment of such benefits, she may have a right to sue in federal court under ERISA. First off, however, an employee seeking such benefits must pursue an internal claim for the benefit directed to the employer’s plan administrator. Failure to comply with proper procedures can be fatal to the employee’s claim for benefits.

ERISA Claims

Attorney Steve Kunkle has the experience to interpret complex ERISA statutes as well as applicable regulations and case law to protect your entitlement to benefits.

As an outgrowth of his employment law practice, Steve has had the opportunity to handle many claims for disability insurance benefits offered to employees as part of their fringe-benefit package. Steve handles claims and appeals asserted against insurance carriers and employee benefit plans before litigation, including claims for disability, accidental death, life insurance, severance, change in control, retention bonus, and health care benefits.

It is crucial to have the assistance of an attorney familiar with the ins and outs of ERISA at this stage because all evidence supporting the claim must be presented to the plan administrator before its final determination of the claim. Generally, the employee is barred from presenting any new evidence to a court in support of a claim once the plan administrator (often an insurance company) has rendered its final decision. The employee typically may only request that court to review the determination of the plan administrator to deny benefits given just the information presented to the plan administrator.

Steve coordinates with healthcare providers (in the case of disability benefit and life insurance claims) and other experts to provide the plan administrator with all evidence in support of the disability, life insurance, or severance claim. If the plan administrator does not grant the benefit, Steve has more than 35 years of experience in prosecuting claims for benefits before federal district courts, even with the stringent standard that courts generally apply to such claims.

Non-ERISA Claims

Not all benefits are covered under ERISA. If you purchased long-term disability coverage or health insurance coverage on your own, rather than through your employer, ERISA will not apply. Instead, state law contract principles and case law will govern claims under these types of coverage. In addition, if you work for the government or for a church and have benefits under their plans, chances are ERISA does not apply. Nor will ERISA apply to what are defined to be employer “payroll practices,” such as vacation benefits and certain other types of benefits. 

That said, however, there are state laws in place that are designed to protect insured individuals. Steve has widespread experience concerning claims for all types of benefits and can represent you to optimize your benefit entitlement.

Let Us Provide the Effective Representation You Need

When you have effective representation, the insurer may reverse its decision and pay your claim. Even if the insurer does not reverse its decision, it is critical to have the assistance of an experienced ERISA attorney in preparing the full record that goes before the plan administrator or insurer before it renders its final decision. This is because that is usually all that a federal court will permit the parties to use as evidence at trial. When claims are denied, it’s crucial that you act immediately. Call a West Chester, PA ERISA attorney today for a consultation.