lawyer

The Employee Retirement Income Security Act (ERISA) is a federal law that regulates and establishes oversight for private industry pension plans, retirement plan, profit-sharing plans and health insurance coverage by establishing rules and minimum standards that are meant to protect plan participants. ERISA only governs private (non-government) employers with 25 or more employees.

ERISA does not mandate the creation of any these plans; it only sets the standards for those that choose to establish them. ERISA was amended by the Consolidated Omnibus Budget Reconciliation Act (COBRA) in 1985 to include provisions for workers whose established health insurance coverage is affected by their employment situation. And a more recent amendment in 1996, the Health Insurance Portability and Accountability Act (HIPAA), protects the transferability and security of health care coverage for workers, especially when there is a pre-existing condition involved.

ERISA addresses the following aspects in its oversight: conduct of the individuals financially responsible for administration of the various plans; detailed documentation for reporting and accountability; the necessity of disclosing specific information about the plans to the participants; written policies for filing of claims and appeals, in a equitable and timely manner; and safeguards to protect funding of the plan and the non-discriminatory collection and distribution of the plan benefits.

ERISA also set up Individual Retirement Arrangements (IRA?s); created easier methods for self-employed workers to set up retirement plans; and added employee stock ownership to the tax code.

The Employee Benefits Security Administration (EBSA), a division of the Department of Labor (DOL), is the governing body responsible for administering and enforcing ERISA. When an insurance company denies a claim for benefits the consumer believes is covered by his/her plan, established appeals procedures, as detailed in the employer?s required Summary Plan Description (SPD), must be followed to appeal their decision. If denied again, the consumer may appeal a second time through either the insurance company or the regional EBSA office, depending upon the company?s established procedure.

Employers who fail to adhere to ERISA requirements face limited penalties. After exhausting all their administrative options, to pursue specific relief, plan participants must then file their ERISA legal claims in Federal Court. Damages are limited. Attorneys experienced in the practice of ERISA Law can assist these consumers with their claims and establishing their rights.