If you have an employer-based health care plan or insurance, such as short-term or long-term disability insurance, you may have heard the term “ERISA.” ERISA is a complex federal employment law that regulates most benefit plans provided by employers. ERISA regulates health insurance, disability coverage, and life insurance plans offered by employers. It also covers some retirement plans. Understanding ERISA can be challenging as the law is incredibly complex.
ERISA provides employees with essential rights. When an employee disputes decisions regarding their employer-based benefit plans, ERISA can provide valuable legal protection. Every employer must abide by the rules outlined in the ERISA law. When employers violate the provisions of ERISA, the legal team at Sapphire Legal, PLLC, can help.
Founding attorney Kristi Favard has 17 years of experience litigating employment-based lawsuits in Washington state. She understands how significant employee benefits are and is ready to protect your rights. Contact Sapphire Legal, PLLC today to schedule your initial consultation.
Understanding ERISA in Washington State
ERISA is a federal law, the Employee Retirement Income Security Act, passed in 1974. ERISA establishes minimum legal standards for employee benefit plans. Congress enacted this act to protect employees who actively participate in employer-provided benefit plans.
Mainly, ERISA requires employers that offer benefit plans to disclose vital information to plan participants and to follow the plan when determining benefits. ERISA also allows employees to bring lawsuits in federal court and preempts any state law that applies.
When Does It Apply?
ERISA applies to most benefit plans provided by employers. If an employee receives life insurance, health insurance, or disability insurance through his or her employer, the protections of ERISA will likely apply. ERISA can also apply when an employer contracts with a separate insurance company to provide employee benefits. When an employee’s health insurance plan identifies an insurer rather than the employer as the plan provider, this law may still protect the employee. At Sapphire Legal, PLLC, we can help you determine whether you are protected by ERISA and help you fight for your legal rights.
The Right to Plan Information
ERISA provides essential legal rights for employees with benefit plans. ERISA plan participants have a right to information regarding their benefits plans. Administrators of employee benefit plans must provide employees with documents that describe the terms of the plan upon request. These types of documents are often called a Summary Plan Description.
Employers must also provide participants with information regarding how the plan decides benefits claims. For example, the participant has a right to know how the company-provided health insurance plan will determine whether or not to pay for a specific treatment. When a plan participant disputes an ERISA plan’s benefits decision and needs to challenge the decision, understanding the plan’s guidelines for decision making becomes important.
When a health care plan denies a specific type of chemotherapy treatment for a participant diagnosed with cancer, the participant has a right to know how the plan decided his or her claim for benefits. If an employee becomes disabled and disability benefits are denied, the language in the plan is very important, as it will define disability and set forth the benefits for which an employee may be entitled. In addition, the initial decision may be appealed but the appeal is filed with the plan administrator and not in court. Before an employee may take the claim to court, it must appeal to the plan administrator.
ERISA Gives Plan Participants the Right to Bring a Federal Lawsuit
Importantly, ERISA provides a legal mechanism for employees to sue in federal court. Congress wanted to make it as easy as possible for employees to bring lawsuits for violations. Thus, successful plaintiffs can recover attorney’s fees. Employee-based plan participants can bring a lawsuit based on the following:
- Establishing their right to a benefits plan
- When employers deny an employee the right to enroll in a benefits plan or deny a claim
- To establish that their health plan coverage covers certain medical treatment
- To establish that the employee has a right to coverage under a disability plan
- To allege that the people administering the plan breached their fiduciary duties
- To allege that those administering the plan breached relevant federal regulations
Employees Must File a Lawsuit Before the Deadline
ERISA imposes strict deadlines on employees and benefit plan participants. Participants must comply with these deadlines to protect their legal rights. Participants must notify the administrators of benefit plans of legal claims within certain deadlines. When participants fail to challenge adverse decisions within the deadlines, they may lose their right to challenge a decision.
Specifically, an ERISA plaintiff must bring a claim within three years of the earliest date that the participant had “actual knowledge” of the violation or breach. The Ninth Circuit Court recently ruled that constructive knowledge does not constitute actual knowledge. Knowledge of a plan transaction alone can constitute actual knowledge when the transaction itself is an inherent breach of duty on the part of the plan. However, when the transaction is not itself a breach of fiduciary duty, the plan participant doesn’t have actual knowledge. If you are concerned about how much time you have to bring a lawsuit, Sapphire Legal, PLLC, can help. After we evaluate your situation, we can advise you as to how the ERISA statute of limitations applies to your situation.
Snohomish County ERISA Lawyers
At Sapphire Legal, PLLC, our legal team provides high-quality legal representation to employees who’ve been adversely affected by ERISA benefit plans. Founding attorney Kristi Favard fights for the rights of Washington employees. Contact our office today to schedule your initial consultation and learn how we can fight for you.