The federal government sometimes creates laws, generally called Acts, to ensure minimum protections are in place for everyone in the United States, no matter what state they live in. Generally, if a person has been wronged by something covered under an Act, a federal lawsuit must be filed, rather than a lawsuit in a state court.
Many individuals across the country obtain employment benefits through retirement (pension) and health (insurance) plans. Because of this, the Department of Labor created the Employment Retirement Income Security Act (ERISA), to ensure that an individual’s retirement and health plans obtained from a private industry are adequately protected and properly maintained.
It is important to note that individuals who have plans that have been created by governmental entities or churches are not covered under ERISA. Additionally, ERISA does not cover plans created by private employers that have been kept up only to follow workers compensation, unemployment or disability laws.
ERISA regulates pension and health benefit plans once an employer has established either plan. However, ERISA does not require employers to provide either pension or health benefit plans. Under ERISA, employers are required to provide employees with certain financial information and follow standards of conduct with thirds parties handling the plans.
If you are entitled to receive benefits under a retirement or health plan, an employer is required to:
- Provide you with your plan’s summaries;
- This is important because ERISA does not provide guidelines for how benefits must be claimed under plans. Requiring the employer to provide a plan summary ensures that employee is informed about how their individual benefits can be claimed;
- Provide information about the plan to the United State Labor Department and employees when requested;
- The Labor Department is in charge of enforcing ERISA. This provides added security for employees who entitled to benefits are unknowingly being taken advantage of;
- Provide employees with a calculation of their accrued and vested pension benefits, upon request;
- Have a financial responsibility to the plans, as well as those who manage any plan investments; and
- Not participate in certain transactions with the party handling the plans money or who has an interest in it.
- This also bars employers from investing more than 10% percent of the plan’s assets in the businesses’ securities.
If your retirement or health plan is covered under ERISA, you may be entitled to file an enforcement lawsuit in a federal court. A federal lawsuit under ERISA may be filed:
- When your retirement or health benefits have been unjustly denied;
- To obtain documents about your plan that you have requested in writing;
- Generally, documents must be provided within 30 days of the written request;
- To challenge a pension plan’s decision that will affect your future pension benefits or health benefits;
- To clarify your right to future benefits under the plan;
- To force the compliance with ERISA disclosure requirements discussed above; or
- To address inadequate management of your pension plan by your employer or any other fiduciary.
ERISA does not prescribe a uniform procedure for how pension benefits must be claimed. Instead, each pension plan has its own procedures. This is why strict rules are put into place requiring plan summaries to be provided to those covered. To move forward with claiming your pension benefits, it is important to first review your plan summary to review your eligibility and familiarize yourself with the process.
Certain ERISA rules do apply to the process of claiming your pension benefits. For example:
- You must receive the decision for your filed claim in writing and within 90 days;
- The decision deadline can be extended under special circumstances, but you must be informed of the extension during the initial 90 days;
- If your claim to pension benefits is denied, the reasoning must explain in a clear way and include the specific reason for the denial of any pension benefits;
- The plans rule in which the reason for the denial comes from must be listed in the notice of denial. Additionally, if more information is needed to make the decision, you have the right to be informed what information was missing and why it is necessary;
- Your pension plan materials need to outline and explain the appeals process;
- This includes the procedure and deadlines for submitting an appeal;
- For your appeal, the pension plan must permit you to examine its files and records; and
- The pension plan administrators are required to produce a written decision. This must occur within 60 days of filing your appeal.
It is important to note that if your claim is denied on appeal, you still may be entitled to pursue your claim in state or federal court. If you have been denied your benefits or have difficulties claiming pension or retirement benefits, you should seek the help of a qualified employment attorney.
The sooner you consult with an attorney about an issue you are having with your health or retirement plan, the better. ERISA laws are complex and you will more than likely need to hire an
employment law attorney with the appropriate knowledge and experience to guide you through the process.