If you become unable to work due to a disabling medical condition and are receiving long-term disability benefits through your employer, your disability benefits are likely governed by the Employee Retirement Income Security Act (ERISA). Similarly, your health insurance, life insurance, retirement benefits, and most other benefits you receive by virtue of employment, aside from wages, are subject to the federal ERISA statute and Washington law.
ERISA is a highly specialized area of the law. Your benefits are too important to leave in the hands of a generalist. With over 60 years of combined legal experience, almost exclusively in ERISA and benefits litigation, the attorneys at DeBofsky Law have a proven track record of obtaining results for our clients. Our attorneys can recognize the traps laid by insurance companies and plan administrators and put the ERISA statute to use for you.
What Benefits Does ERISA Cover?
ERISA is a federal statute that governs nearly all benefits you receive through your employer, aside from wages. ERISA does not apply to government or religious employers, though religious employers can elect to be subject to ERISA. ERISA also does not apply to certain salary continuation plans (known as “payroll practices”) or to stock options, nor does it apply to individual policies of insurance purchased in the open market.
Subject to the foregoing exceptions, all other benefits you receive through your employer are governed by the ERISA statute, including pension and retirement, health, disability, life, accidental death and dismemberment (AD&D), and other insurance coverage.
Are ERISA Plans Subject to State Law?
ERISA preempts all state laws related to employee benefits, except criminal laws and laws that regulate insurance, banking, and securities. ERISA also preempts all state laws remedies for the wrongful denial of benefits and other misconduct, including state insurance bad faith laws. ERISA does not preempt state laws that regulate the content of insurance policies, nor does it preempt state laws of general applicability.
Federal ERISA vs. Washington State Law
Under ERISA, damages are limited to the benefits due under the plan, plus attorney’s fees and costs. There are no consequential or punitive damages. In certain circumstances, ERISA provides equitable remedies such as a declaratory judgment, restitution, disgorgement of profits, and making whole relief.
Courts have interpreted the ERISA statute to require a bench trial, as opposed to a jury trial. Often, the “trial” is not a trial at all but rather a hearing based on a cold record without live witnesses. Courts frequently limit discovery in ERISA cases to the evidence submitted to the plan administrator prior to the filing of the lawsuit. Claimants in ERISA benefits disputes must appeal a denial of benefits prior to filing a lawsuit, or their suit may be dismissed.
Under Washington state law, the picture is very different. Except for government pension systems, most benefit plans are treated as contracts, and plaintiffs may recover incidental and consequential damages (including attorney’s fees) in addition to the benefits due under the plan. There is no requirement that you appeal a denial of benefits prior to filing suit; discovery is conducted like any other civil dispute, and jury trials are available.
Additionally, Washington state law recognizes the common law tort of insurance bad faith and provides extra-contractual damages, such as damages for pain and suffering and attorney’s fees. The Washington Insurance Fair Conduct Act also provides for treble damages in the event an insurer unreasonably denies a claim.
Know Your Rights
ERISA is a complex law that governs a wide range of employee benefits. We can help you understand your rights, and if your benefits are denied, we can help you protect those rights.
Does This Apply to You?
Contact DeBofsky Law for an attorney consultation. We will work with you to figure out your problem, and how we can help.
Our Recent ERISA Victories
In ERISA cases, the odds are stacked against claimants. We’re here to fight on your behalf. See How We’ve Won for Our Clients.
Long Term Disability Insurance
Robinson v. Aetna Life Ins. Co.
DeBofsky Law won two cases for our client. In the first, the court denied Aetna’s motion to dismiss, noting the plan did not address retroactive SSDI awards. The judge found Robinson’s claim was not time-barred due to her voluntary appeals. In the second, the court ruled the denial of benefits arbitrary and capricious due to Robinson’s retroactive SSDI award and found Aetna’s refusal to toll its review problematic.
Disability Insurance & ERISA
Sherrell v. Sun Life Assurance Company of Canada
DeBofsky Law won an appeal for a cancer research coordinator who was denied long-term disability benefits by Sun Life. The insurer’s decision was overturned, with the court criticizing Sun Life’s use of a medical consultant who never examined the claimant. This ruling underscores the need for insurers to conduct proper evaluations and consider all relevant evidence in disability cases.
Long Term Disability | Spinal Pain
Scanlon v. LINA
A system analyst with spinal pain and a sleep disorder won his appeal with the help of DeBofsky Law. The court ruled that the district court erred in its assessment, failing to properly consider the claimant’s functional capacity and inability to earn 80% of his income due to his condition. This decision underscores the importance of thorough evaluations in long-term disability cases, especially the impact on job performance.
How do I file a complaint Under ERISA?
To file a complaint under ERISA, you must usually submit a pre-suit appeal of the denial of your benefits to the ERISA plan administrator, subject to a few exceptions. If your appeal is denied, only then may you proceed with filing a lawsuit. You may challenge a denial of benefits in state or federal court, and any party may remove the case to federal court if it desires.
The exhaustion requirement only applies to suits for benefits under 29 U.S.C. §1132(a)(1)(B). Suits for plan-wide relief, suits for interference with protected rights, and suits for other appropriate equitable relief may be filed without first appealing to the plan administrator. Such suits may only be filed in federal court.
You may also file a complaint with the U.S. Department of Labor (DOL). The DOL investigates allegations of abuse by ERISA plan administrators. However, the DOL has discretion in whether to bring an enforcement action.
Let Our Experienced ERISA Attorneys Help Your Appeal Wrongfully Denied ERISA Claims
If your benefits have been wrongfully denied, call the experienced attorneys at DeBofsky Law today. With offices in Seattle, Washington, and Chicago, Illinois, our attorneys have helped clients nationwide to obtain justice after a wrongful benefits denial.
“Thank you. A thousand times, thank you.”
“Mark, I’m not very good at saying thank you. But I’m going to try. I don’t know what I’d do right now, or where my mind would go, if I didn’t have someone like you beside me, who knows the whole case… There are dark places I could go, and to which I’m not going, largely because your help and the resultant safety net that provides. Thank you. A thousand times, thank you.”
Todd B | Client
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