If you become unable to work due to a disabling medical condition or injury and have disability benefits coverage 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 claim is 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 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.
Our ERISA attorneys analyze your plan language, identify the deadlines that apply to your claim, and build your administrative appeal with the evidence needed to succeed. If your appeal is denied, we represent you in federal court. ERISA cases follow strict procedural rules unfamiliar to general practice attorneys. DeBofsky Law has focused on these cases for over four decades.
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 church-affiliated 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”), 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.
How to Determine Whether Your Benefit Claim Falls Under ERISA or Washington State Law
Many Seattle workers and professionals are unsure which law applies to their benefit claim. The answer affects your deadlines, your appeal process, and the damages you can recover. Here is how to determine your path.
Your Employer Provides the Benefit Through a Group Plan
Most employees at Amazon, Microsoft, Boeing, Starbucks, and other large Seattle employers receive disability, life, and health coverage through employer-sponsored group plans. These plans fall under ERISA. ERISA governs the claims process, the appeal deadlines, and the remedies available if your insurer denies your claim.
You Work for a Government Entity or Church
Government employers and churches are generally exempt from ERISA. If you work for the State of Washington, King County, the City of Seattle, or a religious organization, your benefit claim likely falls under Washington state law instead. This distinction matters because Washington state law offers broader remedies than ERISA.
You Purchased an Individual Policy on Your Own
Physicians, attorneys, tech executives, and other high earners often carry individual disability or life insurance policies. These policies are not employer-sponsored and do not fall under ERISA unless provided as supplemental benefits under a comprehensive benefit plan. Claims involving individual policies are governed by Washington state law. This opens the full range of Washington remedies, including bad faith damages, jury trials, and treble damages under the Insurance Fair Conduct Act.
Your Employer Pays Benefits Directly from Company Funds
Some employers fund disability benefits (mostly short-term disability) from their own assets rather than purchasing insurance. Such benefits fall within a payroll practice exception to ERISA and are subject to state employment laws. We analyze your specific plan documents to determine whether this exception applies to your Amazon, Microsoft, or Boeing benefits.
Each path carries different deadlines, procedures, and available remedies. Understanding which law governs your claim is the first step in protecting your benefits and maximizing your recovery.
For a detailed guide to determining whether your plan falls under ERISA, read our full article on ERISA plan governance.
Federal ERISA vs. Washington State Law
Under ERISA, damages are limited to the benefits due under the plan, plus interest, 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 testimony from 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.
Individual disability and life insurance policies purchased outside of employment also fall under Washington state law. High-earning professionals, including physicians, attorneys, and tech executives, often carry these policies alongside their employer-sponsored coverage. If an insurer denies a claim on an individual policy, the full range of Washington state remedies applies. These include bad faith damages, IFCA treble damages, and the right to a jury trial.
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.
How DeBofsky Law Structures Fees for ERISA Cases
ERISA cases have their own rules, deadlines, and procedural requirements. We tailor our fee arrangements to match. Depending on your case, we offer hourly, contingency, or fixed fee options. Under a contingency arrangement, we collect our fee only if your disputed claim succeeds. We base contingency fees on benefits received when the claim resolves, not on future payments. We cover all of this during your initial consultation.
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?
Before filing a lawsuit 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.
ERISA regulations require plan administrators to issue appeal decisions within specific timeframes. For disability claims, the plan generally has 45 days to decide your appeal. If the plan misses this deadline, your administrative remedies may be “deemed exhausted.” This means you may file suit immediately without waiting for a decision. DeBofsky Law tracks these deadlines closely in every case.
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
Frequently Asked Questions About ERISA Claims in Seattle
How long do you have to appeal an ERISA benefits denial?
What is the ERISA appeal process?
How would you resolve a denial for no prior authorization of medical treatment under ERISA?
What are typical ERISA appeal steps in Seattle disability cases?
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