Why Do ERISA Claims Get Denied in Pennsylvania?

If your employer maintains something like a retirement fund, disability benefits, or health insurance plans for you and other employees, they might be regulated by ERISA. This is a very complicated area of federal law that aims to protect employees. If your employer or your employer’s insurance company violates ERISA regulations, a lawyer can help you file a claim, but not all claims have happy endings.

ERISA claims may be denied for a whole host of reasons. A common reason for claims being denied is that they are filed in the wrong court. While you and your employer might be located in Pennsylvania, ERISA is a federal law that must be heard in federal courts. You might also be denied for failing to follow proper procedures under ERISA. Usually, courts will not even entertain the idea of a claim until it has exhausted any available appeals under ERISA. Claims are also frequently denied due to a lack of proper documentation.

If you need help filing a claim, call our Pennsylvania disability attorneys for a free review of your case at Young, Marr, Mallis & Associates at (215) 515-2954.

Filing ERISA Claims in the Wrong Court in Pennsylvania

The Employee Retirement Income Security Act (ERISA) of 1974 is a very large, complex area of federal law. ERISA applies to employers not just in Pennsylvania but in all 50 states. It may preempt certain areas of state law, meaning employers must follow federal laws when it comes to complying with ERISA. This can sometimes trip people up when they file claims for ERISA violations. Claims may be denied if you file in the wrong court.

Since ERISA and related violations are matters of federal law, claims must be filed in federal courts. If you were to mistakenly file your ERISA claim in a state court, it would likely be quickly dismissed, and you would need to refile the case in federal court. While this is not a death sentence for your claim, it might cost you valuable time and resources.

Finding the right federal court may be tricky, depending on where you live in Pennsylvania. There are federal courts for Pennsylvania’s western, middle, and eastern districts. There might be multiple federal district courts in each district, and our Pennsylvania disability lawyers will file your case in the appropriate court.

Filing an Appeal Under ERISA Before Taking Your Claim to Court in Pennsylvania

When an employee believes their employer or the insurance company has violated ERISA, there are certain procedures in place that must be followed. Filing an ERISA claim is not the same as filing a typical lawsuit. Typically, you must file an appeal with the insurer in charge of your disability benefits or other accounts that fall under this law.

Violations are often resolved on appeal, and no court case is needed. For example, suppose the violation was due to a clerical error or some other mistake. In that case, it may be quickly corrected, and any money you lost may be paid back, or, if your disability benefits were put on hold, they may be reinstated. Unfortunately, the appeals process does not always work for everyone. Talk to a lawyer about it, as you might need to go through several rounds of appeals before your appellate options are exhausted. At that point, it may be appropriate to file a case in a federal court.

If you go to court without ever filing an appeal, the court may quickly dismiss your case. Courts do not like to hear cases if there are other legal options available you could or should have taken first. It is a good idea to exhaust all appellate options under ERISA before taking your case to court. Your lawyer can help you determine what these options are and how long it might take to exhaust them.

ERISA Claims Denied for a Lack of Evidence and Documentation

Much of the evidence heard in an ERISA claim will likely come from the insurance company’s records of your ERISA claim, including anything that was discovered when you filed an appeal. This is another reason it is important to file an appeal before taking your case to court. The appellate process might beef up the file on your case and provide more information for the court to consider.

You might also be able to bring your own evidence and documentation. Check with your attorney about what kind of evidence you are allowed to present. For example, you should have documentation about any claims you filed with your employer and insurance company. You should also have documentation regarding any communications between you and the insurance company.

If you do not document your claim, proving you suffered from an ERISA violation may be extremely difficult. While the defendant – your employer, the insurer, or both – might also lack important documentation, they do not have the burden of proof. If you cannot prove your claims, they do not have to prove anything.

How a Lawyer Can Help You if Your ERISA Claims Are Denied in Pennsylvania

Since ERISA is notorious for being an extremely complex area of law, it is crucial that you have a lawyer assist you throughout your claim, including during the appeals process before you file the case in federal court. An experienced attorney can help you save documentation and build your case as it unfolds. Your lawyer should also help you determine what kind of damages you might be entitled to.

If your disability benefits through your job were affected by the ERISA violation, you might be in serious financial trouble. Your lawyer can help you assess how much the violation cost you and get those damages compensated. If your benefits were unlawfully terminated, your lawyer can help you get them reinstated.

Contact Our Pennsylvania Disability Attorneys for Legal Support

If you need help filing a claim, call our Philadelphia disability attorneys for a free review of your case at Young, Marr, Mallis & Associates at (215) 515-2954.