What is a Plan Administrator in ERISA medical claims? What role do they play in your Long Term Disability and Short Term Disability policy?
One role played in a claim under the federal statute known as the Employee Retirement Income Security Act (“ERISA”) is that of the Plan Administrator. Typically, this role is played by the Employer who has the contractual relationship with the insurance company providing the benefits.
One issue which has come up more often recently, are claims directly against the Plan Administrator for the Short Term Disability, Long Term Disability or Life Insurance benefits at issue. This would occur after the insurance company has denied the claim for a reason which the Employer/Plan Administrator caused. This might be the result of not enrolling an employee in a Plan, failing to implement changes in benefit elections or, more simply, a refusal to meet the good faith duty of cooperation. A Plan Administrator (Employer) is in a fiduciary capacity and cannot just sit back and allow an unwary employee lose benefits because of its failure to meet its statutory obligations. Another issue which has arisen is the situation when an Employer mis-characterizes the nature of the disability benefits claimant’s occupation. This is of critical import during the early stages especially when the question of disability relates specifically to that occupation.
Our experience is that it is necessary to address these issues early. Some clients want to wait to see how the benefits determination comes out first. Rather, we think it important to address this
issue early on if it presents itself. The use of an inaccurate job description generated by the employer indicates bad faith from the inception, i.e., going all the way back to when the claimant initially signed up for the benefits, not just when he or she later became disabled. This is one of the reasons why we secure the documents from the employer and the insurance company so we can review with you the precise job description provided by your employer to the insurance company.
Do You Need Represenation For ERISA Medical Claims? We Can Help
If you have any questions about your Short Term Disability or Long Term Disability claim, please give Herbert M. Hill, P.A. a call and we would be glad to answer any questions you may have. If you would like, after discussing your case, we can set a conference. In most circumstances, that conference would be free of charge but in no circumstance would you be under any obligation to hire me nor would you feel any pressure from me to do so.
Herbert M. Hill, P.A. is a law firm located in Orlando, Florida with a practice extending throughout the state of Florida. While the vast majority of cases handled are for disability insurance benefits, areas of practice include employee benefit claims of all sorts. The firm handles any claims arising under the Employee Retirement Income Security Act (“ERISA”) for disability benefits, medical benefits, retirement benefits of any sort, including pension, 401k, termination agreements or the like as well as claims arising under private disability policies.
