If the company you work for provides health benefits, it must comply with ERISA (the Employee Retirement Income Security Act), a federal law that regulates the plans that provide these benefits, and it must keep its promises.
ERISA was enacted to set federal minimum standards for voluntarily established pension and employee benefit plans within the private sector and hold employers to strict rules intended to protect employees' rights to promised benefits. Participants have the right to sue to obtain promised health and disability benefits and for breaches of fiduciary duty.
A company that breaks its agreement to provide health or disability insurance benefits to an employee or retiree not only violates your rights, it creates fear and uncertainty for the future. Without coverage, a serious illness or catastrophic injury can bring financial ruin. You may have rights to health, disability and other benefits and insurance coverage promised by your employer. Our attorneys stand ready to explain and help you obtain these rights.
Increasingly, we see employee loyalty being repaid with denial of benefits when they need it most. Denial of benefits seems to be most common in claims related to:
Your employer might have made promises to provide benefits for these conditions, and those promises may be enforceable under ERISA. For example, ERISA requires coverage of some pre-existing conditions. HIPAA limits a new employer’s health insurance plan from excluding coverage for preexisting conditions and prohibits discrimination against employees or their family members based upon prior medical conditions, prior claims, or genetic information.
There are many laws – federal and state – that may protect your right to health benefits when you voluntarily or involuntarily leave your job or when there are changes in your life. They include ERISA, the Health Insurance Portability and Accountability Act (HIPAA), American Recovery and Reinvestment Act (ARRA), Unemployment Compensation Act of 2010, Newborns’ and Mothers’ Health Protection Act, Affordable Care Act (ACA), Genetic Information Nondiscrimination Act (GINA), Mental Health and Parity and Addiction Equity Act (MHPAEA) and, perhaps most prominent, Consolidated Omnibus Budget Reconciliation Act (COBRA).
At Martin & Bonnett PLLC, our Phoenix health insurance and COBRA lawyers are well versed in all of these laws, and can help you get the benefits you deserve.
Understanding COBRA Benefits. COBRA gives employees and their families the right to choose to continue their group health insurance benefits for a limited period of time after you lose your job, are terminated, voluntarily leave your job, retire, transition between jobs, or lose benefits because of a reduction in hours worked, death or divorce.
COBRA requires group health plans with 50 or more employees to offer employees and their families the opportunity for a temporary continuation of health insurance coverage in certain circumstances. Some states have their own statutes with more liberal requirements. If you qualify for continued health insurance coverage, you may be required to pay the entire premium for health coverage, up to 102% of the cost to the insurance plan.
COBRA requires employers and health plans to provide notice to an employee who may be losing their health benefits. COBRA also explains how employees and their family members may choose to extend their health insurance coverage.
Life events, such as marriage, pregnancy, childbirth, adoption, legal separation, divorce, death or a dependent child becoming too old for coverage under the plan may affect your rights or your family’s rights to health benefits.
COBRA and the Uniformed Services Employment and Reemployment Rights Act (USERRA) also allow military servicemen and servicewomen to continue coverage for themselves and their family under group health insurance plans.
If a disability prevents you from working, your long-term disability insurance or short-term disability insurance plan may entitle you to continued pay and benefits during your disability. If an employer provides these benefits, the benefit plan is most likely governed by ERISA, which sets standards with which the plan must comply, and requires that employers live up to their promises to provide disability insurance benefits.
However, it is not always easy to get what you are entitled to. It may feel like being "hit when you are down" to be denied the disability or health benefits you need at this time. Our attorneys are nationally renowned advocates for employees who have been treated unfairly and denied benefits.
Even if your doctor states that your condition prevents you from working, you could be turned down for long-term disability insurance benefits. Any one of us is subject to disabling conditions, or multiple conditions that could prevent us from working. Mental and emotional disability claims can be harder to document than physical conditions that x-rays or other tests may show. Yet, many people have these illnesses to a disabling degree. Among the conditions for which you may be entitled to long- or short-term disability benefits because of mental health claims are:
Other serious illnesses that may be covered include congestive heart failure, carpal tunnel syndrome, chronic fatigue, kidney disease, osteoarthritis, back injuries, lung disease, fibromyalgia, chronic pain, hepatitis C, leukemia, paralysis, diabetes, asthma, cancer and lupus.
If you think your rights as an employee or retiree may have been violated, you should consult with an attorney who is experienced in labor, employment and ERISA benefits. Our practice includes fully documenting your claim, filling out the necessary forms, and pursuing appeals with the Plan Administrator when necessary.
Our experienced lawyers can help you determine what should be covered and help you fight for what you have been promised. You have a right to appeal a denial of benefits and to file a lawsuit if, after appeal, your benefits are denied. You also have rights to request and receive documents governing your entitlement to health benefits.
Our practice includes fully documenting your condition, filling out the necessary forms, and pursuing appeals with the Plan Administrator when necessary. Know your rights before you file an appeal with the plan. Many times, the failure to consult an attorney before appealing to the plan will limit your chances for success if you later decide to pursue your claim in court. It is most important to know that if you need to take your case to court, you may be limited in your evidence to what you have earlier presented in your appeal to the plan administrator.
Going through the administrative claims processes without consulting an attorney and gaining an understanding of your rights is a mistake that may ruin your chances of ultimate success.
Know your rights before you file an appeal with the plan. Many times, the failure to consult an attorney before appealing to the plan will limit your chances for success if you later decide to pursue your claim in court. It is most important to know that if you need to take your case to court, you may be limited in your evidence to what you have earlier presented in your appeal to the plan administrator.
We strive to resolve the matter, but we will litigate on your behalf if your health and disability benefits are wrongfully terminated or denied.
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Cases and Investigations
Read about some of our current and recent Employee Health and Disability Insurance Benefits cases.