Understanding ERISA in Washington DC 

Like many legal schemes that come out of Washington, DC, ERISA is a system that was designed to help workers but is so complex that provisions often seem to provide just as much confusion as assistance.

One of the keys to understanding ERISA in Washington DC is to realize that the provisions are administered by three large agencies of the federal government: the U.S. Department of Labor, the Treasury Department’s Internal Revenue Service, and the Pension Benefit Guarantee Corporation.

If you believe an ERISA violation has occurred, it may be helpful to consult an attorney with experience handling ERISA claims who can evaluate which agency is involved and how to proceed.

The Provisions of ERISA Were Designed to Protect Employee Benefits

ERISA establishes standards for retirement plans and health plans provided by private employers. Among the requirements established by this set of federal laws are provisions specifying that:

  • Employees must be provided with adequate information about the plan, including features and how it is funded
  • Those who manage and control the plan have certain fiduciary responsibilities to the plan participants
  • Plans must have process for handling grievances and appeals
  • Participants have the right to sue for breach of fiduciary duty
  • Participants have the right to sue for benefits

Since ERISA was enacted in 1974, the provisions have been expanded to add extra protections for health plan participants and their families. For example, COBRA (the Consolidated Omnibus Budget Reconciliation Act) enables some employees and their families to continue receiving health insurance coverage for a limited time after certain changes such as the ending of employment.

Other major amendments came as a result of HIPAA (the Health Insurance Portability and Accountability Act). This act was intended to provide additional protection to employees who might be subject to health care coverage discrimination due to preexisting conditions or other factors.

Violations of Fiduciary Duty

One the primary facets of ERISA is the specific fiduciary duty imposed on sponsors, administrators and providers of employee benefit plans.  In a fiduciary relationship, the party with the duty is obliged to act in the best interests of the party to whom the duty is owed. That means taking proper actions as well as refraining from taking improper actions.

Types of improper actions that could be considered a violation of fiduciary duty include a situation where a plan administrator appropriates plan assets for personal use, where a plan sponsor personally receives compensation from a third party for providing plan business, or where the plan lends money to someone who is disqualified due to conflict of interest provisions.

Long Term Disability Insurance Claims

ERISA governs long term disability insurance policies obtained through an employer.  In many cases, those who file for long term disability benefits are rejected or denied by the insurer.

The federal statutes provide a means for filing an appeal of a denied claim, although applicants often find it helpful work with an experienced ERISA lawyer to help ensure that appeal procedures are followed correctly and necessary information is correctly documented.

Speak to a Washington DC ERISA Attorney Today

Washington may be the place where ERISA laws originated, but that does not mean that those living in the city find the provisions any easier to understand.

If you feel that you may be the victim of ERISA violations either through breach of fiduciary duty, unreasonable denial of a disability claim, or violation of one of the many other ERISA protections, it is a good idea to speak to an experienced ERISA attorney who can provide help understanding ERISA in Washington DC.