ERISA the Employee Retirement Income Security Act
ERISA, the Employee Retirement Income Security Act, is a federal law passed by congress in 1974, ostensibly to safeguard and provide fair and regular procedures for the administration of employee welfare benefit plans subject to ERISA. These plans include health, disability, life insurance and other plans. An ERISA Plan is administered by a Plan Administrator, who is charged with administering the Plan in a fair and objective fashion on behalf of participants and beneficiaries of the Plan. Despite this charge, the courts have provided Plan Administrators a great deal of discretion in administering the Plans, especially in making substantive decisions about whether a given benefit or claim should be paid. In effect this has served to protect Plan Administrators from legal jeopardy for self-interested decision-making, in direct violation of the intent and the clearly-stated provisions of the law.
In addition, the litigation of denied benefits claims under ERISA differs starkly from litigation in state law breach of contract claims. Even Perry Mason, the iconic and beloved television lawyer, would find it daunting to attempt to litigate an ERISA claim, as he would be hampered by being unable to present his claim to a jury, to call witnesses, to cross examine witnesses, to present expert testimony, or to offer the reasonable argument, based on the facts of the case that justice would be best served by finding for his client. This is because the law and the courts have made litigation a largely administrative process in which the “evidence” concerning the claim must be presented to the Plan Administrator during the processing of the claim. Thus the claimant and/or the claimant’s lawyer must submit evidence in a timely fashion, addressing the specific issues presented by the Plan and the applicable law.
Below is a brief discussion of representative ERISA cases which I have handled. I currently pursue ERISA claims in the administrative stages and in litigation in federal court and the court of appeals. You may find these cases interesting.
Joy, an operating engineer, was tasked with moving earth from a steep slope near the Oregon coast. The cat that he operated was tied to a winch which let the cat go down the slope and then retrieved it in yo-yo fashion. Joy was lap-belted and harnessed in his seat to ensure he did not fall off the cat. Over the course of several days, Joy noticed
Stone became disabled from a combination of conditions, including traumatic brain injury, mold-caused illnesses, allergic reactions, pulmonary compromise and cancers, while employed as a customer service representative by Bayer. When Bayer finally denied her application for disability benefits on the basis that she was
Scoles was employed as a systems analyst at Intel’s Beaverton, Oregon Plan. She became disabled by a combination of anxiety, panic attack with agoraphobia and major depression. Despite presentation of objective findings of continued disability, the Plan denied her claim. She then filed suit in federal district court in Portland, Oregon.
Many ERISA cases are accepted or settled, depending on the language of the Plan, the medical evidence and the applicable law. Plan language is different from Plan to Plan, and the medical evidence in each case is unique to the applicant. ERISA jurisprudence — court decisions — is dynamic and changing. One thing is certain in an ERISA case, however — you must review and understand the Plan and develop the record while the claim is still in the process of being considered by the Plan Administrator. It is primarily this record which the federal district court will consider and be bound by once the claims administrative process finally ends. Thus it is extremely important that an applicant for benefits obtain counsel early on during the time the claim is still being processed by the Plan.