ERISA disputes arise when a client has an employer-sponsored group benefit, such as health insurance or disability insurance. If the client is denied a benefit under the plan unfairly, he or she has the rights to bring a lawsuit in court. For example, if a group health plan denies a treatment as not necessary, we can challenge that decision in court.
However, sometimes it is beneficial not to go to court. Instead, you might benefit from mediation. Is mediation a good solution for everybody?
Mediation is a type of guided negotiation. The person doing the guiding is the mediator, who is a neutral third party. The mediator does not act as a judge and does not pick a winner or loser.
Instead, the mediator’s role is to facilitate discussion and listening. Many lawsuits can be avoided if each side is prepared to negotiate in good faith and to find common ground. The mediator can help identify the real issues in dispute and work with parties to reach a compromise. Any agreement is written up in a settlement agreement, which is a binding contract. When successful, mediation can keep people out of court.
Yes. You can mediate practically any dispute, and ERISA is no exception. In the typical ERISA case, the plan administrator will be the “other side.” This is the person who denied you the benefit to which you think you are entitled.
You can have a lawyer in mediation, which is helpful since you can be sure that the plan administrator will have legal counsel. However, a lawyer’s job in mediation is not to make arguments like they do in court but to work toward a favorable resolution.
One benefit is the opportunity to tell your story, which you cannot do in court. Instead, a court case will revolve around the administrative record—the documents and testimony submitted to the plan when you are seeking benefits or a reconsideration of the denial. In mediation, you can express how you feel that you were denied vital benefits. Although this is not an occasion to vent, many clients feel relieved at finally being able to express their frustration.
Mediation can also be faster and less stressful for all parties involved. You might gain your badly-needed benefits much more quickly, which can reduce financial strain.
Mediation is not appropriate for every dispute. For example, the other side might be unreasonable or completely wrong on the law and not be willing to resolve the dispute. You will have no choice but to present your case to the judge and ask him or her to rule in your favor. Each case is different.
If you have been denied benefits, contact the Law Office of Michael Bartolic today. Our firm has represented many clients in Chicago, and we have the experience you need to get the benefits you deserve.
Contact us today to schedule your free consultation by calling 312-635-1600.