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Who is the Liable Party in ERISA Claims?

ERISA is a complex federal law governing employer-provided benefits. It provides strict rules regarding how they are administered and dictates processes for appealing denied claims. If your appeal is denied at administrative hearings, you may have the right to file a lawsuit against those involved. Our Chicago ERISA litigation lawyer explains who can be held liable for financial losses you suffer in this type of claim. 

ERISA Dictates Your Rights in Taking Your Case To Court

The Employee Retirement Income Security Act of 1974 (ERISA) governs health and wellness benefit programs offered by employers. While each state has its own rules and regulations governing employer-provided benefits, ERISA simplifies the matter by providing a single set of federal rules which everyone is required to follow. 

Policies and procedures under ERISA dictate the following: 

  • How employer-provided benefits are managed and administered:
  • How denied claims are handled and your rights in filing appeals;
  • The appeals process, which requires appearing before administrative judges;
  • Your rights to file a federal lawsuit through the local court if your claim continues to be denied or disputed. 

While ERISA aims at maintaining uniformity when it comes to how employer-provided benefits are handled, the question of who may be held liable in an ERISA lawsuit varies. 

Determining Who is Liable in an ERISA Lawsuit

Under ERISA Section 502(a)(1)(B), any plan participant may be entitled to file a lawsuit through the local federal court seeking to appeal denied benefits. In some cases, monetary judgments can only be ordered against the benefit plan as an entity and may not be enforced against an individual party unless you can prove their actions violated policy terms and ERISA rules and regulations. 

In other cases, anyone involved in the decision-making process can have a judgment enforced against them. This includes: 

  • The plan sponsor, which is usually the employer, as they are ultimately responsible for establishing and maintaining the plan properly. 
  • The plan administrator, who is responsible for plan management and operation and has a legal duty to protect the best interests of participants and beneficiaries. 
  • The insurance company, who can be held liable for wrongfully denying claims or failure to comply with federal law regarding the terms of policies. 
  • Third-party claims administrator, who may have been hired by the employer to handle administrative tasks and can be held liable for processing errors. 
  • Medical professionals, who can be held liable for inaccurate or misleading information used in denying benefits. 
  • Fiduciaries, which include anyone with control or authority over the plan, who has a legal duty to protect plan participants. 

Discuss Your Case With Our Chicago ERISA Litigation Lawyer

Filing an ERISA lawsuit is a complex process, but may be the only way to get the benefits you are entitled to. To discuss who can be held liable in your specific cases, request a consultation at the Law Offices of Michael Bartolic, LLC. Call or contact our Chicago ERISA litigation lawyer online today.  

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