ERISA Litigation: Employee benefits rights

If you are involved in an employee benefits dispute, the ERISA is the collection of federal laws that governs your legal rights in this situation. Our qualified attorneys have in-depth knowledge of the ERISA and represent individuals and business entities in employee benefits litigation involving nonpayment of benefits, fiduciary duty breaches, and more. If you would like to learn more about how to protect and exercise your legal rights in ERISA litigation, please contact our qualified attorneys to learn more.

Please read on to learn more about the ERISA, the rights it provides to employees, and what types of situations may govern ERISA litigation.

What is the ERISA?

The ERISA, or the Employee Retirement Income Security Act, is a federal law that created minimum requirements on private industry pension plans. Additionally, the ERISA outlines extensive regulations regarding the effects of federal income tax as relating to employee benefit plans.

What is the purpose of the ERISA?

The ERISA is intended to protect the rights and interested of employees (and their families) who participate in employee benefit plans. The federal statute does not require employers to provide such benefits as pension and healthcare, but it does provide numerous protections to pension and healthcare plan participants if an employer does provide these benefits to their workers.

The ERISA’s employee protections

The Department of Labor, Department of Treasury and the Pension Benefit Guaranty Corporation are responsible for interpreting and enforcing the ERISA.

The ERISA is a detailed set of laws that outlines many rights and regulations pertaining to the administration of employee benefits in the private sector.

Generally speaking, for employees that are provided benefits from their employers, the ERISA provides numerous protections, including:

  • the right to full disclosure of financial and other relevant information relating to the benefits plan,
  • standards of conduct for employers and plan administrators, who have a fiduciary duty to act in the best interest of plan participants,
  • provides appropriate remedies and access to the federal courts when ERISA litigation is necessary.

The ERISA gives individuals the right to sue for benefits and breaches of fiduciary duty relating to employer-sponsored pension and health care benefits programs.

Read on to learn more about ERISA regulations pertaining to pension plans and health care plans. Below, you will also find information about employee rights and what to do if your rights have been violated.

ERISA and Pension plans

The ERISA does not require that employers provide pension plans nor does it establish the minimum level of benefits an employer must provide to its employees. However, the ERISA does regulate the operation of pension plans that have been provided to employers.

Under the ERISA, an employer who sponsors a pension plan is required to meet minimum funding requirements and to vest of employee pension benefits after a set number of years. Furthermore, the ERISA also outlines how benefits are paid through a pension plan.

To provide additional protection to employees with pension plans through their employers, the Pension Benefit Guaranty Corporation was set up through the ERISA to offer benefits in cases where the employers’ plan does not have sufficient assets to funds. This means, for example, that even if an employer falls on hard times and does not have sufficient funds to pay pension benefits, the employer will still be able to collect the monies they are lawfully owed per the benefits plan.

Health benefit plans

As with pension plans, the ERISA does not require that an employer provide health benefits, nor does it establish minimum health plan provisions. However, the ERISA does regulate health care plans that are offered by private sector employees.

In the history of the ERISA, many amendments have provided expanding protection to employer-sponsored health plan participants and beneficiaries. Some of the significant ERISA amendments include:

COBRA

(The Consolidated Omnibus Budget Reconciliation Act—1985)

This law provides employer sponsored health care plan participants and their beneficiaries the right to continued health care coverage for a set time in specific cases, such as the loss of employment.  This health coverage often costs more than for active employees, yet it is typically cheaper than individual health care plans.

HIPAA

(The Health Insurance Portability and Accountability Act—1996)

This law provides plan participants and their beneficiaries protections under group healthcare plans by prohibiting coverage refusal based on health status, disability, genetic information, or pre-existing conditions under some circumstances.  It also may give additional rights to those who have exhausted COBRA coverage and need individual coverage.

In addition to the COBRA and HIPAA, other important ERISA health care laws include:

  • Newborns’ and Mothers’ Health Protection Act (1996): requires that employer-sponsored health care plans that provide maternity coverage to pay for a hospital stay of 48 hours for vaginal delivery and 96 hours for cesarean section following childbirth.
  • Women’s Health and Cancer Rights Act: requires that ERISA covered plans provide coverage to pay for medical and surgical expenses related to mastectomy, reconstructive surgery and treatment of complications in patients with breast cancer.
  • Mental Health Parity Act (1996): Requires equality in mental health benefits with medical and surgical benefits with regard to aggregate lifetime and annual dollar limits in employer-sponsored health care plans. It also provides that employers use discretion regarding the extent and scope of mental health benefits to employees and beneficiaries. This law does not cover chemical and substance abuse.

Termination of Lifetime Health Coverage

Over the last 30 years numerous employers have terminated lifetime health benefits plans to employees and retirees. While the ERISA does not cover these specific cases, such individuals have the legal right to sue their employer for breach of contract, or by challenging the health benefit plan administrator’s right to change its plan documents for the purpose of eliminating promised benefits.
To learn more about the termination of lifetime health care plans, please contact our qualified attorneys.

Employee Rights under the ERISA

With respect to both pension and health plans provided by employers, the ERISA provides benefit plan participants and their beneficiaries a number of benefits including, but not limited to:

  • The right to plan summaries and other pertinent information
  • The right to see plan information furnished by the employer to the Labor Department
  • The right to learn of their accrued and vested pension benefits upon request of the employer

Moreover, employers have a fiduciary duty to the participants and to the pension and/or health pans. Certain transactions between the plan and the employer are prohibited under ERISA. For example, a pension plan cannot invest more than ten percent of its assets in employer securities. While an employer may have the legal right to terminate a benefit plan, the ERISA stipulates when this is and is not possible, with consideration of the effects on the employees. Furthermore, the ERISA allows for the government to terminate employer-sponsored benefits plans under certain conditions.

ERISA litigation

ERISA litigation may an appropriate means to recover losses associated with the denial of employment benefits and breaches of fiduciary duty on the part of an employer or benefit plan administrator. ERISA litigation may involve any of the following:

  • Pension claims (including disability pension matters)
  • Welfare benefit claims, including medical and severance pay benefits
  • Breach of fiduciary duty or prudence duty
  • Improper recovery of surplus pension assets
  • Prohibited transaction cases
  • Failure to diversify investments
  • Claims that an employer or plan has discriminated against an employer
  • Benefit continuation claims under the COBRA
  • Medicare secondary payer issues
  • Bankruptcy issues related to employee benefit plans
  • Insurance issues
  • Fraud claims
  • Violation of securities law relating to benefits plans
  • Federal Employees’ Group Life Insurance Act claims
  • Tax and penalty claim
  • Violations of reporting and disclosure duties
  • Plan termination issues
  • Executive compensation and stock options
  • And more.

Our attorneys are qualified to handle complex ERISA litigation cases, including those involving multi-plaintiff and complex medical or financial issues. We are able to represent numerous parties involved in ERISA litigation including employers, employees, trustees, administrators, and professional advisors.

To learn more about ERISA litigation and protect your legal interests, please contact the experienced attorneys at Oshman & Mirisola who can evaluate your case to determine the best way to protect and exercise your legal rights.