ERISA insurance plan recipients who have been following me for any length of time probably know that they don’t have as many options available to them in regards to suing their insurers. You can’t punish them for acting in bad faith. You can’t get damages. You can’t sue for pain and suffering.
In fact, the only thing that you can really expect if you win your appeal is to get the benefits you should have gotten in the first place and (if you’re lucky) have the insurer pay your legal costs. Still, there are several different codes defining the “remedies” that are available to you, and if you’re considering filing an appeal it’s important that you understand them ahead of time.
The Four Codes Defining ERISA Remedies
- 1. 29 U.S.C. 1132(a)(1)(B)
- You have the ability to recover any benefits that are owed to you as defined under the terms of your policy
- You can enforce any rights that are given by the policy
- You can clarify what your rights are to future benefits under the policy
- 2. 29 U.S.C. 1132(a)(2) – This code acts as a remedy against a plan’s fiduciary for breach of duty
- 3. 29 U.S.C. 1132(a)(3)
- You have the ability “to enjoin any act or practice” that goes against either the terms of the policy or any provision in Title I of ERISA
- You have the ability to get “other…equitable relief” by:
i. Redressing plan violations
ii. Enforcing Title I of ERISA or any policy terms
- 4. 29 U.S.C. 1140 – You have the ability to bring a suit against anyone who blocks the rights that you have been granted under ERISA or the terms of the policy.
What the Four Codes Really Mean
All of that sounds really nice, but in many ways it’s just stating the same thing four different ways. Why do I say that? Because the result for you is always the same if you win – all you can get are the benefits you should have already gotten and money to cover your legal costs.
Still, it’s valuable to know so that your attorney can attack and reference the appropriate codes when filing the lawsuit and preparing your strategy. In these kinds of cases, language and procedure matter, so you absolutely need someone on your side who’s been there before.
Whatever you do, make sure you work with a disability expert you trust who knows this area of the law. Don’t play games with your health. Check out our free e-book for more details about ERISA disability and be sure to stay up to date on new long term disability information through our weekly blogs!