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ERISA / Employee Benefits

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.  ERISA does four main things with respect to covered pension and health plans:

  1. it requires plans to provide participants with plan information including important information about plan features and funding;
  2. it provides fiduciary responsibilities for those who manage and control plan assets;
  3. it requires plans to establish a grievance and appeals process for participants to get benefits from their plans; and,
  4. it gives participants the right to sue for benefits and breaches of fiduciary duty.

In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees or plans which are maintained solely to comply with applicable workers’ compensation, unemployment or disability laws.

Over the years, there have been a number of amendments to ERISA that expand the protections available to health benefit plan participants and beneficiaries.  One such amendment, the Consolidated Omnibus Budget Reconciliation Act (COBRA), provides some workers and their families with the right to continue their health coverage for a limited time after certain events, such as the loss of a job.  Another amendment is the Health Insurance Portability and Accountability Act (HIPAA).  Among other things, HIPAA provides certain protections for working Americans and their families who have preexisting medical conditions or might otherwise suffer discrimination in health coverage based on factors that relate to an individual’s health.

In most cases, an employee or beneficiary with an ERISA claim must exhaust his/her administrative remedies before filing a lawsuit.  The usual avenue for administrative relief comes in the form of petitioning the benefit plan administrator to reverse an adverse decision.

Where administrative remedies have been unsuccessfully exhausted, the employee or beneficiary can file a lawsuit.  The typical ERISA claim must be filed with an appropriate court after the earlier of (a) six years after the date of the last action which constituted a part of the breach or violation or, in the case of an omission, the latest date on which the fiduciary could have cured the breach or violation or (b) three years after the earliest date on which the employee or beneficiary had actual knowledge of the breach or violation (except that in the case of fraud or concealment, the lawsuit may be commenced not later than six years after the date of discovery of such breach or violation).

If you or someone you know in the North Mississippi/West Tennessee area is in need of representation or legal advice from an experienced employment lawyer, contact the attorneys of Stroud & Harper, P.C., by making a toll-free call to (866) 359-4878. Or, if you prefer, complete the Free Online Case Evaluation form, which you can find on the Areas of Practice page.