Do You Have A Case?

The ERISA (Employee Retirement Income Security Act) is a federal law that sets standards for voluntary retirement, as well as health plans for private industry. Overall, the goal of it is to provide individuals with protection within these plans. If you need to sue your insurance company over ERISA issues, the process can be arduous and complex. Because it is a federal law, this usually involves federal court. Knowing the basics of how these lawsuits work can be beneficial to you. But ultimately, working closely with your attorney can be important in securing the best results.

When Can I Start My ERISA Lawsuit?

Generally, you cannot start an ERISA lawsuit until you have exhausted all administrative remedies for your situation. This may include administrative appeals and final denial. This may vary by policy. Your attorney can help you interpret the requirements specific to your policy. Additionally, ERISA litigation usually has to start within a specific time limit. This time limit can be policy specific. Consult with your attorney early on to be ready to start the lawsuit process as soon as possible.

Who Do I Sue During ERISA Litigation?

Almost always, you will be suing the insurance company, rather than your former employer. However, under some circumstances, you may also sue the employer as a separate entity. Your ERISA lawyer can help you determine if the circumstances require this. If this is the case, they will help you file separate suits.

How Do I File a Summons and Complaint for My ERISA Lawsuit?

Your ERISA lawyer will initiate the lawsuit by filing the summons and complaint. This is done in the federal District Court. This documentation will lead to the defendant being notified. This will also inform them as to why you are pursuing legal action. The summons and complaint will be served to the defendant within a certain time period. However, your lawyer will be able to handle this for you.

The Defendant’s Answer and Possible Counterclaims

After the defendant has been served, they will have to file an answer. This means that they must respond to your allegations as mentioned in your complaint. However, they may also file a counterclaim. The basis of a counterclaim would usually occur when the individual is paid benefits, but then receives income from another offset. Offsets may include Social Security Disability Insurance (SSDI), Workers’ Compensation, or a settlement from a different lawsuit. If the defendant gives a counterclaim, your lawyer will have to file a reply to it.

Working Toward an ERISA Settlement

After the lawsuit is answered by the insurance company, your attorney will work with you to build your claim. In some cases, your attorney may discuss with you initiating settlement discussions. Usually, this begins by making a settlement demand. Your attorney can help you determine a reasonable settlement demand to start with. This can vary based on claim value, the burden of proof, and the merits of your claim. The insurance company will usually counter, and numbers may go back and forth before a settlement is agreed upon.

Settlements are often a good way to resolve your claim faster than going to court. However, not every case will reach a settlement. There are a variety of factors that can affect the likelihood of achieving a settlement. These include:

  • Your goals
  • The standard of legal review
  • The strength of your claim
  • The willingness of the insurance company to engage in settlement discussion

It is important to remember that settling is not required, and is not always the best course of action. Your attorney can advise you on the best course of action for your case. The length of time spent on settlement mediation can also vary. In some cases, a settlement can be resolved in one conference, or after months of deliberation. Sometimes, a settlement is not reached, and the claim continues.

The Discovery

If settlements are not reached, the parties may engage in discovery before going to trial. During discovery, the parties will exchange information for what will be presented at the trial. This will often include evidence, witnesses, expert testimony, etc. Your attorney may take depositions from insurance company employees involved in your case.

The insurance company may also object to certain aspects of the discovery. This can often result in delays to the court date. If objections are made, your attorney will argue on your behalf as to why the information is relevant to your case.

The Motion For Summary Judgement in ERISA Litigation

Before the trial, either party can make a motion for summary judgment. This is a request for the judge to make a decision before going to trial. Generally, your attorney will argue for your case to be granted, while the insurance company will claim that the case should be dismissed. If the judge grants your motion, you would win. However, if they grant the defendant’s motion, you lose. The judge may also deny a motion for summary dismissal. If this happens, your case will go to trial.

ERISA Litigation and Trial

If a case is not settled or finished in a summary judgment, it will go to trial. During the trial, there will likely be many hours of legal preparation and drafting done by your attorney. The trial process can often be long and tedious. Unfortunately, going to trial may be necessary to fight your claim.

At the end of the trial, the judge will give their final order and decision. They may grant or deny your claim. Sometimes, a judge may approve of only some of a claim. You and your attorney may try to appeal the decision if they deny your claim in whole or in part.

Can an Attorney Help Me With My ERISA Case?

If you are looking to file an ERISA litigation against your disability insurance company, you should seek out an experienced attorney. At D’Agostino & Associates, we help people living with disabling conditions file long-term disability claims and ERISA litigation. We help you through the process step by step to help you build a strong case. Our law team is here for you.

At D’Agostino & Associates, our team of lawyers can help you sort through all the details, understand what you are entitled to, and fight to get what you deserve. D’Agostino & Associates P.C. has offices in New York and New Jersey. Contact us, or call us at 1-888-245-2924 to schedule a free consultation with our attorneys.