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If Your Insurance Claim Is Subject to ERISA — BEWARE

ERISA controls all insurance provided through employer-sponsored benefit plans. For most working people, this means all of their health, disability, and life insurance claims are governed by ERISA, a federal statute that is a disaster for consumers.

Bob Rutter has written an article entitled "Taming the ERISA Beast: Contesting the Denial of ERISA Insurance Claims" which addresses the problems and pitfalls that arise in ERISA claims.

If you have received a denial of an insurance claim and the letter states that your claim is subject to ERISA, then BEWARE. A wrong move can jeopardize your claim, regardless of the merits of your claim. Do not try to handle a wrongful denial yourself. Speak to a lawyer who knows and understands ERISA's complexities — NOW.

A company executive in Ohio was diagnosed with a rare and disabling condition within the first year of starting a new job. There was no question that the insured was disabled, so the insurer tried a common tactic — asserting that the disease was a pre-existing condition (PEC). The claim was denied and the insured came to Rutter & Russin for help. Knowing the rules governing ERISA claims, Rutter & Russin demanded an administrative appeal, obtained the administrative record, reviewed the report from the defense doctor, and successfully argued that the carrier's interpretation of the PEC exclusion was incorrect. After months of wrangling, the carrier finally backed down and paid the claim in its entirety.


ERISA claim denials are notoriously difficult to contest. The attorneys of Rutter & Russin have experience successfully resolving ERISA cases and know how to best proceed when your claim has been denied. Contact us today for a free consultation.

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