• Skip to primary navigation
  • Skip to main content

Law Offices of Scott Glovsky

Site by GNGF

OUR OFFICES:
  • Claremont
    • 343 Harvard Avenue
      Claremont, CA 91711Get Directions
    • Call: (909) 296-7700
  • Pasadena
    • 299 N. Euclid Ave.
      Second Floor
      Pasadena, CA 91101
      Get Directions
    • Call: (626) 243-5598

(626) 243-5598

Free Case Evaluation

  • Home
  • About
    • About Our Firm
    • Attorneys
    • How Our Firm Has Changed Lives
    • How We Operate
  • Practice Areas
        • Health Insurance Denials
          • Insurance Bad Faith
          • Health Insurance Claim Denials
          • Medical Necessity Denials
          • Experimental/Investigational Denials
          • Out-of-Network Denials
          • Insurance Policy Rescission
          • Health Insurance Denials Public Employees
          • Medicare Advantage Health Insurance Denial
          • We Fight All Health Insurance Companies, Including:
            • Aetna Denial
            • Anthem Blue Cross Denial
            • Blue Shield of California Denial
            • Cigna Denial
            • Health Net Denial
            • Kaiser Permanente Denial
            • OSCAR Health Plan Denial
            • Magellan Healthcare Denial
            • Molina Healthcare Denial
            • Regal Medical Group Denial
            • UnitedHealthcare Denial
        • Medications
          • Prescription Denial
          • Gene Therapy
          • Cancer Treatment
            • Proton Radiation Therapy
          • New Cancer Drugs
          • Expensive Drugs
          • Biologic Drugs
          • Cosentyx
          • Dupixent
          • Enbrel
          • Entyvio
          • Euflexxa
          • Harvoni
          • Humira
          • Intravenous Immunoglobulin (IVIG)
          • Ketamine
          • Leqembi™
          • Monovisc
          • Mounjaro
          • Orthovisc
          • Ozempic
          • POLIVY
          • Radicava
          • Remicade
          • Synvisc
          • Spinraza
          • SpaceOAR Hydrogel
          • Stelara
          • Wegovy
          • Xeljanz
          • Xifaxan
          • Zolgensma
        • Injuries & Surgeries
          • Spinal Cord Injury
          • Brain Injury
          • Surgery
          • Back Surgery
          • Ablation Surgery
          • Prosthetic Limb
          • Respite Care
          • Pain Treatment
          • Partial Hospitalization
          • Magnetic Resonance Imaging (MRI)
          • Radiofrequency Ablation (RFA)
        • Health Conditions
          • ALS
          • Alzheimer’s Disease and Dementia
          • Autism
          • Autoimmune Disorders
            • Ankylosing Spondylitis
            • Crohn's Disease
            • Fibromyalgia
            • Multiple Sclerosis
            • Lupus
          • Blood Disorder
          • Cancer
          • Cerebral Palsy
          • COVID-19
          • Counseling
          • Diabetes
          • Eating Disorder
          • Genetic Testing
          • Genomic Testing
          • Heart Condition
          • Hydrocephalus
          • Intensive Outpatient Program
          • Mental Health
          • Migraine
          • Obesity
          • Osteoarthritis
          • Parkinson's Disease
          • Postural Orthostatic Tachycardia Syndrome
          • Residential Treatment Center (RTC)
          • Rheumatoid Arthritis
          • Skin Treatment
          • Spinal Muscular Atrophy
          • Substance Use Disorders & Addiction
          • Ulcerative Colitis
        • Personal Injury
          • Accidents
            • Bicycle Accidents
            • Car Accidents
            • Motorcycle Accidents
            • Truck Accidents
          • Traumatic Brain Injury
          • Catastrophic Injury
          • Burn Injury
          • Wrongful Death
          • Premise Liability
          • Slip & Fall
          • Product Liability
          • Nursing Home Abuse
          • Elder Abuse
        • Sexual Abuse
          • Types of Sexual Abuse
          • Child Sexual Abuse
          • Campus Abuse
          • Special Needs Abuse
          • Abuse at School
          • Abuse at Camp
          • Abuse by a Clergy Member
          • Abuse by Athletic Coaches
        • Business Issues
          • Employment & Business Issues
          • Broker & Agent Negligence
          • Business Contingency Litigation
          • Unfair Business Practices
          • Workplace Harassment
          • Wrongful Termination
          • Whistleblower
            • Qui-Tam
  • Results
    • Testimonials
    • Case Results
  • In The Media
  • Resources
    • Frequently Asked Questions
    • Trial Lawyer Talk Podcast
    • Fight Health Insurance Denials Book
    • Download Our eBook
    • Helpful Resources
    • Blog
    • Guides
    • Sign Up for Our Mailing List
    • Power of Resilience Scholarship
  • Contact
Contact Us
Call Us
  • Home
  • About
    • About Our Firm
    • Attorneys
    • How Our Firm Has Changed Lives
    • How We Operate
  • Practice Areas
        • Health Insurance Denials
          • Insurance Bad Faith
          • Health Insurance Claim Denials
          • Medical Necessity Denials
          • Experimental/Investigational Denials
          • Out-of-Network Denials
          • Insurance Policy Rescission
          • Health Insurance Denials Public Employees
          • Medicare Advantage Health Insurance Denial
          • We Fight All Health Insurance Companies, Including:
            • Aetna Denial
            • Anthem Blue Cross Denial
            • Blue Shield of California Denial
            • Cigna Denial
            • Health Net Denial
            • Kaiser Permanente Denial
            • OSCAR Health Plan Denial
            • Magellan Healthcare Denial
            • Molina Healthcare Denial
            • Regal Medical Group Denial
            • UnitedHealthcare Denial
        • Medications
          • Prescription Denial
          • Gene Therapy
          • Cancer Treatment
            • Proton Radiation Therapy
          • New Cancer Drugs
          • Expensive Drugs
          • Biologic Drugs
          • Cosentyx
          • Dupixent
          • Enbrel
          • Entyvio
          • Euflexxa
          • Harvoni
          • Humira
          • Intravenous Immunoglobulin (IVIG)
          • Ketamine
          • Leqembi™
          • Monovisc
          • Mounjaro
          • Orthovisc
          • Ozempic
          • POLIVY
          • Radicava
          • Remicade
          • Synvisc
          • Spinraza
          • SpaceOAR Hydrogel
          • Stelara
          • Wegovy
          • Xeljanz
          • Xifaxan
          • Zolgensma
        • Injuries & Surgeries
          • Spinal Cord Injury
          • Brain Injury
          • Surgery
          • Back Surgery
          • Ablation Surgery
          • Prosthetic Limb
          • Respite Care
          • Pain Treatment
          • Partial Hospitalization
          • Magnetic Resonance Imaging (MRI)
          • Radiofrequency Ablation (RFA)
        • Health Conditions
          • ALS
          • Alzheimer’s Disease and Dementia
          • Autism
          • Autoimmune Disorders
            • Ankylosing Spondylitis
            • Crohn's Disease
            • Fibromyalgia
            • Multiple Sclerosis
            • Lupus
          • Blood Disorder
          • Cancer
          • Cerebral Palsy
          • COVID-19
          • Counseling
          • Diabetes
          • Eating Disorder
          • Genetic Testing
          • Genomic Testing
          • Heart Condition
          • Hydrocephalus
          • Intensive Outpatient Program
          • Mental Health
          • Migraine
          • Obesity
          • Osteoarthritis
          • Parkinson's Disease
          • Postural Orthostatic Tachycardia Syndrome
          • Residential Treatment Center (RTC)
          • Rheumatoid Arthritis
          • Skin Treatment
          • Spinal Muscular Atrophy
          • Substance Use Disorders & Addiction
          • Ulcerative Colitis
        • Personal Injury
          • Accidents
            • Bicycle Accidents
            • Car Accidents
            • Motorcycle Accidents
            • Truck Accidents
          • Traumatic Brain Injury
          • Catastrophic Injury
          • Burn Injury
          • Wrongful Death
          • Premise Liability
          • Slip & Fall
          • Product Liability
          • Nursing Home Abuse
          • Elder Abuse
        • Sexual Abuse
          • Types of Sexual Abuse
          • Child Sexual Abuse
          • Campus Abuse
          • Special Needs Abuse
          • Abuse at School
          • Abuse at Camp
          • Abuse by a Clergy Member
          • Abuse by Athletic Coaches
        • Business Issues
          • Employment & Business Issues
          • Broker & Agent Negligence
          • Business Contingency Litigation
          • Unfair Business Practices
          • Workplace Harassment
          • Wrongful Termination
          • Whistleblower
            • Qui-Tam
  • Results
    • Testimonials
    • Case Results
  • In The Media
  • Resources
    • Frequently Asked Questions
    • Trial Lawyer Talk Podcast
    • Fight Health Insurance Denials Book
    • Download Our eBook
    • Helpful Resources
    • Blog
    • Guides
    • Sign Up for Our Mailing List
    • Power of Resilience Scholarship
  • Contact

What is ERISA?

Home » Frequently Asked Questions » What is ERISA?

Page Contents:

  • Los Angeles ERISA Lawyer
  • The Law Offices of Scott Glovsky takes non-ERISA cases
  • Limitation of Rights for Claims Under ERISA
  • Employee Benefits Under ERISA
  • Who’s Covered By ERISA

Los Angeles ERISA Lawyer

An individual’s insurance claim often falls under a federal law called ERISA. This law dramatically curtails what a policyholder can do and how a policyholder can do it. In short, you have fewer rights under ERISA.

The Law Offices of Scott Glovsky takes non-ERISA cases

Teachers, first responders, police officers, firefighters, government employees, business owners, people working for religious organizations and individuals who obtain their own insurance are the people most likely NOT impacted by ERISA.

Non-ERISA insurance holders fall into one of five categories below:

  • You’re a Government Employee
    Employees of government entities – local, county, city, state, or federal
  • Individually Obtained Insurance Policy
    You purchased your own insurance as an individual, not part of any business
  • You Work For a Religious Organization
    Employees of religious organizations
  • You’re a Business Owner – And Your Policy Covers no Employees Other Than the Business Owners
    Individually issued to an owner of business where no other employee is insured under the policy

ERISA stands for the “Employee Retirement Income Security Act of 1974.” It is a federal law which was designed to federalize and unify the field of employee benefits and applies to most insurance obtained as an employee benefit from an employer. Originally ERISA was targeted at employee pension plans and provided employee protections. Over the years, the law has been amended numerous times and now covers most employer provided insurance benefits and does more to protect insurance companies than policyholders.

ERISA covers employer issued benefits including those related to pensions, life insurance benefits, disability insurance benefits and health benefits.

ERISA also set up a series of administrative procedures and standards of review that stripped most policyholders of the ability to sue an insurance company in a normal court of law. Think of ERISA as a different system with its own set of rules.

Limitation of Rights for Claims Under ERISA

Some of the restrictions apply to areas such as:

  • No jury trials
  • Not full trials
  • Breaches of the insurance contract
  • No suits for bad faith (the ability to get punitive damages – a huge incentive for good plaintiff attorneys)
  • Ability to sue an insurance company for its bad behavior
  • Pre-trial discovery (depositions, getting witness testimony, etc.)
  • Evidence admissible about the insurance company in a trial

These restrictions limit how badly an insurance company can be punished for wrongfully denying a claim. There is no penalty for behaving badly.

Employee Benefits Under ERISA

Under ERISA, employers or their agents must adhere to numerous standards involving areas such as:

Behavior/Conduct:

  • Regulates the conduct required for fiduciaries – such as the person or organization financially responsible for the administration of a covered plan – and health care plan providers – such as insurance companies and managed care plans like HMOs.

Reporting and Accountability:

  • Mandates detailed reporting and accountability to the federal government.

Disclosures and Information:

  • Disclosures and information must be provided to plan participants. A health plan would have to disclose what’s covered and not along with the insured’s payment responsibility. A retirement plan would have to disclose benefits and calculate any defined benefit amounts owed to employee.

Procedural Safeguards:

  • ERISA requires an actual plan that includes policies and procedures for things such as how claims should be filed, appeals process for claims that are denied and standards used to review the appeals.

Financial Protection and Best-Interest:

  • ERISA acts as a safeguard to assure that plan funds are protected and delivered in the best interested of the plan members. ERISA also prohibits discriminatory practices in obtaining, and the collection of, plan benefits for qualified individuals.

Who’s Covered By ERISA

ERISA governs all claims for benefits (whether procured through insurance or otherwise) from an “employee welfare benefit plan” and includes coverage such as life, health or disability. Most employees are subject to ERISA. Exceptions are employees of religious organizations, employees of government organizations and entities and business owners with their own policies.

Generally, any insurance policy that is issued as a benefit of one’s employment is covered by ERISA. This would include disability, health, and life insurance policies. If you have a claim under any such policies, you are probably limited to the very few rights available under ERISA.

Primary Sidebar

Testimonial

“As a young lawyer, I am appreciative of great lawyers like yourself, who are willing to take the time to pass your knowledge and wisdom onto others.  I just finished your podcast with Greg Reeves.  I grew up with Greg’s niece, and his brother built my childhood home.  I had no idea how great of a lawyer he was until recently.  I started following him on Instagram after I graduated law school, and he is the reason I was led to your podcast a few months ago and to Gerry Spence’s book “Win Your Case”.

I hope to be able to attend the Ranch and effectively incorporate the techniques you discuss in one of the coming years. I hope you are able to keep the podcast going, and I look forward to each episode.

Thank you for sharing your gift with us.”

- J.F.B

Free Case Evaluation

  • Hidden
  • This field is for validation purposes and should be left unchanged.

343 Harvard Avenue
Claremont, CA 91711
(626) 243-5598
  • Facebook
  • Linkedin
  • Twitter
  • YouTube
  • Apple Podcast

Copyright © 2023 Law Offices of Scott Glovsky
Disclaimer Privacy Policy

The Law Offices of Scott Glovsky is a Professional Corporation. Information on this website is not intended as and is not legal advice. The information does not establish an attorney-client relationship. Case results are not a prediction or guarantee of potential case outcomes. This website is an attorney advertisement.

  • Home
  • About
    ▼
    • About Our Firm
    • Attorneys
    • How Our Firm Has Changed Lives
    • How We Operate
  • Practice Areas
    ▼
    • Health Insurance Denials
      ▼
      • Insurance Bad Faith
      • Health Insurance Claim Denials
      • Medical Necessity Denials
      • Experimental/Investigational Denials
      • Out-of-Network Denials
      • Insurance Policy Rescission
      • Health Insurance Denials Public Employees
      • Medicare Advantage Health Insurance Denial
      • We Fight All Health Insurance Companies, Including:
        ▼
        • Aetna Denial
        • Anthem Blue Cross Denial
        • Blue Shield of California Denial
        • Cigna Denial
        • Health Net Denial
        • Kaiser Permanente Denial
        • OSCAR Health Plan Denial
        • Magellan Healthcare Denial
        • Molina Healthcare Denial
        • Regal Medical Group Denial
        • UnitedHealthcare Denial
    • Medications
      ▼
      • Prescription Denial
      • Gene Therapy
      • Cancer Treatment
        ▼
        • Proton Radiation Therapy
      • New Cancer Drugs
      • Expensive Drugs
      • Biologic Drugs
      • Cosentyx
      • Dupixent
      • Enbrel
      • Entyvio
      • Euflexxa
      • Harvoni
      • Humira
      • Intravenous Immunoglobulin (IVIG)
      • Ketamine
      • Leqembi™
      • Monovisc
      • Mounjaro
      • Orthovisc
      • Ozempic
      • POLIVY
      • Radicava
      • Remicade
      • Synvisc
      • Spinraza
      • SpaceOAR Hydrogel
      • Stelara
      • Wegovy
      • Xeljanz
      • Xifaxan
      • Zolgensma
    • Injuries & Surgeries
      ▼
      • Spinal Cord Injury
      • Brain Injury
      • Surgery
      • Back Surgery
      • Ablation Surgery
      • Prosthetic Limb
      • Respite Care
      • Pain Treatment
      • Partial Hospitalization
      • Magnetic Resonance Imaging (MRI)
      • Radiofrequency Ablation (RFA)
    • Health Conditions
      ▼
      • ALS
      • Alzheimer’s Disease and Dementia
      • Autism
      • Autoimmune Disorders
        ▼
        • Ankylosing Spondylitis
        • Crohn’s Disease
        • Fibromyalgia
        • Multiple Sclerosis
        • Lupus
      • Blood Disorder
      • Cancer
      • Cerebral Palsy
      • COVID-19
      • Counseling
      • Diabetes
      • Eating Disorder
      • Genetic Testing
      • Genomic Testing
      • Heart Condition
      • Hydrocephalus
      • Intensive Outpatient Program
      • Mental Health
      • Migraine
      • Obesity
      • Osteoarthritis
      • Parkinson’s Disease
      • Postural Orthostatic Tachycardia Syndrome
      • Residential Treatment Center (RTC)
      • Rheumatoid Arthritis
      • Skin Treatment
      • Spinal Muscular Atrophy
      • Substance Use Disorders & Addiction
      • Ulcerative Colitis
    • Personal Injury
      ▼
      • Accidents
        ▼
        • Bicycle Accidents
        • Car Accidents
        • Motorcycle Accidents
        • Truck Accidents
      • Traumatic Brain Injury
      • Catastrophic Injury
      • Burn Injury
      • Wrongful Death
      • Premise Liability
      • Slip & Fall
      • Product Liability
      • Nursing Home Abuse
      • Elder Abuse
    • Sexual Abuse
      ▼
      • Types of Sexual Abuse
      • Child Sexual Abuse
      • Campus Abuse
      • Special Needs Abuse
      • Abuse at School
      • Abuse at Camp
      • Abuse by a Clergy Member
      • Abuse by Athletic Coaches
    • Business Issues
      ▼
      • Employment & Business Issues
      • Broker & Agent Negligence
      • Business Contingency Litigation
      • Unfair Business Practices
      • Workplace Harassment
      • Wrongful Termination
      • Whistleblower
        ▼
        • Qui-Tam
  • Results
    ▼
    • Testimonials
    • Case Results
  • In The Media
  • Resources
    ▼
    • Frequently Asked Questions
    • Trial Lawyer Talk Podcast
    • Fight Health Insurance Denials Book
    • Download Our eBook
    • Helpful Resources
    • Blog
    • Guides
    • Sign Up for Our Mailing List
    • Power of Resilience Scholarship
  • Contact