We handle ERISA § 502 claims against group health insurance policies and administrators for benefits payable under the plan, and breaches of fiduciary duty. The firm has represented countless clients in getting health plans to cover the cost of necessary services, and in forcing employers and other fiduciaries to pay the cost of services due to misrepresentations and other breaches of fiduciary duty. Recently, the firm successfully represented a client who was assured by the insurer that a hospital was in-network, but afterward had his claim denied as out-of-network. The Firm demonstrated that the insurer was liable because of its misrepresentation. We also helped a client have insurance cover a costly surgery that was necessary for the client to conceive children where the insurer denied the claim as “cosmetic.” In another case, an employer switched insurance carriers while our client was receiving COBRA coverage, but never enrolled the client with the new insurer. We helped the client get the cost of her child delivery covered despite there being no binding insurance coverage at the time of delivery.
Employer provided group health insurance policies offered through your employer are usually employee benefit plans covered by ERISA. The administrator may deny coverage for a costly surgery and after-surgical treatment because it claims the treatment falls into an exclusion in the plan. In other instances, health insurers provide an approval for the treatment or procedure, only later to deny paying for the cost, leaving you with doctor and hospital expenses in the upper five figures, six figures, or in some cases even in the millions. Often, the surviving spouse of a participant with a morbid condition is left with bills which the insurer rightfully should have covered.
When your insurer refuses to pay for a treatment or surgery you already underwent, it is critical to involve an ERISA lawyer immediately. Ignoring the problem, or letting the hospital fight with the plan, will only result in the hospital suing you for payment. And, if you wait long enough, you can lose your right to appeal the claim with the insurer.
These claims often present unique issues for executives, managers, and other professionals, whose families depend upon them for financial support and need to devote their attention to their business, rather than dealing with an insurer. We help clients obtain reimbursement for surgeries, procedures and treatments that should be covered under the health plan.
Unlike life insurance lawyers or general insurance lawyers, Michael Bartolic, LLC is a unique kind of law firm serving executives and other Chicago professionals in employee benefits and deferred compensation matters. The Firm devotes itself full-time to representing individuals in disputes arising under ERISA § 502 and the pre-litigation administrative claim and appeal process.
The Firm handles all sorts of claims on behalf of individuals under ERISA § 502. Most employee benefit plans are governed by the Employee Retirement Income Security Act of 1974, more commonly known as ERISA. While ERISA does not mandate that your employer provide you with a pension, 401(k), long term disability, life insurance, or health insurance plan, ERISA demands employers that choose to provide such benefits comply with complex rules and regulations.
Michael Bartolic, LLC handles ERISA § 502 claims in Chicago and the rest of Illinois against group long term disability insurance policies for disability benefits payable, and where appropriate, against the administrators of the plans who’s breach of fiduciary duty harmed the participant. Michael Bartolic has successfully obtained long term disability benefits for clients suffering from all kinds of conditions, including:
The Firm represents executives and other professionals in Employee Benefits Discrimination and Interference Claims arising under ERISA § 510. ERISA prohibits any adverse employment action against an employee for exercising any right under an employee benefit plan. It also protects employees from interference with their attainment of any right under a benefit plan, and retaliation for participating in proceedings related to ERISA.
Michael Bartolic, LLC represents individuals facing claims by employee benefit plans for recoupment of overpayment of benefits. The Firm successfully resolved cases involving pension overpayments, long term disability overpayments, and health insurance overpayments. In approaching these matters, the fact of whether or not the overpayment occurred is often a subsidiary inquiry to how it occurred.
When a private employer offers certain benefits, including retirement, health insurance, or long term disability insurance, the plans offered must comply with the requirements set out by the Employee Retirement Income Security Act, also known as ERISA. One requirement is that ERISA imposes a strict fiduciary duty on certain individuals who are involved in the management of a benefit plan. This is important, because when a plan is mismanaged, it can harm employees and can deny them benefits to which they would have otherwise been entitled.
Serious physical or mental health conditions can arise when you least expect them, and they may prevent you from working and earning a living. Fortunately, if you have ERISA long term disability insurance coverage through your employer, you can receive monthly benefits while you are unable to work. However, before you can receive benefits, you must first apply and have your claim approved. In order to have a claim approved, you must be deemed to have a condition that qualifies as a “long term disability” under your policy.
Employee benefits can come in many forms, from health insurance to retirement funds to long-term disability insurance. When private employers decide to offer certain benefits, they must make sure that their offerings are in full compliance with the federal law, the Employee Retirement Income Security Act (ERISA). For a benefit plan to be covered by the law, it must be established and administered by the employer and must cover at least one employee.
When an individual receives a denial of a valid insurance claim, they often have the right to file a legal claim against their insurer to obtain the proper benefits under their coverage plan. If your insurance plan is an employer-provided plan regulated under the Employee Retirement Income Security Act (ERISA), however, there are highly specific and strict procedures for appealing a claim denial.
Not every private employer in the U.S. is required to provide access to an employer-sponsored pension or retirement plan. However, if a private sector employer does choose to do so, they do not have the discretion to completely design a plan however they wish. Instead, such pension funds and plans must comply with the Employee Retirement Income Security Act of 1974, commonly known as ERISA. The following is some information regarding pension funds and plans under ERISA.
Providing health, retirement, and long term disability benefits for employees can be extremely beneficial for both the employer and employees; however, such benefits are not cheap; and employers are always seeking ways to cut back on costs. If they want to reduce spending on health plans or pension plans, a company may be tempted to terminate an employee who has a serious medical condition or who has a pension that is about to vest. If this occurs, the employee is not only left without an income,, but also without access to the benefits they need and deserve.
As with any other type of insurance, you may have many options when selecting long term disability insurance, which provides benefits in the event you become disabled and cannot work for an extended period of time. There is the option to purchase an individual insurance policy on your own by simply choosing a provider, signing a contract, and paying premiums directly to the insurance company. However, in many cases, your employer may provide a group plan for long term disability insurance.
We handle ERISA § 502 claims against group health insurance policies and administrators for benefits payable under the plan and breaches of fiduciary duty. The firm has represented countless clients in getting health plans to cover the cost of necessary services and in forcing employers and other fiduciaries to pay the cost of services due to misrepresentations and other breaches of fiduciary duty.
Michael Bartolic is a life insurance lawyer who represents individuals with disputes over life insurance and accidental death and dismemberment benefits under ERISA § 502. In addition to claims arising under ERISA, the life insurance lawyers at Michael Bartolic, LLC handle claims against insurers of individual policies, as well. The Firm has successfully resolved cases for both the life insurance benefits under the terms of the policy, and claims where benefits would have become payable except for a breach of fiduciary duty, usually a misrepresentation.
If you work for an employer that provides you with long term disability (LTD) coverage governed by the Employee Retirement Income Security Act (ERISA), you should be able to expect that you will receive the benefits you need if you become disabled and properly file a claim in accordance with ERISA claims procedures. However, your application for benefits will be reviewed by a claims administrator who is likely working for the insurance provider.
Retirement plan claims arise in a number of different contexts, but all contexts share one thing in common: your benefit or your account balance is not worth as much as it should be. That’s when you need a retirement benefits attorney. Michael Bartolic, LLC has represented clients with claims against all types of ERISA covered retirement plans, including defined benefit pension plans, ESOPs, 401(k) plans, profit sharing plans, cash balance plans, SERPs, and other executive retirement plans.
Michael Bartolic represents executives and managers who have been denied benefits under a supplemental executive retirement plan, excess benefit plan, or any other deferred compensation or retirement plan for executives and management, including short term and long term incentive compensation. Most forms of deferred compensation and retirement plans available only to executives or management lack some of the features other retirement plans offered to all other employees.
Severance benefit claims in Chicago and the rest of the country arise in several contexts. Your employer may have a formal written severance plan, sometimes called an income protection plan, applicable to all employees or a select class of employees, outlining the number of weeks or months of separation compensation payable in the event of an involuntary termination. These plans may or may not include other benefits, usually continued participation in the employer’s health insurance plan at a subsidized rate.
The Firm handles claims for short term disability benefits under employer provided disability plans and programs in the Chicago area and in the rest of Illinois. Employer provided short term disability plans may or may not be governed by ERISA, often depending on the method of funding. Whether or not the plan is covered by ERISA dramatically alters the process by which you claim the benefits and appeal any denial.
Nearly every disabled individual who applies for disability benefits through an employer based disability plan or from private disability insurance is encouraged or even required to also apply for disability benefits from the Social Security Administration. The employer provided disability plan will usually provide for a benefit, net of an offset for benefits you receive from the Social Security Administration.
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