How ERISA disability denials work

On Behalf of | Dec 28, 2021 | ERISA

There’s an emerging trend in the world of the Employee Retirement Income Security Act of 1974 (ERISA) which is only growing more prevalent in New Jersey and across the rest of the United States. There have been countless attempts at swaying the courts to start treating basic ERISA cases – ones that deal with completely standard and routine ERISA benefits – as if they were routine litigation.

Treating ERISA claims like routine litigation

In some ERISA claims for benefits, a district court may find that there were indeed errors made in the claim, but they still don’t have an adequate amount of information on the record to award the claimant their benefits. This is already happening in some Ninth Circuit courts, where it is now permissible to bring forth the alternate pleading options of fiduciary duty claims and claims for benefits – even for instances in which the only breach of fiduciary duty being claimed is the benefit claim being denied.

When that happens, the matter may be remanded by the court so it may undergo further review by an administrative body. This process of dealing with these ERISA claims has been going on for decades, affirmed by numerous circuit courts, without the Supreme Court ever providing its ruling. Until a case is brought before the SCOTUS that the justices deem worthy of their legal insight, lower courts will remain free to regulate themselves.

A mixed bag of standards

It’s impossible to predict how different ERISA’s permissible scope of discovery is from district to district. Since there’s no federal governing standard, these rules are a mixed bag – and it’s up to claimants to keep track of the regulations that they should follow.

For anyone with an ERISA disability denial, it’s crucial to understand what the laws are in the specific district where you are claiming those benefits. Importantly, it gives you a better sense ahead of time if you will be dealing with a litigation process that’s in line with other types of ERISA litigation or not.