ERISA Benefits

ERISA Benefits

The ERISA Benefits Litigation Group is dedicated to combatting abusive practices in health and disability employee benefits with a strong commitment to upholding the rights of employees and their families. Recognizing the substantial impact of benefit denials, the group strives to address systemic issues within the employee benefit system, such as the overselling of disability plans without adequate premiums and the use of health insurance as a loss leader to gain market share, leading to substandard healthcare and fraudulent denial of care. These practices not only burden the government and taxpayers with correcting these abuses through social safety nets but also undermine the integrity of the employee benefits sector. By facilitating an information exchange platform, the group endeavors to promote the public good through collective efforts to ensure that employee benefits are rightfully paid, providing necessary compensation to injured and sick employees.

Regrettably, the federal judiciary's actions have allowed the perversion of the intended purpose of the Employee Retirement Security Act, which was designed to protect employees' interests. Instead, it has been used as a shield to protect those engaging in abusive and fraudulent practices within the insurance industry. Benefits that should be rightfully granted are denied, and fiduciary duties are neglected without repercussions, owing to inadequate remedies devised by the courts, disregarding congressional intent.

Healthcare payers resort to cost-cutting measures by unjustly denying treatment payments. Some insurers even engage in random denials to identify potential fraudulent claims, adversely affecting those with genuine claims. Additionally, excessive co-pays and unscrupulous provider contracts burden patients and place physicians in a conflict of interest, compromising the quality of care. Coerced into suboptimal contracts, physicians are economically compelled to provide inadequate treatment, creating an ethical dilemma.

Another concerning issue lies in the denial of payment for "experimental and investigative treatment," despite many of these procedures being widely accepted within the medical profession and offering the best care. Instead, such denials often lead to less effective treatment options being provided due to their lower cost. Furthermore, the involvement of medical device manufacturers paying physicians to prescribe or implant their products raises concerns about the quality and safety of these devices.

Disability benefit carriers frequently deny payments by creating arbitrary requirements not specified in the policy, and even when payments are made, they can be terminated arbitrarily. The opinions of treating physicians are often disregarded, while insurance doctors provide questionable reports to justify these illegal and abusive denial practices. Bonuses offered to adjusters for terminating high-dollar claims further exacerbate the situation.

The ERISA Benefits Litigation Group endeavors to address these troubling practices and strives to uphold the rights of employees, seeking fair and just treatment for all those covered under employee benefits programs. Through concerted efforts and advocacy, the group aims to create a system that ensures the rightful provision of benefits and prioritizes the well-being of employees and their families.

• Meetings: AAJ Annual and Winter Conventions, or as need by group members.

• Membership: Open to all Regular, Sustaining, Life, and President's Club AAJ members.

• Dues: The Litigation Group is complementary to members of the AAJ Insurance Law Section and members of the AAJ Social Security Disability Law Section who can agree to the terms and conditions of membership in the Litigation Group's Affidavit. If you are not yet a member, you can join the Insurance Law Section here and the Social Security Disability Law Section here. 

Leadership

Chair: Britney McDonald | Marc Whitehead & Associates LLP, Houston, TX

Chair-Elect: Melanie J. Garner | The Garner Firm, Ltd., Philadelphia, PA

Vice Chair: Stacy Tucker | Kantor & Kantor, LLP, Northridge, CA

Treasurer: Anthony Vessel | Marc Whitehead & Associates LLP, Houston, TX

Secretary: Kaci Garrabrant | Eric Buchanan & Associates, Chattanooga, TN