ERISA Violations Stopped in 3 Days
An insurance company implementing a government settlement decided to proceed as though ERISA didn’t exist. But when a case was filed and pursued by Richard Quadrino and his team seeking to enforce ERISA’s provisions, the insurance company promptly backed down, in 3 days, and settled the class action.
ERISA gives all beneficiaries the right to receive documents “relevant” to their claims. This rule applies to group health insurance claims as well as other group sponsored employee benefits, such as life, disability and pension benefits.
It may not seem like much, but in reality the ability to demand and receive internal insurance company emails, investigative files, and claims documents is powerful. ERISA was designed to foster transparency to level the playing field between claimants and administrators.
Once a claimant understands what an insurer / claim administrator was thinking or doing, it is only then that a claimant can truly and effectively appeal, addressing the error, misconception, or improper claims action.
At QLG, we use the ERISA claims regulations to the advantage of clients, often as a tool to demonstrate that the administrator cannot provide a sound basis for its action.