ERISA Benefits

ERISA Benefits

The ERISA Benefits Litigation Group is dedicated to recognizing and combating the abusive practices in health and disability employee benefits. The denial of benefits negatively impacts employees and their families. The employee benefit system is a huge segment of our economy. Systematic problems include the overselling of disability plans without the collection of adequate premiums, the sale of health insurance as a loss leader to gain market share, and then chiseling the patients and physicians—leading to substandard health care and fraudulent denials of care. These practices wrongfully shift the burden to the government and taxpayers to correct the abuses with the social safety nets. This Group provides a forum for the exchange of information between members. The Group strives to promote the public good though concerted efforts to secure that employee benefits are paid and plenary compensation is available to injured and sick employees.

A conspiracy of the federal judiciary has permitted the perversion of the Employee Retirement Security Act that was intended to help employees. It has become a shield for those who engage in some of the most abusive and fraudulent practices in the insurance industry. Benefits are denied that should clearly be paid. Fiduciary duties are ignored with impunity because there are truncated remedies that have been cobbled together by the courts in clear disregard of congressional intent.

Health care payers cut costs by refusing to pay for treatment. Some insurers deny payment on a random basis to ascertain "fraudulent" claims in the system to the detriment of those with valid claims. Some insurers shift part of the burden to the patients by charging excessive co-pays or where providers balance bill against state law. Provider contracts shift the risk to the physician for treatment and put the physician in a conflict of interest with their patients. Doctors are coerced into contracts that do not provide adequate compensation and are compelled economically to provide sub-standard treatment.

Payers deny payment for "experimental and investigative treatment." However, most of these procedures are well accepted in the medical profession and may be the best care, but they are expensive. This results denial of treatment or provision of less efficacious treatment because it is cheap. Medical device manufacturers pay physicians to prescribe or implant medical devices. These may be substandard with known defects.

Disability benefit carriers deny payments for disabled by inventing requirements that are not in the policy/plans. If payments are paid, they are terminated on a whim. Treating physicians are ignored, and insurance doctors for the carriers provide spurious reports to give cover for the illegal and abusive denial practices. Bonuses are given to adjusters to terminate high dollar claims.

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

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

• Dues: $100 per attorney

Leadership

Chair: Audrey C. Dolmovich | Eric Buchanan & Associates, PLLC, Chattanooga, TN

Chair-Elect: Jennifer M. Danish | Bryant Legal Group PC, Chicago, IL

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

Treasurer: Melanie J. Garner | The Garner Firm, Ltd., Philadelphia, PA

Secretary: Stacy Tucker | Kantor & Kantor, LLP, Northridge, CA