If the insurer makes an "adverse benefits determination" (meaning a decision that is in some way not favorable to you - such as terminating or denying your benefits claim), ERISA regulations require that you be allowed to submit an administrative appeal to the insurer. The administrative appeal must be submitted to the insurer within a time frame that is determined by the type of benefit for which you are making a claim, and should include all information you can gather in support of your claim. The administrative appeal is VERY important because once the insurer has received you appeal, there is no other chance to submit any new information. The insurer will decide whether to stand by or reverse its original decision based on what you have submitted. If the insurer decides to stand by its original decision to deny or terminate your benefits, your only recourse is usually to bring a case in federal court.
Sometimes people ask us why they should bother with submitting the administrative appeal. Maybe you are sure the insurer will deny the appeal anyway. Or maybe you are in a hurry - administrative appeals take time and money to prepare, and you may end having to bring a lawsuit in the end anyway. Why not bypass all that hassle and go right to court?
The answer is that ERISA requires you to do all required administrative appeals before bringing a lawsuit. If you initiate a lawsuit before completing the administrative appeals, your lawsuit will be dismissed without being heard. While there are a few exceptions to this rule, generally you must submit all required administrative appeal process before going to court.
If you have questions about administrative appeals, you can contact us at the Law Office of Katherine L. MacKinnon for a consultation on your case.
Tuesday, January 20, 2015
Thursday, January 8, 2015
Katherine MacKinnon named an Attorney of the Year for 2014!
Kate was recently named an Attorney of the Year for 2014 by Minnesota Lawyer. This is a wonderful honor, and Kate is thrilled to be in the company of the other attorneys who have received this award.
Congratulations, Kate!
To read the entire article in Minnesota Lawyer about all the honorees, click here.
Congratulations, Kate!
To read the entire article in Minnesota Lawyer about all the honorees, click here.
Thursday, November 6, 2014
Life Insurance Win in MN Supreme Court!
After years of hard work for Ms. Jacky Larson, our firm won a huge victory in the Minnesota Supreme Court on behalf of anyone with life insurance in Minnesota!
Minnesota Stat 61A.11 says that: "In any claim upon a policy issued in this state without previous medical examination, or without the knowledge or consent of the insured, or, in case of a minor, without the consent of a parent, guardian, or other person having legal custody, the statements made in the application as to the age, physical condition, and family history of the insured shall be valid and binding upon the company, unless willfully false or intentionally misleading."
Larson v. Northwestern Mutual was about what the language "willfully false or intentionally misleading" means. Does it mean simply that the information given on a life insurance application was incorrect, and the applicant should have known the correct information? Or does the insurance company need to prove the insured subjectively intended to lie? We argued that the insurance company needs to show more than that the information given in the application was wrong - and the Supreme Court agreed:
"To rescind a life insurance policy under Minn. Stat. 61A.11 for 'willfully false or intentionally misleading' answers in an insurance application, an insurer must prove that the insured intended to deceive the insurer."
We are thrilled at the result, if you'd like to view the entire opinion click here.
Minnesota Stat 61A.11 says that: "In any claim upon a policy issued in this state without previous medical examination, or without the knowledge or consent of the insured, or, in case of a minor, without the consent of a parent, guardian, or other person having legal custody, the statements made in the application as to the age, physical condition, and family history of the insured shall be valid and binding upon the company, unless willfully false or intentionally misleading."
Larson v. Northwestern Mutual was about what the language "willfully false or intentionally misleading" means. Does it mean simply that the information given on a life insurance application was incorrect, and the applicant should have known the correct information? Or does the insurance company need to prove the insured subjectively intended to lie? We argued that the insurance company needs to show more than that the information given in the application was wrong - and the Supreme Court agreed:
"To rescind a life insurance policy under Minn. Stat. 61A.11 for 'willfully false or intentionally misleading' answers in an insurance application, an insurer must prove that the insured intended to deceive the insurer."
We are thrilled at the result, if you'd like to view the entire opinion click here.
Monday, October 6, 2014
US Supreme Court to review ERISA case
The United State Supreme Court has accepted review of a new ERISA case involving the statute of limitations in retirement fund cases. (Tibble v. Edison Int'l, U.S., No. 13-550, cert. granted 10/2/14)
"The case presents the question: whether participants in retirement plans can hold plan fiduciaries liable for including higher-cost investment funds in the plan when those funds were initially chosen more than six years before the lawsuit, or whether these types of claims are barred by the six-year statute of limitations found in the Employee Retirement Income Security Act."
Check out the full article here.
"The case presents the question: whether participants in retirement plans can hold plan fiduciaries liable for including higher-cost investment funds in the plan when those funds were initially chosen more than six years before the lawsuit, or whether these types of claims are barred by the six-year statute of limitations found in the Employee Retirement Income Security Act."
Check out the full article here.
Monday, September 22, 2014
The Mastocytosis Society 20th Annual Conference
Thank you to The Mastocytosis Society for having us come speak at the 20th Annual conference this weekend in Rochester, Minnesota!
Thursday, September 18, 2014
Happy Birthday, ERISA!
The Employee Retirement Income Security Act - E.R.I.S.A. (or as one judge put it, Everything Ridiculous Invented Since Adam) turned the big 40 this month!
There has been no shortage of litigation since its enactment, as this article put it:
"In the past 40 years, lawsuits concerning ERISA have been filed by employees and plan beneficiaries, alleging their employers and/or plan fiduciaries have violated ERISA laws. Meanwhile, recent changes to ERISA laws have strengthened the requirements for people who act as plan fiduciaries. As more ERISA lawsuits are filed, more sections of the act are being interpreted and reinterpreted."
This is an active and interesting are of law, and gives our office the opportunity to help real people with real problems.
Happy Birthday, E.R.I.S.A.!
Check out the full article at:
http://www.lawyersandsettlements.com/articles/stock_option/erisa-plan-lawsuit-retirement-employee-28-20101.html#.VBtBHvZ0zIU
There has been no shortage of litigation since its enactment, as this article put it:
"In the past 40 years, lawsuits concerning ERISA have been filed by employees and plan beneficiaries, alleging their employers and/or plan fiduciaries have violated ERISA laws. Meanwhile, recent changes to ERISA laws have strengthened the requirements for people who act as plan fiduciaries. As more ERISA lawsuits are filed, more sections of the act are being interpreted and reinterpreted."
This is an active and interesting are of law, and gives our office the opportunity to help real people with real problems.
Happy Birthday, E.R.I.S.A.!
Check out the full article at:
http://www.lawyersandsettlements.com/articles/stock_option/erisa-plan-lawsuit-retirement-employee-28-20101.html#.VBtBHvZ0zIU
Wednesday, September 17, 2014
Proud to announce newest hire: Francesca!
Welcome Francesca, the newest addition to the Law Office of Katherine L. MacKinnon family. She's cute, she's cuddly...and she's almost potty-trained!
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