The United States Supreme Court, which issues a major ERISA decision every couple of years, has described ERISA as “a comprehensive and reticulated statute.” To those of you, like me, who thought “reticulated” had something to do with snakes, I can tell you that it means “constructed, arranged, or marked like a net or network.” ERISA is definitely a net.
And it’s a BIG net. It’s like a giant office building in which two people might work for years, and never meet. Lawyers can spend their careers actively involved with ERISA issues, and never handle the same kind of problems. There are lawyers who deal with the complex tax and regulatory issues involved in establishing and maintaining ERISA plans, and making sure that they keep favorable tax treatment. Such lawyers might never get involved in a dispute over whether an ERISA participant is due money from the plan. On the other hand, those of us who spend decades litigating ERISA claim disputes might not know the first thing about tax issues involved in forming plans.
This blog is going to focus on one “small” part of the ERISA net. What happens when a claim for benefits is made? How should claim administrators investigate, evaluate and decide the claim? And what happens if there’s litigation after a claim is denied? This is just one small part of the reticulated statute, but it’s plenty big enough to keep us busy