Q: What is ERISA and how does it relate to my health insurance?

A: ERISA stands for the Employee Retirement Income Security Act of 1974. ERISA governs most employee benefits including health benefits. While ERISA was originally intended to protect employee rights, it has adversely effected employees' rights to quality health care by limiting damages to the delivery of benefits. Under ERISA you have the right to sue for benefits wrongfully denied and you may be able to collect attorney's fees for the cost of your suit. You may also sue for a declaratory judgment to clarify your rights to future benefits. However, many courts have found if an insurance company wrongfully determines that you do not require a certain treatment like an MRI, psychiatric care, or a referral to a specialist, the insurer is not liable for your injuries even if you can prove that the insurer negligently caused your injuries. In many cases this has meant that injured patients and families who have lost loved ones due to an insurer's negligent denial of medical care have no remedy. However, some attorneys have successfully obtained a recovery for their clients through innovative legal theories. The paper "Piercing the Armor: Approaches to Managed Care Liability" discusses approaches for holding managed care providers liable for their negligence and can be found in our Cyber Library.