Employee Retirement Income Security Act (ERISA). These types of plans are loved by insurers and not so much by the insured. The reason is that so often, the decisions of plan administrators are final in that the courts uphold their decisions. A Southern District, Galveston Division opinion is good reading to illustrate this favoring of the ERISA plan administrators. The opinion is styled, Kristin Walker v. Regency Blue Cross Blue Shield of Oregon.
After citing some lengthy and convoluted facts the court’s opinion read thus:
This Court had previously found the plan to be covered by ERISA. A claimant must exhaust all available administrative remedies before filing suit. An exception to this rule found in 29 C.F.R., Section 2560.503-1(g) wherein there is non-compliance with requirements.