Law Offices of John Michael Jensen

Benefits Law

Employee earn benefits as part of their overall compensation, financial security, and in retirement. California state employees , teachers, and local government employees have vested rights in their pension.

CalPERS Contracting Employers, please visit here.

Benefits Litigation

Employee earn benefits as part of their overall compensation, financial security, and in retirement. California state employees , teachers, and local government employees have vested rights in their pension. However, sometimes the pension fund does not provide the correct benefits or miscalculates the benefits.

1. ERISA Benefits

The Employee Retirement Income Security Act (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. ERISA requires plans to provide participants with plan information including important information about plan features and funding; sets minimum standards for participation, vesting, benefit accrual and funding; provides fiduciary responsibilities for those who manage and control plan assets; requires plans to establish a grievance and appeals process for participants to get benefits from their plans; and gives participants the right to sue for benefits and breaches of fiduciary duty.

What ERISA Governs:

ERISA covers retirement plans such as:

• 401(k) plans,
• Traditional pensions (defined benefit plans),
• Profit-sharing plans, and
• Some 403(b) plans, among others.

It also covers employer-provided welfare benefit plans, such as:

• Health insurance,
• Life insurance,
• Disability insurance, and
• Apprenticeship plans.

However, ERISA does not cover plans established or maintained by government entities and churches, plans maintained solely to comply with applicable workers’ compensation, unemployment, or disability laws, and plans maintained outside of the United States primarily for the benefit of non-resident aliens.

Remedies Available Under ERISA:

The remedies available under ERISA are somewhat limited compared to other areas of law due to its preemption of many state laws that might provide more expansive remedies.

1. Benefits Due Under the Plan:
   • Participants can sue to recover benefits due to them under the terms of their plan, to enforce their rights under the plan, or to clarify their rights to future benefits.
2. Breach of Fiduciary Duty:
   • ERISA imposes fiduciary responsibilities on those who manage and control plan assets. If these duties are breached, ERISA provides participants the right to sue the fiduciary. A fiduciary can be held personally liable to restore any losses to the plan or to restore any profits made through improper use of the plan’s assets.
3. Interference with Protected Rights:
   • Participants may also sue for circumstances where an employer has unjustly fired them or discriminated against them to prevent them from obtaining a pension or health benefit.
4. Plan Information:
   • Participants have the right to sue for plan information that has not been provided within 30 days of request, subject to statutory penalties.
5. Attorney’s Fees:
   • In some cases, courts may award attorney’s fees to the prevailing party.

However, punitive damages and compensatory damages for pain and suffering are generally not available under ERISA. The law typically limits recovery to the benefits that are due under the plan, plus attorney’s fees and interest.

Preemption:

One key aspect of ERISA is its strong preemption clause, which often precludes state-law-based claims that “relate to” employee benefit plans. This preemption has been a significant factor in limiting the remedies available to plan participants and beneficiaries, as they cannot avail themselves of many state law remedies that might otherwise be available for breach of contract or tortious conduct.

ERISA litigation can be complex and is subject to specific procedural and substantive rules. Cases under ERISA are heard in federal courts, and claimants must exhaust the plan’s administrative remedies before they can file a lawsuit.

2. Health Benefit Disputes

We litigate disputes regarding health insurance reimbursement.

The Employee Retirement Income Security Act (ERISA), a federal law, also plays a role in regulating employer-provided health plans and can pre-empt state law in many respects. Disputes under ERISA-regulated plans are handled in federal court and have a specific set of procedural and substantive rules that differ from California state law.

3. California Public Employee Pension Benefit Litigation – CalPERS CalSTRS CERL 1937 Act

In select service retirement benefit cases, John Jensen represents employees and beneficiaries to achieve their proper pension due them.

CalPERS Contracting Employers, please visit here.

Pension Benefits and Public Employee Pension Benefits:

In California, pension benefits for public employees are primarily governed by the California Public Employees’ Retirement Law (PERL), which is part of the California Public Employees’ Retirement System (CalPERS). For teachers, the California State Teachers’ Retirement System (CalSTRS) administers pension benefits.

The laws establish the rules for eligibility, contribution rates, benefit calculations, and vesting. They also provide for disability retirement, survivor benefits, and health insurance for retirees. The PERL is in the California Government Code, starting at Section 20000.

Disputes over pension benefits often arise over issues such as:

• The calculation of benefits, including what constitutes “compensation” for the purposes of pension calculations.
• The eligibility for disability or retirement benefits.
• Service credit disputes.
• Misclassification of employees versus independent contractors, affecting pension rights.

These disputes are typically resolved through administrative proceedings within the respective retirement system. If the dispute cannot be resolved administratively, it may lead to litigation in the California Superior Court. The administrative decisions can be challenged through a petition for a writ of administrative mandamus.

We do not litigate disability determinations or disability benefits.

Public Employee Health Benefit Disputes

Health Benefits and Health Insurance Reimbursement:

Health benefits for public employees may also be managed by systems like CalPERS, while private-sector employee benefits are often governed by the terms of the employment contract and the employer’s policies.

Health insurance reimbursement is typically subject to the terms of the insurance policy or health plan. Under California law, health maintenance organizations (HMOs) and insurance companies are regulated by the California Department of Managed Health Care (DMHC) and the California Department of Insurance (DOI), respectively.

Disputes about health benefits and insurance reimbursements may involve:

• Denial of coverage for certain treatments or medications.
• Disagreements over the necessity of medical procedures.
• Disputes about the rates of reimbursement for out-of-network care.
• Issues regarding the interpretation of policy terms and coverage limits.

These disputes are often initially handled through the insurance company’s internal review process. If the issue is not resolved, the insured individual can appeal to the DMHC or DOI. There are also external review processes available. If these administrative remedies do not resolve the dispute, litigation may ensue.

The Employee Retirement Income Security Act (ERISA), a federal law, also plays a role in regulating employer-provided health plans and can pre-empt state law in many respects. Disputes under ERISA-regulated plans are handled in federal court and have a specific set of procedural and substantive rules that differ from California state law.

Resolution of Disputes

Resolution of Disputes:

For both pension and health benefit disputes, individuals often begin by utilizing the administrative review and appeal processes available within the pension system or the insurance plan. If the dispute is not resolved to the individual’s satisfaction, they can then seek judicial review.

Administrative Decisions: Individuals may file for an administrative hearing or appeal within the relevant agency. Decisions from these hearings can be appealed further within the agency.

Judicial Review: If the administrative appeals are exhausted or if there is a fundamental issue of law, parties may seek judicial review by filing a lawsuit in the appropriate court, which often involves a writ of administrative mandamus to challenge an agency’s decision.

Litigation: If a dispute escalates to litigation, the case would be presented in court, where a judge (and sometimes a jury) would determine the outcome based on evidence, legal arguments, and applicable statutes and regulations.

During any stage of the dispute resolution process, parties may also engage in settlement negotiations to resolve the issue without the need for a formal hearing or court case.

John Michael Jensen has litigated individual pension and beneficiary claims against the California Public Employees Retirement System (CalPERS), California Teachers Retirement System (CalSTRS), the Legislators Retirement System (LRS),the County Employees Retirement Law of 1937 (CERL) and others.