California Firefighters and Health Insurance Denials

Firefighters put their lives on the line every day to protect communities, often facing dangerous and physically demanding conditions. In return, they rely on employer-sponsored health insurance to cover medical expenses. However, when an insurance company wrongfully denies a claim, the consequences can be severe. Fortunately, California firefighters are generally exempt from the Employee Retirement Income Security Act (ERISA) which covers employer-sponsored plans in the private sector, giving them stronger legal options to fight wrongful insurance denials. At Gianelli & Morris, our California bad faith insurance lawyers are proud to represent firefighters in Los Angeles and statewide when their claims for coverage have been wrongfully denied as medically unnecessary or other unreasonable denials.

Why California Firefighters Are Exempt from ERISA

ERISA governs most private-sector employer-sponsored health plans, imposing strict limitations on policyholders who want to challenge claim denials. However, ERISA does not apply to government-sponsored plans, such as those provided to public employees, including firefighters. Since most firefighters in California work for municipal, county, or state fire departments, their health plans are not subject to ERISA’s restrictions.

How ERISA Exemption Benefits Firefighters

Being exempt from ERISA provides California firefighters with significant legal advantages when fighting wrongful insurance denials. Key benefits include:

1. The Right to File a Bad Faith Insurance Claim – Under ERISA, policyholders cannot sue their insurance company for bad faith. Firefighters, however, can hold insurers accountable if they wrongfully deny a claim, unreasonably delay payments or engage in deceptive practices. This includes wrongfully denying a prescribed treatment as experimental or medically unnecessary.
2. The Ability to Recover Full Compensation – ERISA limits policyholders to recovering only the value of their denied benefits. Firefighters, on the other hand, may be entitled to additional compensation, including:
   • Financial losses due to denied medical treatment
   • Emotional distress
   • Punitive damages if the insurer’s actions were especially egregious
3. Avoiding the Exhaustive Administrative Process – ERISA requires policyholders to go through a lengthy and complex internal appeals process before they can file a lawsuit. Firefighters, however, can often take their case directly to court if the insurer fails to resolve the issue through its grievance system, allowing policyholders to fight back more efficiently.

Firefighters Covered by Non-ERISA Plans

Most California firefighters fall under the ERISA exemption, including:

• Municipal Firefighters – Firefighters employed by city fire departments such as the Los Angeles Fire Department (LAFD) or San Francisco Fire Department (SFFD).
• County Firefighters – Firefighters working for county-operated fire departments, such as the Los Angeles County Fire Department.
• State Firefighters – Employees of Cal Fire (California Department of Forestry and Fire Protection), which manages wildfire response across the state.
• Firefighters at Public Airports – Those working for government-owned airports, such as Los Angeles International Airport (LAX) Fire Rescue.

How Gianelli & Morris Can Help

If you are a California firefighter facing an unfair health insurance claim denial, you have legal options. At Gianelli & Morris, we have extensive experience holding insurance companies accountable and ensuring that policyholders receive the coverage they deserve. Our team understands the legal protections available to firefighters and can help you navigate the process to fight back against bad faith insurance practices.

Contact Us Today

You risk your life to protect others—don’t let an insurance company put your health and financial security at risk. If your California health insurance claim has been wrongfully denied, contact Gianelli & Morris today for a free consultation. We are committed to defending your rights and ensuring you receive the benefits you are entitled to.