Rights of California Teachers and School Employees in Bad Faith Health Insurance Denials
Teachers and school employees dedicate their lives to education and the well-being of students. No one enters the teaching profession because of the great pay, but comprehensive compensation packages including benefits like health insurance provided through the school system can help create a measure of economic security. However, when an insurance claim is wrongfully denied, it can create significant financial and emotional hardship. Fortunately, unlike many private-sector employees, teachers and school employees are generally exempt from the Employee Retirement Income Security Act (ERISA), which provides them with greater legal remedies when challenging a wrongful denial.
The California insurance bad faith attorneys at Gianelli & Morris are proud to represent the dedicated teachers of the Golden State when their insurer wrongfully denies their request for medically necessary services, including surgeries, referrals to specialists, medications, durable medical equipment, and more. We help educators get the benefits they are entitled to as well as compensation for any harm done by an unreasonable delay or denial of health care, including punitive damages in appropriate instances.
Why Teachers and School Employees Are Exempt from ERISA
ERISA governs most employer-sponsored health plans in the private sector, but it does not apply to government-sponsored plans, such as those provided by public schools, state universities, and other state government-funded educational institutions. Since most teachers and school employees work for public schools or government entities, their health plans may not be subject to ERISA restrictions.
How ERISA Exemption Benefits Teachers and School Employees
Because their health insurance plans fall outside ERISA’s jurisdiction, teachers and school employees have stronger legal protections and more options for recourse when facing an unfair insurance denial. Key benefits include:
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The Right to File a Bad Faith Insurance Claim – Unlike ERISA-governed plans, which prohibit bad faith lawsuits, teachers and school employees can sue their insurers for acting in bad faith. If an insurance company wrongfully denies a claim, delays payment, or engages in deceptive practices, the policyholder may seek compensation beyond the denied benefits.
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The Ability to Recover Compensatory and Punitive Damages – Under ERISA, claimants can only recover the cost of the denied benefits, with no additional damages. Teachers and school employees, however, may be entitled to compensation for financial losses, emotional distress, and even punitive damages if the insurer’s actions were particularly egregious.
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Avoiding an Overly Burdensome Administrative Process – ERISA requires policyholders to go through a lengthy internal appeals process with specific steps and timelines before they can take legal action. Teachers and school employees are not bound by these restrictions and can proceed to court more quickly after pursuing a grievance or appeal with the insurance company that remains unresolved.
Examples of Teachers and School Employees Covered by Non-ERISA Plans
The ERISA exemption applies to a wide range of school employees, including:
- Public School Teachers – Elementary, middle, and high school teachers employed by public school districts.
- State University Faculty and Staff – Professors, administrators, and other employees working for state-funded colleges and universities.
- School Support Staff – Counselors, nurses, janitors, cafeteria workers, and administrative personnel employed by public schools.
- Charter and Community School Employees – Employees of publicly funded charter schools and community colleges.
How Gianelli & Morris Can Help
If you are a teacher or school employee facing a wrongful health insurance claim denial, you do not have to face this challenge alone. At Gianelli & Morris, we concentrate our legal practice on representing policyholders against insurance companies, ensuring they receive the benefits they are entitled to. Our legal team has extensive experience handling bad faith insurance claims and helping individuals secure the compensation they deserve.
Contact Us Today
Don’t let an unfair insurance denial jeopardize your well-being. If you are a California teacher or school employee dealing with a wrongfully denied health insurance claim, contact Gianelli & Morris today for a free consultation. We are committed to protecting your rights and ensuring that insurers are held accountable for wrongful actions.
