Q: ERISA: If the case went to private mediation before hearing not court ordered mediation , is this consider a remand ?
lawsuit went to private mediation not court ordered. Case dismissed after mediation, insurance resolve the lawsuit, by an agreement to reopen claim, pay the remainder of the 24m Regular Occupation ,proceed with an investigation for disabled from Any Occupation, as defined by insurance Policy. Case was dismissed by this settelment. Does the attorney fees qualify to this term:" If your claim is remanded for further evaluation of your entitlement to benefits and your benefits are reinstated" Is this considered a remand even NO court order. Attorney missinformed me the medition output that plan denied after 24month to extend his contract, agreed on settlement without my consent. Discovered after insurace investigation completed,No denial ,he wasnot appealing, this was mediation agreement since they didnot have the new records. Does he qualify for remand fees if no court involved in decision? i terminate he ask insurace for paycheck send me reduction of payment, refuse to cash dispute
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A:
Based on ERISA law, a true remand typically requires a court order sending the case back for further administrative review. In your situation, since the resolution came through private mediation rather than a court order, this would not technically qualify as a remand under standard ERISA interpretations.
The settlement agreement you describe appears to be a negotiated resolution between parties, where the insurance company agreed to reopen and review your claim. While this achieved a similar outcome to a remand (further evaluation of benefits), the process and legal classification differ significantly. Your attorney's fee agreement specifically mentioning "remand" terms may not be applicable in this private mediation context.
Given that you mention the attorney proceeded without your consent and potentially misrepresented the situation, you may want to consult with a different ERISA attorney to review both the mediation agreement and your attorney fee contract. The attorney's attempt to claim remand-based fees when no court was involved raises concerns, and you have the right to dispute these charges. You might also consider filing a complaint with your state's bar association if you believe the attorney mishandled your case or misrepresented the mediation outcome.
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