Each benefit claim is different depending on the facts of your case, the plan, and the benefits at issue. However, below are some frequently asked questions regarding ERISA disability claims. If you have further questions or your long term disability or ERISA disability claim has been denied, contact one of our experienced ERISA disability attorneys for a free consultation today.
1. What is ERISA? “ERISA” means the Employee Retirement Income Security Act of 1974 – a federal law designed to protect employees who are enrolled in retirement or benefits plans through their employment. ERISA requires accountability of plan fiduciaries and generally defines a fiduciary as anyone who (1) exercises discretionary authority or discretionary control over a plan’s management or exercises any authority or control respecting management or disposition of its assets, (2) renders investment advice for a fee or other compensation, direct or indirect, with respect to any moneys or other property of such plan, or has any authority or responsibility to do so, or (3) has any discretionary authority or discretionary responsibility in the administration of such plan. In addition to keeping participants informed of their rights, ERISA also grants participants the right to sue for benefits and breaches of fiduciary duty.
2. Who controls ERISA? According to the Department of Labor, there are three separate bodies that administer and enforce ERISA: the Employee Benefits Security Administration, the Internal Revenue Service, and the Pension Guaranty Corporation.
3. What is covered under ERISA? ERISA may apply to a variety of benefit plans such as long-term disability (“LTD”), short-term disability (“STD”), life insurance, accidental death and dismemberment (AD&D), pension, retirement, and some health insurance benefits.
4. Can certain plans be exempt from ERISA? Yes. ERISA generally exempts plans that are considered government plans or church plans. In some cases, the court must determine whether ERISA controls a plan after a dispute arises.
5. Are there exceptions to ERISA plans? Yes. If your plan was part of a payroll practice or is a voluntary plan under the law, the plan will not be subject to ERISA. These are often referred to as the “safe harbor” exceptions. In some cases, the court must determine whether ERISA controls a plan after a dispute arises and if the requirements of “safe harbor” have been met. Generally, the more involvement an employer has in a plan will result in the plan being controlled by ERISA – even if obtaining the coverage was voluntary.
6. What is an ERISA plan administrator? An ERISA plan administrator is the person or entity responsible for keeping an employee benefit plan in compliance and managing the plan for the exclusive benefit of participants and beneficiaries.
7. Is your short-term or long-term disability policy covered by ERISA? It is possible for short-term or long-term disability coverage to be covered by ERISA. How the plan was established will determine if ERISA controls the plan. If ERISA does control your disability plan, you are given certain rights to an administrative appeal process if your benefits are denied, access to the documents gathered related to your claim(s), and the right to bring a lawsuit for benefits and/or breaches of fiduciary duties. The administrative process is significant to claims in the event a lawsuit has to be filed.
8. How does ERISA impact health benefits? ERISA requires plan participants to be provided with certain plan information, mandates fiduciary responsibilities, requires an administrative process for appeals, and enables plan participants to file a lawsuit under ERISA for benefits and breaches of fiduciary duty. According to the Department of Labor, there have been multiple amendments to ERISA, expanding the protections available to health benefit plan participants and beneficiaries. One important amendment, the Consolidated Omnibus Budget Reconciliation Act (“COBRA”), provides some workers and their families with the right to continue their health coverage for a limited time after certain events, such as the loss of a job. Another amendment to ERISA is the Health Insurance Portability and Accountability Act (“HIPAA”) which provides important protections for working Americans and their families who might otherwise suffer discrimination in health coverage based on factors that relate to an individual’s health.
9. When does ERISA apply to life insurance or accidental death & dismemberment coverage? If your employer provided these benefits to you, ERISA may apply to those benefits. If your claim for benefits are denied, then you may have a claim under ERISA. Similar to short-term and long-term disability plans, how the plan was established determine if ERISA controls the plan. If ERISA does control your disability plan, you are given certain rights to an administrative appeal process if your benefits are denied, access to the documents gathered related to your claim(s), and the right to bring a lawsuit for benefits and/or breaches of fiduciary duties.
10. When does ERISA apply to retirement benefits? Pensions and retirement funds managed by employers are covered under ERISA. If an employer has established a retirement plan, there are minimum standards that must be met in the administration of the plan. Specifics for each plan, however, varies from employer to employer.
If your long term disability claim or ERISA disability claim has been wrongfully denied or you are in the process of filing a claim, contact Mehr, Fairbanks & Peterson Trial Lawyers at 800-249-3731 to secure a free consultation about your rights and benefits.
This information should not be construed as legal advice or a guideline to your specific claim for benefits.