Exploring Civil Case Proceedings

ERISA Disability Claims 101

17 March 2017 by Becky Freeman

When you work for a privately-owned business that offers a retirement plan, the terms of that plan are covered by the Employee Retirement Income Security Act of 1974 (ERISA). This federal law administered by the U.S. Department of Labor sets out the minimum standards that voluntarily offered plans must meet. The name of the act is a bit of a misnomer as it covers not only retirement, but health, disability, and life insurance benefits as well.

As with most programs that have government oversight, there can be the usual bureaucratic red tape to deal with when it comes to ERISA. Here are the basics you need to know.

What Does ERISA Require From Employers?

ERISA disability expects group plan administrators to provide plan participants with the features of their benefits package. It also requires that participants know how the plan is funded. ERISA also sets the fiduciary guidelines that plan administrators must follow to ensure the proper use of the assets to maintain plan solvency. Additionally, ERISA requires a grievance and appeal process is set in place as well as provisions that allow for a participant to seek legal recourse if need be. This is important in case your plan administrator rejects your disability claim; you can legally sue if a settlement cannot be reached.

What Changes Have Taken Place Since Its Inception?

Over the years, a number of amendments have added extra protection to plan participants and their beneficiaries. These include:

• Consolidated Omnibus Budget Reconciliation Act (COBRA) This allows continued health insurance coverage for a limited time frame after a qualifying event, such as job loss.
• Health Insurance Portability and Accountability Act (HIPAA) This allows protection from pre-existing conditions being denied coverage from subsequent insurance carriers as well as increases in your health information privacy.
• Newborns' and Mothers' Health Protection Act This allows minimum maternity care standards and allows the new child medical coverage under your health care policy.
• Mental Health Parity Act This act ensures that mental health and substance addictions are treated with the same level of benefits as other health issues.
• Women's Health and Cancer Rights Act of 1998 (WHCRA) This act ensures women who must have a mastectomy have the right to have breast reconstruction covered if they so desire.

Are There Exemptions From ERISA?

If you purchase your own private disability insurance, ERISA does not apply. ERISA also does not govern government entities, including state universities, or churches and any hospitals or universities run by churches.

Share