What is an ERISA Disability Plan?
Many medium to large-size companies offer benefits through an ERISA-governed disability plan. But what’s the difference between an insurance policy and an insurance plan? Typically, the long-term disability policy is one part of an overall benefit plan. The benefit plan may include other benefits like life insurance, health insurance, disability benefits and other types of group plan benefits.
Is Your Disability Policy an ERISA Policy?
In ERISA, which is short for the Employee Retirement Income and Securities Act of 1974 has certain requirements for plan administrators like your employer who’s offering these benefits. Specifically, ERISA requires the plan administrators to provide participants with key information about the plan benefits, the funding of the plan, their fiduciary responsibilities, management of the plan, the grievance process and appeals process for denials under the plan.
One thing that’s really crazy is that ERISA allows plan administrators to interpret the plan provisions so long as there’s a clause in the policy that allows them to interpret the plan provisions, which means the insurance company is allowed to determine whether or not you meet the requirements of the policy.
If you are covered by a Group Long Term Disability Policy through your employment, your claim is probably governed by ERISA. As stated throughout the remainder of this website, if you did not obtain disability coverage through your employer or employee group, and instead purchased it as an individual policy from an insurance agent or broker, then there is a good possibility that your disability claim will not be covered by ERISA and your legal options and remedies are more favorable. Moreover, church and governmental (including most City and University) employees are also exempt from ERISA.
What to Do If You Are Denied Coverage for a Non-ERISA Policy
If you have church policy, a governmental employee policy, or an individual disability policy purchased directly from an agent or broker then you may not have to appeal the denial before filing a lawsuit. In these instances, you should consult an attorney immediately.
Table of Contents
Chapter 1: Is Your Disability Policy an ERISA Policy?
Chapter 2: Appealing the Denial of Disability Insurance Benefits – ERISA Policies
Chapter 3: Non-ERISA Policies
Chapter 4: Exertion Levels
Chapter 5: Understanding Your Policy
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