We do not handle Social Security Disability (SSDI) claims.

Is my disability plan governed under ERISA?

Shawn E. McDermott

Group disability coverage typically falls under the ERISA umbrella if the conditions fit the criteria. Plans come with tried and true guidelines but the impact of the Colorado court can mold how claims get interpreted.

What is ERISA?

A federal law enacted in 1974, the Employee Retirement Income Security Act ensures employees get the benefits of affordable coverage. ERISA applies to short- and long-term disability coverage. Unfortunately, the regulations are often construed in a way that gives the impression ERISA favors insurance organizations.

Criteria for Disability Policy Covered by ERISA

There are generally two types of coverage for disability insurance. These are “group” and “individual.”

Gauging how federal courts have interpreted ERISA and used it to make decisions, we could say there are specific requirements to meet for a disability policy to fall under ERISA. Coverage has to entail:

  • A fund, plan or program
  • Establishment and maintenance by either an employee organization, employer or both
  • Set up of medical, hospital, surgery, accident, sickness, disability, vacation or unemployment benefits, or loss of life

What Is ERISA’s Role?

Covered by the ERISA-governed plan, employees get a variety of protections, including:

  • Notification of benefits, information and coverage
  • Details for filing a claim
  • Ability to file disability claims with ERISA moderating

If your claim and appeal get denied, a lawsuit can be filed by an individual against the employer or the plan provider.

There may be injuries not covered by a plan. For instance, an injury on the job is not immediately considered a disability matter. Workers’ compensation manages benefits and payments for incidents that occur while working.

Courts use the aforementioned criteria but will further scrutinize ERISA to establish the validity of a claim. That leaves no finite answer to how ERISA impacts your disability coverage. It’s best to know the details of coverage and always have the documentation that supports your actions and claims.

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