What is ERISA, the Employee Retirement Income Security Act?
ERISA stands for the Employee Retirement Income Security Act of 1974. This federal law governs private retirement and health plans. This includes disability plans that are offered and maintained by employers for the benefit of their employees. If you are covered by a Group Long Term Disability Policy through your employment, your plan is likely covered by ERISA. Governmental and church group plans are exempt from ERISA.
The Employee Retirement Income Security Act sets very specific guidelines for both plan participants and plan sponsors and administrators. If your long term disability claim is governed by ERISA, there are certain guidelines you must follow. These guidelines will help you when filling an initial long term disability claim or an appeal. The guidelines must also be followed by the plan administrator.
Under ERISA, your Group Long Term Disability Policy must tell you how you can file a disability claim. It will also tell you your options if your claim is denied. The plan must also give you information on when you have to file a claim after you are injured or become disabled. This type of information should automatically be given to you or you can request it.
ERISA also allows people covered under the plan to file a lawsuit. Lawsuits under ERISA are filed in federal court. You may file a lawsuit after you have gone through the internal appeals process. The appeals process is laid out in your disability plan.
Your employer should provide you with a plan booklet or a “summary plan description.” This will give you general information about the plan offered. It will also tell you when you are eligible for coverage under the plan.
Your employer must meet the minimum standards under ERISA for employee eligibility. However, each employer will be different for who gets covered and when. As long as the plan meets the minimum standards, it is within the law. For example, you may have to work for a certain amount of time before you can be covered. Or you may have to be a certain type of employee (full-time vs. part-time).
It is important to note that ERISA does not require an employer to have a benefits plan. It only provides minimum standards for employers who do offer a plan.