The federal Employee Retirement Income Security Act of 1974 (ERISA) provides regulations over disability insurance plans offered to workers of private employers as part of a worker benefit package. If a person decided to purchase disability insurance privately on their own, ERISA would not cover that plan.
ERISA covers how the worker can claim benefits under their disability insurance plan. Employers must, under ERISA, give workers precise information of what the disability insurance plan covers, and what is not covered. Employers must also make it known to workers how a worker can file a claim if they suffer a disability. Finally, per ERISA, employers must let workers know what they have to do to appeal a denied claim.
If a worker files a claim with their disability insurance provider, there are timelines that affect how long the insurer has to either approve or deny the claim. If denied, ERISA mandates that the insurer gives the policyholder the reason for the denial in writing. A policyholder can appeal a denied claim, and if that appeal is still denied, then ERISA allows the policyholder to pursue legal action. In essence this consists of an administrative hearing. The judge at this hearing will make a decision based on the previously established record.
In short, while it is meant to protect workers, ERISA regulations are complex, and if a person pursuing a claim fails to meet ERISA requirements they may lose their right to appeal a denied claim. Therefore, those who want to file a claim with their disability insurance or who want to appeal a denied claim may want to do so with the assistance of an attorney who understands ERISA requirements.
Source: FindLaw, “ERISA and Disability Benefits,” accessed Nov. 12, 2017
