You may have disability coverage under your employer — but do you really know what it entails? If you’re receiving benefits from your employer, there are federal laws in place that protect your rights to seek disability benefits and provide legal measures for employers refusing coverage. However, not all disability insurance programs are covered by ERISA.

What is ERISA?

ERISA stands for the Employee Retirement Income Security Act. Created in 1974, the act was put into place to set minimum standards for employee group benefits, including retirement, health, life, and disability benefits. Since most people have private disability coverage through their employer-sponsored benefit plan, the ERISA governs most of the private long-term disability benefits. The ERISA helps to regulate employer disability plans, covering information on how disability benefit claims are processed, what the timeline looks like for processing a claim, and what the individuals rights are should their disability claim get denied. Employees should receive all this information upon getting hired, and should be clearly explained by the employer during onboarding and beyond.

How might ERISA affect my long-term disability claim? 

Because ERISA is a complex and hefty federal statute, the following instances may happen where your long-term disability claim is affected. 

• If your benefits are denied or terminated, the ERISA will require your plan to provide claimants, documents, records, and any other information that might be relevant. This is usually on request and free of charge. 
• In the event an unfavorable decision has been made, the claimant is allowed an appeals process of at least 180 days.
• When it comes to ERISA, timing is everything. If you don’t appeal within that time frame, they forfeit rights to the disability claim and won’t be able to appeal or file a lawsuit at a later time. 
• The disability plan has to decide on an appeal in less than 45 days after it’s written and received. If it’s decided an extension is needed due to special circumstances, the plan is allowed to take up to an additional 45 days to decide. If these circumstances exist, it is on the plan to notify you in writing that more time is needed to make a decision. A decision HAS to be made after that 90 days. 

These instances are just scratching the surface of ERISA. Be sure to educate yourself on all the implications of ERISA on your employer’s disability plan here. 

While we don’t specialize in the area of long-term disability with ERISA, please contact us if you’re looking for assistance in social security disability income and supplemental security income! Contact Disability Associates today.