Employer Disability Coverage & ERISA Law: Governance and Restrictions

by Lisa Coleman on August 7, 2013

  • SumoMe

A US law blog on some important insurance issues facing employees. Employer provided long-term disability coverage is considered a company benefit. Employers are not required to provide this type of insurance. In fact, most employees who have this type of insurance purchase it outside of their company.

For those who do have long term disability coverage through an employer sponsored program, it is important to understand that these policies are regulated under the ERISA guidelines and not normal insurance laws.

ERISA, or Employee Retirement Income Security Act of 1974, is a federal law that regulates retirement and other employee benefits that are granted by the employer. Managed through the Department of Labor, this law includes long term disability plans.

ERISA vs. State Insurance Laws

Under ERISA, an insurance plan that denies benefits must be handled in a different manner than state regulated policies. ERISA specifically states that all internal remedies, such as mediation, must be thoroughly exhausted before a beneficiary that has been denied disability can file a lawsuit against the insurance provider. This means that unlike a state governed policy that allows for an immediate lawsuit to be filed if a denial is issued, you must go through every internal level that the insurer has stated is required in your policy. If at that time the issue has not been resolved, a lawsuit can ensue.

Hiring a Disability Attorney that Understands ERISA

If you have been denied a long term disability claim through a company sponsored insurance program, you will need the assistance of an attorney who is familiar with how ERISA claims work. Sadly, most attorneys are not familiar with this process because of the lack of employers providing this benefit. This is what makes it even more necessary to find an attorney who knows and understands the process.

One factor that many are not aware of is regarding evidence in an ERISA case. If the case must go to trial, under ERISA law, there cannot be any new evidence submitted to the trial. The only thing that can be admitted is what both parties already have in possession. This means that your attorney must submit medical records and findings throughout the appeals and mediation process with the insurer to ensure that all evidence is available should the case go to trial. Lack of this knowledge can cause the client to have their claim denied.

Another mistake that is often made by inexperienced attorneys in an ERISA case is the mandatory deadlines for submission of paperwork and evidence. The federal guidelines are very strict and there are absolutely no exceptions. If the client or the attorney fails to meet the deadlines, the case is simply denied and dismissed.

In the end, anyone who is facing an ERISA claim will always do better using an attorney who is experienced with this type of law. Someone suffering with a permanent disability already has much to worry about; they do not need to add to their stress by hiring an attorney that is unfamiliar with these federal laws and regulations.

Legal writer Lisa Coleman shares what ERISA law is and how it is governed at a federal level instead of a state level, including how such a claim has tough restrictions that accompany it. She recently researched how an experienced disability attorney, such as Marc Whitehead & Associates, L.L.P., can help a person who has been denied disability by an employer, and the importance of experience for a denial attorney handling an ERISA claim.

Lisa Coleman
Lisa Coleman enjoys writing about her passions, which include law, animals, family, hobbies and travel.
Lisa Coleman

Latest posts by Lisa Coleman (see all)

Previous post:

Next post: