ERISA Frequently Asked Questions

Established in 1974, ERISA stands for Employee Retirement Income Security Act. This law applies to most benefits purchased or provided through an employer group. It governs how employers must handle all employee’s benefits, from the front line worker all the way up to the CEO.  ERISA also gives workers certain rights, including:

• ERISA requires benefit sponsors to provide employees with benefit plan information.
• ERISA establishes minimum requirements for how employers and unions fund and manage benefit plans.
• ERISA requires employers and unions to set up a process by which workers can file for their benefits and appeal denials.
• ERISA guarantees that employees will receive their benefits even if their employer declare bankruptcy.
• ERISA gives workers the right to sue benefit plan administrators (usually an insurance company when disability insurance benefits are involved) for failing to carry out their duties.

There is no qualifying for ERISA.  You are either participating in an ERISA plan or not based on how you received your benefit plan coverage.  If it is through your employer, the odds are that ERISA applies.

The only exception in the private sector are individuals who work for a governmental entity or for a church or church-run organization. Private individual disability insurance purchased outside of an employer’s group plan is also not subject to ERISA.

ERISA covers a whole host of different types of benefits. These range from retirement, 401(k), some severance plans, and the various types of insurance that you can get through work, i.e. accidental death,  disability, dental, health, life, and vision coverage.

Start by filing a claim. Ask your human resources office how to do that. Be sure to ask for a copy of the insurance policy for the plan also. If they cannot give you one immediately or one is not available online, you should send a written request for in a way where you can prove the date it was received. Keep in mind that claims, appeals, and litigation under ERISA can be complex For this reason, securing your benefits may be a little tricky. To be sure, many people receive denials on their claims for this very reason.

While the following outlines some pointers, we recommend you speak with an experienced ERISA attorney for a richer understanding. Getting in touch with a well-established ERISA law firm is the best way to secure your benefits.

As mentioned above,  it is important to understand that insurance policy documents are crucial. They provide the rulebook for what you can claim and how you can claim it. Getting all of the relevant documents is vital.

If your claim gets denied,  you will only have 180 days to appeal the decision. That 180-day period may be the most important in all of your claim. If the insurance Company has denied your claim, you only have 6 months to compile all of the evidence that you would ever want the court to consider. Once your appeal is decided by the administrator, the file is effectively sealed and neither side can add more evidence about whether you are disabled or not. It is absolutely crucial that you have all of the types of evidence that you need included in your case, including expert medical reports, expert vocational reports, and other objective tests that prove your disability. For that reason, if you have not already done so, we recommend hiring an experienced ERISA attorney as soon as you receive a denial letter on your claim.

If your appeal is denied, your lawyer will have to file a lawsuit in federal court. Under ERISA, a jury will not hear your case. A federal judge will make the final ruling, and this will occur without any testimony. Very often, the judge will decide your case on motions without any type of trial at all based solely upon the documents that were in your claim filed during the claim and appeal.

Again, we encourage you to approach an ERISA lawyer before pursuing this process. As you can see, the stakes are high and the process is formidable.

In all likelihood, yes. You should seek out the help of an ERISA attorney for your case. Understanding fully the processes involved in an ERISA case takes time and frequent exposure. If this is your first time coming across this legislation, then you are bound to make mistakes while presenting your case.

Fortunately, Tucker Disability Law makes hiring an ERISA attorney easy. We strive to accommodate our clients’ conditions as best we can, and we offer free consultations in person, over the phone, or via video chat. We also offer a State-of-the-Art, encrypted electronic portal which you can access online to see our file at any time of the day – 24 / 7.  This portal is not only secure, but allows you to see what we are working on as your case develops. It also allows you to directly upload documents to your file.