Understanding ERISA Disability Claims

Person looking over paper to understand ERISA Disability Claims

As an employee, you may be entitled to certain benefits through your employer. Commonly known employer-provided benefits include health care and retirement benefits. However, what many workers may not be aware of or fully understand are their disability benefits. 

If you become disabled and cannot work, you may qualify for protection under the Employee Retirement Income Security Act (ERISA). But what exactly is ERISA? And when and how does it apply to disability claims?

We will go over these questions and more below. If you still have questions about ERISA disability claims, we encourage you to browse our website and contact ERISA claims attorney John Peace and the Peace Law Firm for more information.

ERISA: An Overview

ERISA was enacted in 1974 with the purpose of protecting workers covered under employer-sponsored retirement, insurance, and other group benefit plans. In this post, we will be discussing how ERISA applies to disability claims specifically.

You may be entitled to disability benefits if you become disabled and unable to work full time. If you have employer-sponsored disability coverage, ERISA will govern and regulate your claim.

ERISA provides crucial protections to workers. If your claim is denied or you have questions or concerns about the process and your claim, contact an ERISA disability attorney today.

ERISA is not a form of disability insurance

It is important to realize that ERISA is not a form of disability insurance.

Rather, ERISA is a federal law that will govern how a disability insurer will sign up plan participants, analyze their claims, and award benefits.

In other words, it is a set of rights that employees have guaranteeing that they receive fair treatment in the disability claims process. But you need to have group disability insurance with your employer before you get those rights.

Complications that May Arise in the ERISA Disability Claims Process

Navigating an ERISA disability claim is no easy feat. Many complications can arise when an employee submits a request for benefits. Some of these issues include:

  • Whether your injury qualifies as a disability under the plan. Each plan defines disability in its own way, and some plans have fairly strict definitions that will lead to many denials. It is entirely possible to be denied an ERISA disability claim even if you are seriously disabled, all because your particular injury does not fit the plan’s definition of “disability.”
  • Whether the insurer requires that you apply for Social Security Disability Insurance (SSDI). This can save the insurer money, since any money you receive from SSDI is offset against your insurance benefits.
  • The amount of the benefit. Plans typically calculate benefits based on a percentage of the worker’s salary, e.g., 60 percent. So if you make $500 a week, you could get $300 in disability benefits. But questions sometimes arise around how to properly calculate your income.
  • The length of time you receive benefits. Look at your plan. Many plans will set a maximum amount of time, whereas other plans will allow a claimant to receive benefits until they reach a certain age.

While complications can arise, there are ways to overcome them. An experienced attorney can help you with ERISA long-term disability and short-term disability claims, as well as with navigating claim denials.

Applying For Benefits

The process for applying for benefits will be set out in your insurance plan. Each plan is different, and you need to follow the ERISA disability claims process. Often, you need to fill out paperwork and include supporting documentation about your disability.

Typically, an application for benefits will consist of the following:

  • Your application with detailed information about your disability
  • Your employer’s information about your disability
  • Your attending physician’s statement

You submit the claim to the plan’s administrator for consideration. Always keep a copy of everything you submit in the event your application is lost.

Many people unfortunately don’t know how to begin an ERISA disability claim. They haven’t kept good medical records and might not even be sure of the technical diagnosis the doctor made.

However, now is the time to get organized. You need to submit your claim in a timely manner, so any delay could only hurt you. Failure to follow the rules for submitting a claim could cause you to lose important appeal rights.

There also must be a description in the Summary Plan Description (SPD) of how you make a claim. This transparency is a critical safeguard afforded by ERISA. If this description of the claims process is missing, then you might be able to hold the plan accountable under ERISA for not following the law.

Contact the Peace Law Firm Today

ERISA Section 503 requires that plans permit someone to help you make a claim. This authorized representative could be someone close to your or it could be an ERISA attorney. ERISA disability claims are often complicated, and failure to properly follow the requisite rules and procedures can hurt your claim. And if your claim is denied, having quality representation in your corner is that much more important.

So if you need help, do not be afraid to ask for it. In fact, doing so can help ensure that you do everything necessary to get the compensation you need and deserve.

ERISA disability attorney John Peace has extensive experience representing employees as they navigate the complex claims process. He is ready to fight to do the same for you. Contact us today!


Are ERISA and Workers’ Compensation the Same Thing?

No, disability benefits under ERISA and workers’ compensation are two separate and distinct things. Disability benefits cover injuries or illnesses sustained away from work, whereas workers’ compensation covers injuries or illnesses sustained at work.

Will My Injury or Illness Be Considered a “Disability”?

Unfortunately, this is a tough question with no clear answer. Whether your injury or illness will be considered a disability is a very fact-specific question that will depend on the language within your individual disability plan.

Make sure to review your plan. If it’s still unclear, contact our team for a consultation to see whether your injury or illness may be considered a disability.

What Is the Difference Between ERISA Long-Term Disability and Short-Term Disability?

Long-term disability claims (LTD) typically arise in cases involving disease, serious illness, or severe injury that prevents a worker from returning for an extended period of time. This might be months, years, or in some cases, permanently.

Short-term disability claims (STD) exist where the disability results in an inability to work for shorter periods of time.