Your Employee Benefits Must Adhere to Minimum Standards Established by ERISA

ERISA and your employee benefitsHealth insurance, retirement benefits, disability coverage—your Ohio employer offers these benefits and more. But who makes sure the plans are legitimate and that the money you invest through them is secure?

If you work for a non-government employer, your benefits are secured and regulated by the federal government under the Employee Retirement Income Security Act of 1974 (ERISA).

This law sets minimum standards for employee benefits and allows participants to hold their employer accountable if a plan fails to meet the criteria.

What Benefits Are Covered Under ERISA?

In general, any voluntarily-established employee retirement and health plans offered by private-sector employers are subject to the rules and regulations of ERISA. While ERISA doesn't require employers to provide certain benefits, it mandates their plans meet certain standards.

Originally written to cover employee retirement funds, ERISA’s reach has expanded over the years to include any wellness benefit offered by employers, including:

  • Health insurance
  • Long-term disability insurance
  • Accident
  • Life insurance
  • Dental insurance
  • Unemployment benefits
  • Vacation benefits
  • Apprenticeship and training programs
  • Scholarship funds
  • Prepaid legal services
  • Flexible spending or health savings accounts
  • Retirement plans
  • Public pension plans

Even if your participation in the benefit plan is entirely optional, your employer must meet ERISA requirements.

What Are the Requirements Established by ERISA?

Under ERISA, any benefits program offered by your employer must meet these minimum standards:

  • Provide information about the plan, including rules, coverage limits, financial details, and documents on the management and operation of the plan. This information must be communicated to plan participants regularly—not just when signing up.
  • Set minimum standards for plan fiduciaries, such as trustees and administrators. Fiduciaries are expected to run the plan solely in the interest of participants and beneficiaries and exclusively to provide benefits and pay plan expenses.
  • Establish a clear grievance and appeals process for participants to get benefits from their plans.
  • Give participants the right to sue for benefits and breaches of fiduciary duty.

While this is a lot of “fine print” kind of information, the gist is that when you participate in an employer-sponsored benefit program, you have certain rights when your claim for coverage is denied or your investment is handled irresponsibly.

It's important to note that ERISA doesn't cover federally-mandated benefits programs, such as workers’ compensation; or benefits offered by a government employer, such as a school district or government agency.

Why You Need an Attorney to Help You Exercise Your Rights

While ERISA was initially enacted to protect employees, the process for suing for benefits actually favors insurance companies. While you're granted the right to appeal and to go to court, ERISA makes it difficult with these restrictions:

  • You're only allowed one appeal.
  • The deadlines are short and very strict.
  • Your appeal is heard by the insurance company, not an impartial court or board.
  • While you can sue if your appeal is denied, you can't introduce new evidence or choose your court.
  • Even if a judge agrees with you, you have to prove the insurance company acted unreasonably in denying your claim—an extremely high standard to meet.

Because these cases are complicated and time-consuming, it's nearly impossible for a layperson to succeed in getting their claim approved. Very few attorneys take ERISA cases for the same reasons, but it's vitally important to find a qualified ERISA attorney to help you when there's a problem with your benefits.

Monast Law Office Welcomes ERISA Long-Term Disability Appeals

At Monast Law Office, we help workers navigate the ERISA appeals process when their group long-term disability (LTD) claims are denied. As a workers’ compensation attorney with over 30 years of experience, I know what it takes to build a strong disability claim, and I understand how the ERISA process operates. Time isn't on your side with a denied LTD claim. Contact Monast Law Office to get your appeal off to the right start. 

If you have long-term disability coverage through your private-sector employer, do yourself a favor and learn about the law that regulates this and other employee benefit programs—ERISA. I take a stab at explaining how this complicated act applies to you in this article.

James Monast
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