ERISA Claims From A-to-Z: Eligibility and Filing

Chicago ERISA AttorneysUnfortunately, thousands of people become disabled annually. This may stem from illness or injury, but often leaves individuals unable to work.

Luckily, there is some semblance of help. In the United States, ERISA covers about 141 million workers and beneficiaries. This set of federal regulations protects employee benefits in the private sector.

In some situations, ERISA claims can help protect income despite a disability.

Despite their prevalence, many workers are unfamiliar with these regulations and how it affects the terms of their employment. It is critical that you understand your rights as an employee and thus how to protect yourself in the world of employment law.

As it pertains to insurance, most employment-based short and long-term disability plans are covered by ERISA regulations. This means that if you are unable to continue working due to serious illness or injury, there is some recourse to protect income and other benefits.

But, this area of federal law can be tricky. To find out if you are eligible for ERISA-covered disability benefits, read below.

What is ERISA?

ERISA stands for the “Employee Retirement Income Security Act.” It is a group of federal statutes signed into law by President Nixon in 1974.

This law aims to protect the interests of private-sector employees and the benefit plans they receive as part of compensation. If your disability insurance does not run through your employer, it may also be union-sponsored.

In essence, ERISA sets basic standards for employee benefits. The interpretation and enforcement of these regulations are carried out by the United States Department of Labor, the United States Treasury, and the Pension Benefit Guaranty Corporation.

ERISA covers most private companies’ voluntarily established retirement, health, and disability plans.

What Are ERISA Disability Claims?

ERISA disability claims are designed to cover private-sector employees who suffer a disabling injury or illness that renders them unable to work. These claims are then evaluated by your employer and/or the company’s insurer.

If the situation meets the predefined stipulations, you may benefit from insurance payments. These funds can help you maintain an income level that is relatively commensurate to your prior earnings. This way, you can continue to meet financial obligations while navigating your new normal in light of a disability.

According to ERISA law, the insurance administrator must approve or deny the claim within a reasonable period of time. If the claim is denied, you have the right to appeal the decision.

Who is Eligible?

If you have become disabled due to serious illness or injury that renders you unable to work—you may be eligible to file ERISA claims. This applies to both short and long-term, as well as permanent disability.

Due to the nature of illnesses and injuries, the exact eligibility requirements can be tricky. Each insurance plan will carry its own definitions and will need a wealth of supporting documentation.

The illness or injury usually must be debilitating enough that it renders you unable to carry out the typical functions of your job. This can take many forms, as not all illnesses and injuries present in the same way.

The disability can stem from a physical injury, like a broken bone, back injury or a torn muscle. But, there can also be mental or emotional factors at play. PTSD and anxiety are examples of conditions that may prevent maintaining employment.

Generally speaking, the process begins when you file your initial disability insurance claim. From there, the insurance company will investigate. Ultimately, if you did not recover the benefits you deserve, you may choose to appeal the decision and fight for your case.

How Do I File?

The details of actually filing a claim will vary depending on your unique plan and employer. The first step to begin this process should always check your Summary Plan Description and Summary of Benefits and Coverage. This will provide the pertinent information you need to ensure you meet your plan’s requirements.

Also included in this information, you will find a claims procedure booklet. This will detail exactly what to file, where to file it, and the designated contact person for questions about your plan.

While it is designed to protect employees, these regulations can be tricky and unforgiving. In this way, the average person may find difficulty in navigating these laws on their own.

An experienced ERISA attorney in this field of law can help ensure you make the most of your disability claim. With their experience in interpreting and applying ERISA regulations, they can be a key tool.

What if my ERISA Claim is Denied?

If your ERISA claim is denied, there are various routes you can pursue to achieve the justice you deserve.

In addition to setting up basic protections for employees, ERISA laws also establish a grievance and appeals process. This aims to level the playing field, ensuring participants, employers, and insurers can all have a voice throughout the process.

Furthermore, ERISA also paves the way for legal action when appropriate. Workers maintain the right to sue for benefits and other breaches of fiduciary duty—which may result in a full review of the denied claim.

Turning to the Experts

The world of insurance and ERISA claims can be confusing and difficult for the layperson to understand. With this in mind, it’s helpful to consult an expert in long-term disability insurance.

Your chosen attorney should be well-respected, with a wealth of experience in the field. As a Chicago ERISA Lawyer, Roger S. Hutchison represents Social Security disability and ERISA claimants from Chicago and all over Illinois.

We can help obtain insurance or employee benefits, including short and long-term disability, health care, life insurance, or accidental death benefits. Contact us today for a consultation.