Congress ultimately included employer-provided insurance benefits as part of the law. That is why most Short Term Disability, Long Term Disability, and other insurance benefits that are offered by private employers are covered by ERISA. Keep in mind that ERISA applies only to employee benefits provided by private employers. If you work for a government entity or a church, ERISA will not apply to your claim. However, any private employer (even a small company with only one employee other than the owner) that provides employee benefits will be subject to ERISA.
With certain exceptions, ERISA creates one uniform system to administer these group benefit programs sponsored by employers. However, this “uniform system” is far from uniform. The law actually allows employers to establish nearly any type of benefit plan they wish, as long as they provide certain documents to employees and allow for an appeal when benefits are denied.
There are many differences between group benefit cases covered by ERISA and individual insurance claims regulated by state laws. If you or your lawyer do not know those differences and how to handle them, it can hurt your case. ERISA is much less consumer-friendly than state insurance laws, and the insurance companies that administer ERISA plans hide behind its protections to deny many group disability benefit claims that would not be denied if they were individual insurance claims.
No comments:
Post a Comment