Disability claims and employer obligations under ERISA

Disability insurance can be a great benefit. When you’ve become disabled and your ability to work changes, it can help make ends meet so that you’re still able to feed your family.

Ideally, your employer and your employer-provided insurance plan should work with your disability insurance so that your medical needs are covered as well.

The Employee Retirement Income Security Act (ERISA) gives your employer and your employer-provided insurance plan certain obligations to you, even when you have a disability.

Common claims

It can be easy to assume that a “disability” is something that is visible or something that you’re born with. But there are a lot of disabling conditions that come along later in life. There may not even be a known cause for the disability. Things like fibromyalgia and arthritis can have no known cause but can still have a significant impact on your ability to work.

Some of the most common disability claims are for conditions that have a late onset and are not immediately apparent. While this can be an obstacle when you’re talking to your employer about your disability, remember that your employer has significant obligations when it comes to your disability claim.

An obligation to provide plan information

From one perspective, if you don’t have the information, you can’t claim the benefit. And if you don’t claim the benefit, that can be a savings for your employer and their insurance provider. This is not something that your employer or their insurance provider can try to take advantage of.

Your employer doesn’t necessarily have to bring your attention to benefit information when the situation comes up, but they do need to provide it. Many employers will do this once a year to make sure that everyone receives the information.

When you have a change in your circumstances, it’s a good time to ask your employer directly about your benefits and what might apply to your new situation. At that point your employer has an obligation to answer your questions and give you the information you’re looking for.

An obligation to provide an appeals process

Anytime someone has an obligation to pay a claim, there’s a strong chance that they’re going to try to pass that obligation on to someone else. While that may be a normal part of the process, you do need to have the ability to appeal that decision. Your employer has an obligation to provide a process for you to make grievances about the plan including a process for getting those issues resolved.

It’s not for everyone

These obligations only apply to private for-profit companies and their insurance providers. Non-profits and government employers do not fall under the protections of ERISA.

It is worth noting, however, that ERISA is a federal law. This means that if there is a conflicting state law, ERISA still applies and your employer still has these obligations.

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