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(A FEW) COMMON MYTHS ABOUT ERISA

There are many myths about ERISA (the Employee Retirement Income Security Act), and about what it is, what the rules are.  The reason is simple, even if the answers are not.  ERISA, which governs many types of long term disability, short term disability, medical, dental, life and other employee benefits is a complex piece of Federal legislation, and it creates a system that even many lawyers are unsure how to navigate.  If you find that you have a long term disability, short term disability, or other claim that is governed by ERISA you should seek out experienced counsel as soon as possible.  We have been handling ERISA cases, including long term disability and short term disability, for over 15 years.

Here are some of the most common misconceptions that we hear:

Myth: My company is small with only a few employees, so ERISA doesn’t apply

Fact: It is true that many federal laws, including many anti-discrimination laws, exempt “small employers”. However, ERISA, applies to virtually all employer-sponsored benefit plans, regardless of size. Even if there is one participant in the plan, ERISA applies. For that reason, the vast majority of long term disability, short term disability and other employee benefits do in fact fall under ERISA.  The Department of Labor does exclude certain types of group health plans from ERISA, usually those offered by non private employers such as government agencies, municipalities or churches.

Myth: Plan documents are not required

Fact: Actually, ERISA has very strict requirements with regard to plan documents, which are required in almost all circumstances and provide participants with a notice of benefits offered, obligations under the plan and relevant procedures and guidelines.  If you have a question about what your benefits include (or don’t) you must always start with that written document.  For example, the plan document may have important information like the definition of “disabled”, “long term disability”, or “short term disability”, and will include important deadlines.

 

Myth:   I am just the employer, or just an insurance adjuster, I am not a fiduciary for my plan

Fact: Individuals or entities other than the “official” plan administrator can become a fiduciary for their plan without realizing it because the Labor Department bases fiduciary status on functions performed for the plan, not on a person’s title or specific designation.

Myth:  The insurance company is required by law to treat me fairly

Fact:  While not “wrong” per se, most people are surprised to learn that the legal remedies available under private insurance policies (delay damages, bad faith damages and the like) are not available under ERISA.  ERISA is a Federal law, and it preempts many state law remedies.  An experienced lawyer can help you figure out what remedies may be available, including when you are denied long term or short term disability insurance benefits.

Myth:  No one can win an ERISA case

Fact:  Many workers can, and do, when there ERISA cases (no matter how hard it may seem).  And to be clear, it is hard!  Please review our other Blog posts, and website tab for “ERISA” for more information about the obstacles you may face.  We have helped many workers obtain the long term disability, short term disability and other disability clients obtain the benefits they need.  Check out our Published and Important cases, and newsclippings, on the main site for more information about our ERISA victories.

 

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