ERISA requires employers to provide participants and beneficiaries with information about available insurance through Summary Plan Descriptions.
Author: Attorney Lonnie Roach
Long Term Disability (LTD) benefits are disability benefits provided by a private insurer. The Employee Retirement Income Security Act (ERISA) governs group Long Term Disability policies.
ERISA has become synonymous with Long Term Disability Insurance and often claims for LTD benefits are referred to as “ERISA claims”.
However, ERISA does not cover all Long Term Disability insurance policies. Government employers and churches are not required to follow ERISA.
Many private insurance policies purchased individually are also exempt from ERISA. If you are thinking of filing a claim and have questions about your policy you might consider contacting an experienced long term disability lawyer.
ERISA does not require that employers provide coverage, but it governs the coverage that an employer may choose to provide.
ERISA helps keep private insurance plans relatively uniform and provides protections to the insured. Many ERISA requirements fall on the employer rather than the insurance company.
ERISA requires employers to provide participants and beneficiaries with information about available insurance through Summary Plan Descriptions (SPD). Under ERISA, a “participant” is defined as:
“any employee or former employee of an employer, or any member or former member of an employee organization, who is or may become eligible to receive a benefit of any type from an employee benefit plan which covers employees of such employer or members of such organization, or whose beneficiaries may be eligible to receive any such benefit.”
This definition is important, as many employers do not think of former employees when distributing insurance information materials.
Summary Plan Descriptions are required to be distributed to employees within 90 days of becoming covered by the plan. Additionally, updated information must be distributed every five years if the plan is changed in any way.
Besides distribution, ERISA also regulates what the Summary Plan Description must contain.
The exact rules can be found in the Code of Federal Regulations. These regulations can be complicated and can be explained by a long term disability lawyer. Requirements include but are not limited to:
- the name of the plan
- the name and address of the party (usually the employer) that maintains the plan,
- the employer identification number assigned to the plan sponsor
- the type of plan
- the type of administration of the plan and contact information for the plan administrator
- the registered agent and their contact information
- the trustees of the plan and their contact information
- the plan’s requirements for eligibility
- a statement outlining circumstances which may cause a participant to become ineligible
- the sources of contribution and how contribution is calculated
- the procedures for claiming benefits (or a statement that the procedures are provided in a separate document)
- A statement of ERISA rights
The Summary Plan Description is just one of many documents which ERISA requires.
ERISA also requires a Summary of Material Modification if there are changes that effect the price of the plan or the benefits the plan offers. Generally, the employer is required to keep the employee aware of their benefits. If the employee leaves, a COBRA notification is required; if the employee is on a medical leave of absence a Michelle’s Law notice may be required.
Long Term Disability benefits can be complicated. Insurance companies are notorious for trying to deny payment, even to legitimate claims. If you have applied for Long Term Disability benefits and been denied, don’t give up. Most initial claims are denied. Having an experience long term disability lawyer on your side who has been successful fighting insurance companies can make a big difference in your claim. Call the ERISA attorneys at Bemis, Roach and Reed today for a free consultation. Call 512-454-4000 and get help NOW.
Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court - all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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