The Employee Retirement Income Security Act of 1974, more commonly known as ERISA, is a federal law enacted by Congress that establishes minimum standards designed to protect the retirement, health, and other welfare benefit plans (life insurance, disability insurance, etc.) of private industry employees from fiduciary misuse. It is administered by the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA).
Ironically, in many situations, its complicated rules and regulations can have the opposite effect, making it difficult if not impossible to pursue a disability claim. If you don’t meet your ERISA health plan’s eligibility requirements your claim could be denied.
So how do you ensure you meet all the eligibility requirements spelled out in your health care plan?
ERISA requires plan administrators to provide participants with important plan information about plan features and funding; the first step you should take to make sure you meet your plan’s eligibility requirements to receive benefits is to check your Summary Plan Description (SPD).
The SPD is a brochure you receive when you enroll in your employer’s benefits plan. The SPD will provide a detailed overview of your benefits plan and how your plan works, and provides information on what the eligibility requirements are for filing a claim. It also describes your rights and responsibilities under ERISA and your plan and provides information on where to file a claim, forms and paperwork you need to file, and whom to contact if you have questions about your plan.
Under ERISA rules, your plan administrator is required to provide you with a copy of your plan’s SPD. If you do not have a copy of your plan’s SPD you can request one from your plan’s administrator.
You can also contact your local Department of Labor office for information about ERISA eligibility requirements. (In Houston, it’s located at 8701 S. Gessner Drive; the phone number is 713-339-5500.)
If you’ve been denied disability benefits, the most important step you can take is to contact an experienced Houston disability denial lawyer who is familiar with ERISA’s rules and regulations as soon as possible. With ERISA claims, your rights are often determined by what occurs early in the claim process. Your lawyer will know when and how to appeal a denial of benefits and what is needed to get an approval.
Under ERISA regulations you are prevented from exercising many rights and protections that govern non-ERISA disability claims: you may not sue your insurer for insurance bad faith, breach of contract, or punitive damages.
You do, however, have 180 days to file an administrative appeal. An administrative appeal is your only opportunity to submit key medical and vocational evidence that is relevant to proving your disability.
If you have questions about ERISA disability eligibility requirements or have been denied an ERISA disability and need to appeal, contact the Houston disability benefits lawyers at The Law Offices M. Stanley Whitehead. We are intimately familiar with ERISA law and have extensive experience in both the ERISA application process and appeal process.
Call us at 713-993-7311 to schedule a free consultation with one of our attorneys. We will evaluate your case, answer any questions you might have, and explain how we can help appeal your disability claim. As a national disability denial law firm based in Houston, we serve clients across the United States, offering everyone a free, highly informative case evaluation.