Disability Plan

[katieinny]

An employee is told that his disability does not qualify under the employer's disability plan, and therefore his claim is denied.

Does ERISA come into play here? Could he make a claim under ERISA?

[Steve72]

Yes. This is a claim under ERISA. Recently effective Regulations regarding the timing of claims and appeals for disability plans are applicable here.

[katieinny]

So, I would think that in the plan's handbook (or whatever was given to employees) there MUST be a description of how to make a claim under ERISA (after all other avenues have been exhausted). If that language is not there, the employer is in violation of ERISA. How am I doing so far?

[QDROphile]

Too eager, if you think you are going to score a quick advantage. The claimant should ask the plan administrator for information about filing a claim. Leave the gamesmanship to the sleazy lawyers.

[katieinny]

Steve72 mentioned "recently effective regulations." I would like to look at that stuff. Can you point me in the right direction?

[mroberts]

Since you're in NY and if you're talking about a DBL claim, handbooks are not provided by carriers to employees for this coverage. If a claim was denied, the insurance carrier would have sent the employee the declination notice and the necessary steps to appeal the decision. Since this is a state-mandated coverage, information on the claims appeal process can also be obtained on-line or via the phone from the Worker's Compensation Board.

[katieinny]

This doesn't happen to be a NY client. He's in a southern state, and the employer with the disability plan is also in that state. We're trying to determine if he can make a claim through ERISA.

[mroberts]

Whenever it comes to a benefit endorsed by the employer, an employee can file a claim under ERISA. Whether or not it has merit and whether or not he or she is going to win the case is going to be determined by the courts. Was the SPD provided to the employee? Did he or she follow the claims appeal process?