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Frequently Asked Questions about ERISA Disability Plans
Q: My employer doesn't offer a disability benefits plan. Is this illegal?
A: No. ERISA only requires employers to follow certain rules once a disability plan is established. The act does not require employers to start a disability plan, however.
Q: Are there entrance requirements for these plans?
A: Requirements to start investing in these plans change from workplace to workplace. However, the Department of Labor states that typical plans require an employee to be at least 21 years old and work for the company for a year.
Q: My boss won't provide me with copies of the booklets that outline the insurance policies that I am participating in. What can I do?
A: If you don't have a copy of your plan's policies or claims procedures, you have the right to request one from your employer or the plan administrator. Submit a written request for the documents. If your request is unfulfilled, you can file a complaint to the Department of Labor, the administration that enforces ERISA.
Q: If my claim is denied by my employer's insurance company, do I appeal to the company or to the Department of Labor?
A: You'll want to file an appeal with the insurance carrier first. If you can provide them with specific examples of why their decision was unfair, they'll probably change their decision. An experienced attorney can negotiate with insurance companies on your behalf.
Q: How long do I have to file a claim under ERISA?
A: You have 180 days to file a claim of denied or unfair employer insurance claims under ERISA. After an appeal is denied by the carrier, you can file a complaint under ERISA.
Q: How long does a claim take to process/be resolved?
A: That depends on what type of insurance claim you are dealing with and how many benefits you're pursuing. From the time you are first denied a benefit, there are many appeals you have to go through. It can be months until the claim reaches the Department of Labor level.
Q: Is there a set length that I can get benefits from my employer's plan?
A: That depends on the group policy's terms. Your policy may provide short or long term disability benefits, which determines how long you can get benefits for lost wages.
Q: What happens if my employer goes bankrupt or my job is terminated?
A: New laws made organized retirement plans exempt property during a business's bankruptcy proceedings. This means that employees of a business filing for bankruptcy won't have their plans completely wiped out. The Pension Benefit Guaranty Corporation is a federal government corporation that insures plans and backs up funds in case they are wiped out.