What Is ERISA And What’s The Connection To Houston Disability Benefits

If your employer covers your benefits package, it’s likely governed by ERISA. Most employer-sponsored plans are ERISA-regulated, except for privately-purchased policies or those provided by governmental agencies, churches or church-owned hospitals.

What Is ERISA And What's The Connection To Disability Benefits In Houston, TX

Despite the title and description, getting disability benefits isn’t always as simple as filling out forms and waiting for a check. Although ERISA was created to protect employees’ benefits and rights, its complex requirements can sink your claim right after you file it. If you file a claim and don’t follow the ERISA guidelines exactly, you claim may be denied without the right to appeal. Missing a deadline for appeal can prohibit you from filing a future claim.

ERISA Basics

Employer-sponsored benefits plans are regulated by ERISA, or Employee Retirement Income Security Act, established in 1974.This federal law under the US Department of Labor that “sets the minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in the plans.”  If you apply for disability and are denied, ERISA gives you the right to sue the insurer in federal court.

ERISA requires that employers provide their employees with basic information that includes:

  • Details of what’s covered and not covered under the plan
  • Instructions on filing a claim if an employee becomes disabled
  • Details of the company’s appeal process if the company denies an employee’s claim

ERISA sets a limit on the insurer’s timeframe to accept or deny a claim once it’s filed. The insurer has 45 days to render a decision, but can add an additional 30 days, and must notify the employee in writing.

If the insurer denies the claim, it must provide the reasons in writing within 45 days. ERISA controls not only the employee’s time frame for appeal, it also controls the deadlines for insurers to approve or deny the appeal.

Providing Documentation

It’s important to have a wealth of documentation in your claim file at the outset. This includes medical records, test results, doctor’s notes, and other instruments that will prove your claim for disability. Your attorney can advise you on the ERISA requirements, what information you need, and what you’ll need to request.

Note that if your claim is denied on appeal and you decide to move forward with a lawsuit, you will not be able to add additional evidence or information as you would with a civil or criminal trial or appeal. Everything that is already in your file is all that the judge will see. That’s why it’s important to have as much documentation to support your claim as you can obtain as soon as you can.

Discretionary Clauses In Texas Are Denied

You may have heard the term “discretionary clause” when discussing your policy with your employer or with the insurer. This is language written into the policy and allows the insurer plenty of “wiggle room” to limit or deny their claims. The clauses also prevent a court decision from reversing the insurer’s claim decisions.

In 2012, the state of Texas passed a law prohibiting any insurance company from using “discretionary clauses.” That is, any policy written or renewed after January 1, 2012 in Texas cannot contain a discretionary clause.

Deadlines Count

Insurers have specific deadlines for filing claims for disability benefits as well as appeals. Don’t miss a deadline, and make sure your claim adheres to ERISA’s very complicated rules. Let an experienced Houston disability benefits attorney take care of your claim and make sure everything is taken care of.

The Herren Law Firm can help you with your ERISA application, appeals and help you get the long-term disability benefits you need. Contact us in Houston today at 713-682-8194 to schedule your free consultation. There’s no obligation, and no up-front fees.  We only collect if we win your case.