Does ERISA Apply To Your Employee Benefits?

ERISA is a federal law designed to protect benefits due to employees administered by private employers through group benefit plans. Employees often are covered by long-term disability, short-term disability, life insurance, health insurance, retirement plans, and other employee benefits that have been issued through their employers. ERISA sets forth standards for administering employee benefits. Where benefits are not properly administered, ERISA provides plan participants and their beneficiaries a process through which to appeal an insurer’s or plan administrator’s claim denial or other improper action, and to sue in federal court when an appeal is unsuccessful. For persons whose insurance benefits are not governed by ERISA, the process governing claims handling and appeals by the insurer or plan administrator vary greatly from state to state. So do the potential damages available to insureds whose benefits are improperly denied. Therefore, the issue of whether your insurance coverage/employee benefits is governed by ERISA can be very significant.

If you are enrolled in a pension plan provided by your private employer, that plan is governed by ERISA. ERISA also applies to other types of employee benefit plans issued by private employers, including:

• Disability insurance plans
• Life insurance plans
• Accidental Death & Dismemberment insurance plans
• Health and dental insurance plans
• Vision plans
• Severance contracts

When Does ERISA Not Apply to Your Employee Benefits

There are four main exceptions to ERISA. ERISA does not apply to plans offered by government employers and entities, unfunded excess benefit plans, plans maintained outside the United States, and plans established by religious organizations that do not irrevocably opt into ERISA. Whether these exceptions to ERISA apply to your plan can depend on several factors and may require someone with ERISA expertise to determine. Reach out to the ERISA experts at McKennon Law Group PC for a free consultation with experienced attorney for disability coverage in San Diego if you have a question about ERISA’s applicability to a claim denial.

When ERISA Does Not Apply – Government Employers And Entities

ERISA was initially enacted to prevent the systematic abuse of private employees’ pensions and other employee benefits. However, it was decided that state and local governments should be the ones to decide the most effective ways of protecting their employees and their benefits. Thus, benefit plans created by state or local governments or plans under a collective bargaining agreement between a union and a governmental entity are not covered by ERISA.

When ERISA Does not Apply – Plans Maintained Outside Of The United States

Plans that are maintained outside of the United States for the main benefit of non-residents of the U.S. are not covered by ERISA. This is because ERISA was created to apply exclusively to American employees. Because ERISA is governed by the Department of Labor, it can only apply to things or people that the Department of Labor has power over, which does not include persons residing outside the U.S.

When ERISA Does not Apply – the Church Exception and Other Exceptions

If you have an employee benefit plan that was established by your church, temple, mosque, or other religious establishment, it is not governed by ERISA unless the organization irrevocably opts into ERISA. Additionally, plans maintained for the sole purpose of complying with state disability, unemployment, or workers’ compensation laws are not subject to ERISA. Aside from these primary exceptions, there are also voluntary group insurance plans that are not subject to ERISA if the employer does not contribute to the plan. As noted above, religious organizations also have a right to opt into ERISA and some do. If you do not know whether your plan is governed by ERISA, an experienced ERISA attorney can help you. Contact the knowledgeable ERISA attorneys at the McKennon Law Group PC for a free consultation.

How An Experienced ERISA Insurance Attorney Can Help You

If you have questions about whether ERISA applies to you, McKennon Law Group PC offers free consultations. McKennon Law Group PC has a dedicated team of local attorneys specializing in San Diego disability insurance who will fight for your benefits.