The Congress enacted the Employee Retirement Income Security Act (ERISA) in 1974 to set minimum standards for employees’ pension and health plans in private employment. So, if you have a disability, your employer in New Jersey may have a disability plan to help you with medical costs.
Understanding an ERISA disability plan
An ERISA disability plan is an employee benefit offered by employers in the private sector to their employees. It usually covers medical expenses and lost wages due to disability. The federal law governs ERISA plans, so the benefits provided under them are standard across all states in which they operate.
You should note that if your employer has a plan that falls under the “safe harbors,” then ERISA won’t apply to you. A safe harbor is a legal provision that allows employers to sidestep specific regulations. Also, if your employer does not contribute to the plan, employee participation in ERISA is voluntary or not required, this act won’t cover you.
Administrative requirements under ERISA
ERISA disability requires administrators to file certain informational returns with the Department of Labor and the IRS, including a summary plan description and annual financial reports. The administrator must also provide participants with regular information about the plan, including rules and coverage information.
Claiming ERISA disability benefits
If you are suffering from a long-term disability, your human resource personnel or plan administrator should provide you with a detailed overview of the claims process, how to appeal a denied claim, and any other important information related to the ERISA disability plan. Basically, you need three things: your statement, your employer’s statement and the attending physician’s statement.
Your statement should include a detailed description of the injury or illness and its disabling effects, your name, address and Social Security number, and any medical reports you have. The HR personnel will provide the employer statement containing information about your employment, such as job title, dates of service with the employer, salary history and other applicable details. Lastly, the attending physician statement should include diagnosis, prognosis and any other information about your disability.
Equipping yourself with a thorough understanding of your rights, responsibilities and the regulations that govern ERISA plans, you can confidently advocate for the benefits you need. It’s essential to ensure you provide detailed and accurate statements, your employer provides precise information, and your attending physician gives a comprehensive account of your condition to stand a better chance of having your claim approved.
