Reporting and Disclosure in the ERISA Statute

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Reporting and Disclosure in the ERISA Statute. The reporting and disclosure provisions of the ERISA statute appear at §§ 1021 – 1031. These sections – Create the reporting and disclosure duties of administrators ( 1021); Describe the summary plan description ( 1022) and annual report (§ 1023) that are the two most important parts of the reporting and disclosure scheme; … Read More

ERISA Disability Plans Defined

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ERISA Disability Plans Defined. Most people who carry long term disability insurance obtain it by participating in a plan offered by their employers. Although it is possible to obtain long term disability insurance directly from an insurer (called “private” or “individual” disability insurance), those policies are prohibitively expensive for most people. But employers can offer reasonably priced long term disability … Read More

ERISA Disability Policy Causes of Action

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ERISA Disability Causes of Action. There is an elaborate scheme set out in § 1132 of the ERISA statute for enforcing rights under the statute through civil actions. With respect to participants and beneficiaries seeking civil enforcement of ERISA disability benefits, the most important remedy is set out at section 1132 (a)(1)(B), which empowers a participant or beneficiary to bring … Read More

ERISA and Social Security

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Most group long term disability plans require claimants to apply for social security disability benefits. In fact, administrators often offer to assist claimants by referring them to a company that will represent them. They do this because SSDI benefits are typically included as a ‘deductible source of income’ under most plans, meaning that administrators can reduce the amount of any … Read More

Eleven Ways To Assure the Success of a Disability Claim

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Many of the leading disability insurance companies have engaged in systematic strategies to deny valid applications (“claims”) by policyholders for disability benefits.1 Aided by a federal law known as ERISA, (Employee Retirement Income Security Act of 1974), they have been given procedural advantages and have means at their disposal to intimidate and oppress even the most well-informed “claimants” seeking ERISA … Read More

Appeal Denials and Federal ERISA Litigation

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An administrator must give notice of its decision on the appeal, setting forth the basis for a denial, again with 45 days, or 45 plus 30 if necessary for reasons beyond its control. Once the administrator makes a final determination and the claimant has ‘exhausted’ all remedies available under the policy, the claimant can bring an action in federal court … Read More

Applying for Disability Under an ERISA Group Policy

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Plan administrators have the authority under the ERISA statute to review initial ERISA long term disability claims and to deny claims. There is typically a procedure for submitting an initial claim that requires applicants to obtain attending physician reports from health care providers, fill out activities of daily living forms, sign authorizations so that the administrator can gather documents and … Read More

Group Disability Plans Exempt from ERISA

Tony CanataDisability InsuranceLeave a Comment

The ERISA statute provides an exemption for certain categories of employers, including church plans and government plans. Employers that are exempt from ERISA generally provide disability plans through insurers in the same way that nonexempt employers do. As a result, the plans offered by exempt employers are typically identical to ERISA governed plans and are administered in the same way. … Read More