ERISA

Guide to the Employee Retirement Income Security Act



The Employee Retirement Income Security Act (ERISA) is a federal law that regulates and establishes oversight for private industry pension plans, retirement plan, profit-sharing plans and health insurance coverage by establishing rules and minimum standards that are meant to protect plan participants. ERISA only governs private (non-government) employers with 25 or more employees.

ERISA does not mandate the creation of any these plans; it only sets the standards for those that choose to establish them. ERISA was amended by the Consolidated Omnibus Budget Reconciliation Act (COBRA) in 1985 to include provisions for workers whose established health insurance coverage is affected by their employment situation. And a more recent amendment in 1996, the Health Insurance Portability and Accountability Act (HIPAA), protects the transferability and security of health care coverage for workers, especially when there is a pre-existing condition involved.

ERISA addresses the following aspects in its oversight: conduct of the individuals financially responsible for administration of the various plans; detailed documentation for reporting and accountability; the necessity of disclosing specific information about the plans to the participants; written policies for filing of claims and appeals, in a equitable and timely manner; and safeguards to protect funding of the plan and the non-discriminatory collection and distribution of the plan benefits.

ERISA also set up Individual Retirement Arrangements (IRA’s); created easier methods for self-employed workers to set up retirement plans; and added employee stock ownership to the tax code.

The Employee Benefits Security Administration (EBSA), a division of the Department of Labor (DOL), is the governing body responsible for administering and enforcing ERISA. When an insurance company denies a claim for benefits the consumer believes is covered by his/her plan, established appeals procedures, as detailed in the employer’s required Summary Plan Description (SPD), must be followed to appeal their decision. If denied again, the consumer may appeal a second time through either the insurance company or the regional EBSA office, depending upon the company’s established procedure.

Employers who fail to adhere to ERISA requirements face limited penalties. After exhausting all their administrative options, to pursue specific relief, plan participants must then file their ERISA legal claims in Federal Court. Damages are limited. Attorneys experienced in the practice of ERISA Law can assist these consumers with their claims and establishing their rights.

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Articles on HG.org Related to ERISA Law

  • Forum Selection Clauses in ERISA Plans
    Most courts are in favor of providing forum selection clauses enforcement and feasibility, but knowing what this means for an ERISA plan is important to participants of ERISA benefits and those companies that use these programs. Additionally, while many courts are in favor, there are some that will invalidate the forum selection clauses automatically.
  • Employer’s Misuse of Pension Funds
    Pension fraud may affect the individual employee when he or she reaches retirement age, and without uncovering the criminal activity affecting him or her, the crime may lead to further complications. Some fraud occurs due to the use of the pension funds, and other actions happen when the employer provides these funds too early.
  • Proving Mental/Nervous Disability for ERISA Claims
    It is through looking at a course of 24 months for mental or nervous issues that lead to total physical disability where a claim may remain valid or end with partial disability and a re-entrance into the workforce. By taking a closer look at this period, it is possible to determine if the claim should remain or if a change is necessary.
  • ERISA: Independent Medical Reviewers and the Award or Denial of Benefits
    When benefits are necessary for someone in an ERISA program, the role of independent medical reviewers in these decisions where benefits may process through a denial or acceptance, it is important to understand how important or extraneous this decision is regarding ERISA. For the specific person, it could lead to a longer or shorter claim through legal proceedings.
  • ERISA Summary Plan Descriptions
    The ERISA summary must contain certain items in the plan description to ensure the person is eligible with a clear understanding, and this must exist in a manner so that an average participant in the plan is aware of the information. Without the details in the summary, the person may face a negative outcome with the ERISA situation.
  • Missing an Appeal Deadline in ERISA Cases
    It is important to understand what deadline is appropriate for an ERISA case for an individual when he or she needs to make an appeal. During a lawsuit, this is the police already in effect during an ERISA cause of action occurs for the individual, and he or she will need to acquire the deadline for these specific circumstances.
  • Social Security Offset Provisions and Wrongful Denial in ERISA Cases
    Most ERISA plans, as well as any supporting insurance policies for individuals, have certain provisions that will let the person offset disability benefits through Social Security, and a wrongful denial will invalidate these benefits. It is essential to proceed through the wrongful denial and acquire a correct decision in the case.
  • Fibromyalgia Patient Sues Employer after Being Fired for Her Disability
    A Minnesota woman with fibromyalgia and osteoarthritis recently received $30,000 in an Equal Employment Opportunity Commission (EEOC) lawsuit that proved her employer violated the terms of the Americans with Disabilities Act (ADA) by firing her because of her medical condition.
  • What Happens After Filing an Initial Claim for Long Term Disability
    What happens after filing an initial claim for Long Term Disability: The agony of ongoing and periodic LTD eligibility reviews. Throughout the duration of your LTD claim, you will be subject to ongoing and period eligibility reviews.
  • The Powerful Patient: Documentation Before Applying for Medical Leave or Disability Benefits
    Disabled individuals, or those with medical conditions that impair their ability to work, are often frustrated with the process of proving their disability or understanding what and how much of their medical information they must disclose. Frequently, they also express frustration with their doctor’s office in providing the necessary information. But patients are more powerful in these situations than they realize.
  • All Employment Law Articles

    Articles written by attorneys and experts worldwide discussing legal aspects related to Employment and Labor including: discrimination, employee benefits, employees rights, ERISA, human resources law, labor relations, outsourcing, sexual harassment, whistleblower, workers compensation and wrongful termination.

ERISA Law - US

  • ABA - Joint Committee on Employee Benefits (JCEB)

    The ABA Joint Committee on Employee Benefits (JCEB) coordinates the activities of the employee benefits committees of six sections. Those activities include CLE programs and annual meetings with federal agency officials that are reported as a series of questions and answers from each agency.

  • Consolidated Omnibus Budget Reconciliation Act of 1986 - ERISA and COBRA

    Congress passed the landmark Consolidated Omnibus Budget Reconciliation Act (COBRA)(1) health benefit provisions in 1986. The law amends the Employee Retirement Income Security Act (ERISA), the Internal Revenue Code and the Public Health Service Act to provide continuation of group health coverage that otherwise would be terminated.

  • Employee Retirement Income Security Program - Chapter 18

    ERISA requires plans to provide participants with plan information including important information about plan features and funding; sets minimum standards for participation, vesting, benefit accrual and funding; provides fiduciary responsibilities for those who manage and control plan assets; requires plans to establish a grievance and appeals process for participants to get benefits from their plans; gives participants the right to sue for benefits and breaches of fiduciary duty; and, if a defined benefit plan is terminated, guarantees payment of certain benefits through a federally chartered corporation, known as the Pension Benefit Guaranty Corporation (PBGC).

  • IRS - Employee Plans

    In 1974 the Employee Retirement Income Security Act of 1974 (ERISA) was signed into law. It completely revised the legal framework of the qualified pension plan and made significant changes in the areas of minimum participation, vesting, benefits, surviving spouse benefit protection and minimum funding requirements.

  • United States Department of Labor - ERISA Enforcement

    The Employee Benefits Security Administration published this manual solely for the internal administrative use of its employees. This manual does not restrict or limit in any way the Employee Benefits Security Administration's discretion in carrying out responsibilities imposed on the Secretary of Labor by the Employee Retirement Income Security Act. Nothing in this manual is intended to be an interpretation of law or regulation or to serve as guidance for persons outside the Department of Labor. Nor does this manual confer on any person, including one who is the subject of an Employee Benefits Security Administration investigation or enforcement action, a right to rely on any policy or procedure stated herein, or otherwise create any other substantive or procedural rights.

Organizations Related to ERISA Law

  • DOL - ERISA Advisory Council

    Section 512 of ERISA provides for the establishment of an Advisory Council on Employee Welfare and Pension Benefit Plans, known as the ERISA Advisory Council. The duties of the council are to advise the Secretary and submit recommendations regarding the Secretary's functions under ERISA.

  • ERISA Industry Committee (ERIC)

    Since 1976, The ERISA Industry Committee (ERIC) has remained the only organization in Washington, DC committed exclusively to the employee benefits interests of America’s major employers. Our action on legislation, regulations, and other matters is determined solely by our members who are directly responsible for benefits policy within their companies. As a result, ERIC has been extremely influential and successful in its efforts and its mission.

  • National Association of Insurance Commissioners

    The mission of the NAIC is to assist state insurance regulators, individually and collectively, in serving the public interest and achieving the following fundamental insurance regulatory goals in a responsive, efficient and cost effective manner, consistent with the wishes of its members:

  • Pension Benefit Guaranty Corporation (PBGC)

    PBGC is a federal corporation created by the Employee Retirement Income Security Act of 1974. It currently protects the pensions of more than 44 million American workers and retirees in more than 29,000 private single-employer and multiemployer defined benefit pension plans.

Publications Related to ERISA Law

  • An Employee's Guide to Health Benefits Under COBRA

    Health insurance programs help workers and their families take care of their essential medical needs. These programs can be one of the most important benefits provided by an employer. There was a time when employer-provided group health coverage was at risk if an employee was fired, changed jobs, or got divorced. That substantially changed in 1986 with the passage of the health benefit provisions in the Consolidated Omnibus Budget Reconciliation Act (COBRA). Now, many employees and their families who would lose group health coverage because of serious life events are able to continue their coverage under the employer's group health plan, at least for limited periods of time.

  • Frequently Asked Questions about Pension Plans and ERISA

    ERISA does not require any employer to establish a pension plan. It only requires that those who establish plans must meet certain minimum standards. The law generally does not specify how much money a participant must be paid as a benefit.




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