What Terms Apply?

If ERISA does apply, finding out what the terms of the insurance policy are can prove quite difficult. ERISA benefits often involve interpreting several different documents, including global wrap plan documents, summary plan descriptions, and insurance policies or certificates of coverage. These will often have different, conflicting terms, and it is not always easy to know which set of terms the court will find to be controlling.

The other big problem here is that employers will rarely send you all the documents you need and have requested. It is also often quite difficult to know who to request these documents from in the first place. Further, many of the benefits under an employee welfare benefit plan or pension plan will be interconnected. So, if you have an ERISA disability benefits claim, you will need the ERISA life insurance policy as well because the ERISA life insurance policy premiums for that life insurance policy should be waived and coverage continued while you are disabled.

• The most typical types of ERISA-governed employee benefits that we see are disability benefits, life and AD&D insurance, pension benefits, and medical insurance benefits.
• Most people are unaware of the full extent of the group insurance benefits that are provided as part of their employee benefits package. You cannot rely on the insurance company to tell you about these additional benefits.
• It is important to note that the investigations that we conduct into these benefit packages are not limited to things you or your spouse purchased, it is also crucial to investigate what the employer paid for. A lot of people are unaware of the insurance that is provided in the employee benefits packages because the employer pays the premium.