What Is ERISA and How Does It Affect Disability Benefits?

If you have a disability insurance policy through your employer, chances are it’s governed by a federal law called ERISA – the Employee Retirement Income Security Act of 1974. At Cavey Law, we know ERISA inside and out, and we help clients understand their rights under this complex law so they can secure the disability benefits they deserve.

What Is ERISA?

ERISA is a federal law that sets the rules for most employer-sponsored benefits, including:

• Long-Term Disability (LTD) insurance
• Short-Term Disability (STD) insurance
• Health insurance
• Life insurance and pension plans

When it comes to disability, ERISA governs how claims are filed, reviewed, and appealed. Unlike Individual Disability insurance policies that you purchase on your own, ERISA policies are tied to your job and must follow very specific procedures.

How ERISA Affects Disability Claims

ERISA disability claims are very different from regular insurance claims. Here’s why:

1. Strict Deadlines – ERISA sets short and unforgiving deadlines for filing appeals. Missing a deadline can mean losing your rights.
2. Administrative Record – Everything you submit during the claim and appeal becomes part of your “administrative record.” If your case goes to court, the judge usually cannot consider new evidence – you are limited to what’s in that record.
3. Insurance Company Control – Under ERISA, insurance companies often have broad discretion to decide whether to approve or deny claims, which can make the process unfairly tilted against you.
4. Limited Court Review – If your claim is denied and you have to sue in federal court, the judge usually reviews the case under a deferential standard, meaning the insurance company’s decision may only be overturned if it was “arbitrary and capricious.”

Common Challenges in ERISA Disability Claims

Because of ERISA’s strict rules, many people run into problems like:

• Denials based on insufficient medical evidence.
• Insurance companies claiming you can work despite serious limitations.
• Policies with hidden exclusions or definitions that make it harder to qualify.
• Delays or endless requests for more paperwork.

These challenges are why having an experienced ERISA disability attorney is so important.

How Cavey Law Helps With ERISA Claims

We know ERISA’s traps – and how to avoid them. Our team:

• Reviews your policy to identify important provisions and exclusions.
• Collects and submits strong medical and vocational evidence before deadlines.
• Appeals denials with a focus on building the best possible administrative record.
• Prepares cases with an eye toward federal court if the insurance company won’t play fair.

Why ERISA Claims Are Different From Social Security Disability

Many clients confuse ERISA disability benefits with Social Security Disability Insurance (SSDI). While both provide income when you can’t work, the processes and rules are completely different. 

With ERISA claims, you’re fighting against an insurance company under federal law – not the government. That’s why specialized legal experience matters.

Our Mission in ERISA Disability Law

At Cavey Law, we understand how devastating it is when disability forces you out of work. ERISA should protect employees, but too often it protects insurance companies instead. Our mission is to level the playing field – combining legal expertise, persistence, and compassion to fight for your benefits.