ERISA (the Employee Retirement Income Security Act) is a federal law established in 1974 that sets minimum standards for pension, health, life and disability insurance plans offered by employers to employees. Applying only to nongovernmental (private sector) companies, ERISA guidelines further require employers to provide workers with a “grievance and appeals” procedure through which they can receive benefits. Additionally, ERISA protects all employees from violations by plan fiduciaries. A fiduciary is a person given discretionary control over benefits and management of plans. ERISA mandates that a fiduciary works solely in the best interest of plan members.
Alternately, employers hire fiduciaries to develop employee retirement plans that do not pose financial risks to their business. If a fiduciary is responsible for retirement plans that cause large losses for employees participating in an ERISA plan, that individual could be held accountable for replacing that loss.
What is Social Security Disability Insurance (SSDI)?
If you become disabled, have paid a certain amount of Social Security taxes and have worked enough in the past to accumulate “credits”, the Social Security Administration will pay monthly benefits to you if your claim is approved. Also called “total disability”, SSDI is only awarded to claimants who are unable to do any kind of “gainful employment” for at least one year.
SSDI should not be confused with Supplemental Security Income (SSI), a federally funded disability benefit meant for people who have little income and have not worked long enough to earn sufficient credits to qualify for SSDI.
What is the Difference Between Private Disability Insurance (ERISA) and SSDI?
The main difference between ERISA disability benefits and SSDI is the fact that private disability insurance (PDI) is provided by Standard, Hartford and other large insurance companies while SSDI is provided by Social Security taxes paid for by people who earn wages.
Other differences between PDI and SSDI include:
- PDIs are contracts between insured individuals and private insurance companies designed to provide monetary coverage in case the employee becomes disabled and cannot work. The definition of whether an employee is disabled is usually defined by the insurer. SSDI benefits have nothing to do with a contract. Instead, it is wholly based on a person’s work history and amount of Social Security taxes they have paid
- In some cases, PDIs may offer more coverage than SSDI. Further, certain private insurance companies may have a less strict definition of what constitutes a disability than criteria listed in the SSA’s Blue Book of Impairments.
- Employees making ERISA claims are more likely to encounter aggressive questioning by private insurer attorneys regarding the validity of their disability. Alternately, SSDI claims are not represented by SSA attorneys. Instead, any appeal of an SSDI denial is heard by an Administrative Law Judge (ALJ) who reviews the denial process performed by SSA claims agents
What To Do If Your Private Disability Insurance Company Denies Your Claim
Generic PDI claim denials, refusal of employers to work with employees who have become disabled and lack of assistance from PDIs regarding appeals are just a few reasons why you should contact an attorney specializing in ERISA claims as soon as you experience problems with a PDI claim.
Alternately, you might want to schedule a consultation appointment with Joel Thrift Law to determine if there is also a warranted SSDI claim we can help you submit and get approved. In many cases, we find our clients do have an existing SSDI claim that is valid concurrent with their ERISA long-term disability claims. Whether you are having problems understanding an ERISA or SSDI/SSI claim, our Atlanta disability attorneys offer expertise and guidance throughout the submission and approval process.
Call Joel Thrift Law today for immediate legal help with your SSDI/SSI application.