Health Insurance Claim Articles
 
What Law Governs? ERISA Or Not?

By Jeffrey L. Greyber, Esq.

Generally, if you are part of a group health insurance plan, disability insurance plan, or life insurance plan, your claim (and related litigation) will be governed by the federal body of law called ERISA (Employee Retirement Income Security Act).  In my opinion, ERISA is pro-carrier in most jurisdictions.  So, in my opinion, you should try to avoid ERISA like the plague.  Here are some instances in which a group insurance plan is likely exempt from ERISA:

  • Insurance policies issued by government employers or entities.  If you work for the government in any capacity (e.g., teachers or employees of state colleges, state park employees, police officers, firemen), ERISA is unlikely to be the body of law that governs your claim.

  • Insurance policies issued by churches or religious organizations.  If you work for a church (or for a nonprofit organization that is run by a church), ERISA is unlikely to be the body of law that governs your claim. 

  • Insurance policies obtained by and amongst co-workers.  If you and your co-workers purchase an insurance policy using funds deducted from your checks or pooled funds with no employer contribution, ERISA is unlikely to be the body of law that governs your claim. 

It would behoove you to consult with an attorney regarding whether your claim is subject to ERISA or not, as the answer to that threshold question will significantly influence how you approach the claim process and / or litigation.  The Merlin Law Group handles ERISA and non-ERISA claims.





 
Health Insurance Claim Articles
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