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Wade Coye's Blog
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Recent Updates:
Employee Retirement Income Security Act (ERISA)
The Employee Retirement Income Security Act (ERISA) was passed in 1974 and set standards for pension and health care plans provided by private employers. The law is designed to regulate these benefit plans by disclosing financial information to the participating employee, establishing conduct standards for those in charge, and allow the employee to appeal a decision. Three common aspects of the ERISA are outlined below and discussed in relation to workers' compensation claim.
The Coye Law Firm is skilled in workers' compensation claims as well as tax, discrimination, and insurance matters. Our experience can provide you with comprehensive legal advice and representation. The information on this page is an overview of the law, and not meant to take the place of a consultation with a workers compensation attorney because every case is different and needs special consideration.
ERISA Coverage
It is important to note that ERISA doesn't cover the following retirement plans that are:
- established by churches for employees
- established or maintained by governmental groups
- maintained outside of the United States designed to benefit "non resident aliens or unfunded excess benefit plans" (Department of Labor website)
If your employment plan can be described by one of the above scenarios or the ERISA insurance isn't properly obtained through an employer, then the claim be "preempted." This means that the claim cannot be filed in a federal court because ERISA (a federal law) was not broken. Instead, your claim, if valid, may be filed in state court. This distinction and what it means for your claim is something a workers compensation lawyer can explain.
ERISA is the law that mandates these regulatory practices, and the Employee Benefits Security Administration (EBSA) is the agency that enforces it. Their website has information for employees with questions about what benefits they are eligible to receive.
Health insurance is a benefit provided by an employer that is often the most important to an employee. Two major amendments to ERISA in terms of health care coverage are COBRA and HIPPA.
COBRA is the Consolidated Omnibus Budget Reconciliation Act and was passed in 1985. This act gives employees transitioning from one job to another or who have recently become unemployed the opportunity to extend their health care benefits from their previous job. Group rates are generally cheaper than personal plans, so this can save someone a lot of money. They may be required to pay up to 102% of their coverage under the plan, but this can still be a savings. The employee's family members may also claim the benefits of COBRA. More information, including notification and eligibility requirements, can be found at the Department of Labor's website.
The Health Insurance Portability and Accountability Act (HIPAA) allows employees to participate in group health care plans provided by employers and limits their being excluded based on preexisting conditions. It also prohibits discrimination based on the status of their health. Recent legislation made it illegal for insurance carriers to order genetic testing before covering an individual. Read more about it here.
Pension plans, outlined below, are protected much more under ERISA than health care benefits. The employer is required to notify you within 60 of reductions in benefits, but once the benefits end, you may be able continue coverage under COBRA. However, if the employer discontinues all health care plans, an employee will have to find new coverage because COBRA is not available in this case. A fact sheet on employer bankruptcy (a leading cause of benefit plans ending) is available here.
If you are injured at work and end your employment, you may still be eligible to claim the health care benefits provided by your former employer. ERISA protects individuals in a number of circumstances. If your health care coverage is being denied, it is vital to speak with a lawyer to ensure your rights.
ERISA standardized employers pension plans, but doesn't require them. If your employer has a pension system in place, then you may be entitled to receive benefits if you work there for a certain number of years. It is illegal for the employer to exclude employees from participating in a pension plan based on their age if they are above 21 years old. Your case may fall under ERISA and discrimination if this occurs.
Employers are required to:
- meet minimum funding requirements of a pension plan
- fund a plan despite the participant's age if over 21 years old
- provide notice if the plan is changing or being amended
- allow an employee to participate if they have been working for over a year
Employers may terminate a benefits plan due to lack of funds or other reasons. ERISA established the Pension Benefit Guaranty Corporation to help employees who have unexpectedly lost their benefit plans. If you have worked for an employer and earned pension benefits, you are still entitled to receive them through the PBGC. This subtitle of the law is found here if you'd like to read about the corporation's enforcement and computation procedures.
The employee's benefits may be forfeited in the case of death if there is no surviving beneficiary to claim them. Additionally, if a plan is amended to meet ERISA's funding standards after the fact and the contributions are lowered, the employee may be required to forfeit the difference.
This aspect of the law is extensive and discusses issues including the computation of period of service and tax considerations. It can be found here.
In regards to the workers' compensation law, the employee is still eligible to receive their pension plan benefits if they have met the requirements. The employee may not be able to return to work, but they are entitled under ERISA to these benefits. Retaliation is prohibited further under ERISA, stating that "it shall be unlawful for any person to discharge...a participant or beneficiary for exercising any right...of an employee plan [or] this title [ERISA]." Therefore, if an injured worker plans to collect benefits under workers' compensation, but is denied access to their pension benefits under ERISA, it is against the law.
Contact the Coye Law Firm's workers compensation attorneys to discuss the many aspects of your workers' compensation case and what employee benefits you can collect after leaving your job.
Disability
Employers may set up what is referred to as an "Employee Welfare Benefit Plan." These plans protect employees in areas of health care, such as surgeries or hospital care, but also in the event of accidents and disabilities. Again, it is important to note that employers are not required to set up these plans but, if they do, they are regulated by the EBSA.
In general, the disability protection is outlined in a health insurance plan provided by the employer. If you have experienced a disability as a result of an injury sustained at work, you may be entitled to receive benefits from two sources. The process for filing a claim under the employer's health insurance plan is outlined here.
If your injury on the job results in a disability, and the employer refuses to make reasonable accommodations should you choose to return to work, you may be the victim of discrimination. It is illegal for an employer to fire or change the terms of your employment because of your injury.
The Coye Law Firm knows that a workers' compensation claim often involves many other aspects of the law. Our attorneys investigate areas of liabilities to strengthen your case and ways that you can receive benefits under the workers' compensation laws. Contact our office today.
