If you have a disability insurance plan through your church or a religiously affiliated organization, you may be wondering if it’s covered by the Employee Retirement Income Security Act (ERISA). Understanding whether ERISA applies to your plan is important because it can affect how claims are handled, your rights under the plan, and your legal options if your claim is denied. Let’s break down how church plans are treated under ERISA and what that means for you.
What Is ERISA?
ERISA is a federal law that governs most employer-sponsored disability insurance plans. It establishes rules for how these plans are administered, sets standards for protecting plan participants, and provides a legal framework for resolving disputes when claims are denied.
If your disability insurance plan is covered by ERISA, you have certain protections, including:
- The right to a full and fair review of a denied claim.
- Access to the plan documents and information about how decisions are made.
- The ability to file a lawsuit in federal court if your claim is wrongly denied.
However, ERISA doesn’t cover all disability insurance plans.
ERISA and Church Plans
Under ERISA, “church plans” are generally exempt. This exemption applies to plans established or maintained by churches or organizations closely associated with religious institutions. This means that if your disability insurance plan is tied to a church or religious organization, it’s possible that ERISA doesn’t apply.
How Does This Affect You?
If your plan is exempt from ERISA, you won’t have the same federal protections that ERISA provides. Instead, your plan may be governed by state law, which can vary widely depending on where you live. In addition, church plans often have their own internal appeals processes, which may not provide the same level of transparency or recourse as an ERISA-governed plan.
Is Your Plan Really Exempt?
Just because a plan is church-affiliated doesn’t automatically mean it qualifies for an ERISA exemption. Some religiously affiliated organizations, especially larger institutions or hospitals with religious ties, may choose to opt into ERISA coverage. Determining whether your plan is truly exempt can be complicated because it depends on the structure of the organization and how the plan is administered.
To find out if your plan is covered by ERISA, you can:
- Review Your Plan Documents: The summary plan description (SPD) should indicate whether your plan is covered by ERISA or whether it’s exempt as a church plan.
- Ask Your Plan Administrator: They should be able to tell you if your plan is subject to ERISA or if it’s exempt.
- Consult with an Attorney: If it’s unclear whether your plan is ERISA-exempt or not, speaking with an experienced disability attorney can help you get answers.
What If Your Claim Is Denied?
If your disability claim is denied, the steps you need to take will depend on whether your plan is covered by ERISA.
- If Your Plan Is Covered by ERISA: You have the right to appeal the denial through an administrative process. You must exhaust all internal plan appeals before taking your case to court.
- If Your Plan Is Not Covered by ERISA: Your recourse will depend on the terms of the plan and applicable state laws. Some states have more favorable laws for claimants, while others may offer less protection.
In either case, it’s important to act quickly because there are strict time limits for appealing a denied claim.
Get Help with Your Disability Claim
Navigating a disability insurance claim can be challenging, especially when dealing with a church-affiliated plan that may not be governed by ERISA. If you’ve had a claim denied, consulting with an experienced disability attorney can make all the difference. At the Ortiz Law Firm, we help claimants understand their rights under their disability insurance plans and fight for the benefits they deserve. Call (888) 321-8131 to discuss your case and get the guidance you need to move forward.