How Do You Determine If A Claim Is Governed By ERISA?

If you have a claim for benefits under an insurance policy or an employee benefit plan that has been wrongfully denied, the denial at its core is a breach of contract – breaching the promise to pay benefits. That breach of contract claim has traditionally been governed by state law. However, in 1974 Congress passed the Employee Retirement Income Security Act known as ERISA designed to protect employees in employer-sponsored pension and welfare benefit plans.

The general rule is that if your benefits are provided through an employer-sponsored group plan then it is governed by ERISA and not state law. The exception is if it is a governmental plan or church plan. If you are employed by a governmental entity or a church you are not subject to ERISA. In that case, your local state laws would govern your claim and you would not have to comply with the ERISA regulations.

If you purchased your own disability policy, life insurance policy, or accidental death and disability policy then all claims would continue to be governed by your local state law.