What if my claim is not governed by ERISA?

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If your disability claim is not covered by ERISA


In a Non-ERISA covered disability claim, the person who is disabled and can't work due to an illness or injury (usually called the claimant) basically has no rights. What does that mean? Well, the insurance policy specifies everything involved in the claim, all of the rules, definitions, terms - everything.


That usually means:

 You usually have 45 to 90 days to appeal​;


There are no standard review timelines;


Your appeal has no rules governing how it is reviewed -

the insurance company can pretty much do this how they want to;


If you lose your appeal, you have to file a lawsuit in state court

and can get a jury trial;


In state court, the case is analyzed under standard contract law rules, it's really a breach of contract case.  If you have a problem with getting claims paid out in a non-ERISA policy, you should contact an attorney who deals with contracts.



Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer