Many people, including a number of attorneys, think ERISA and Social Security disability claims are joined at the hip. They definitely are not.
The only similarity between them is they were both created by Federal statute. In ERISA a private insurance company is usually added to the mix and that adds tons of problems.
A Social Security claim requires a disabled employee to persuade an administrative law judge, an employee of the Federal government with no financial interest in the outcome, that the claimant is unable to work in any occupation for which claimant is reasonably suited by education, training or experience. Such a person is entitled to benefits under Social Security law. Social Security rules and regulations are followed and the imagination is given very little leeway to interpret.
In ERISA the disability claimant not only has to deal with the requirements of the ERISA statutes and Department of Labor regulations, but also with a for-profit insurance company which runs the show. The insurance company has the right to deny benefits which, if granted, it would have to pay. Talk about a financial conflict of interes and an incentive to deny, deny, deny!
Having pursued disability income claims for more than 30 years, we are constantly amazed to find that many people, including attorneys, think ERISA and Social Security law are more or less the same
Our practice is in ERISA and private disability income claims. ERISA disability income benefits derive from both the ERISA statutes and regulations and from insurance policies which employers purchase for their employees as part of their employment benefits package.
Social Security disability income benefits derive from Social Security taxes paid by the employer and the employee and has its own statutory requirements.
Add to the difference, the requirement in ERISA law that the plan administrator’s (most often an insurance company which would have to pay the benefit if the claim is approved) decision to deny benefits must be deferred to by the courts in adjudicating disputes.
In Social Security, a disinterested administrative law judge decides the matter. In ERISA, a very interested insurance company first decides a claim. Guess which way the decision tends to go.
This is only one difference between the two statutes, but it is obviously a major difference.
Confusing Social Security apples and ERISA oranges in the law doesn’t do much for desperate people who need benefits.