Although the Employee Retirement Income Security Act, better known in DC as ERISA, protects employees by providing safeguards for certain employee benefits, the statute and later additions such as COBRA and HIPAA do not cover every situation. ERISA restrictions and limitations in Washington DC often surprise people, so it is important to understand what the legislation can and cannot do.
An attorney with experience working with ERISA law can provide more information about how ERISA applies in particular situations, but here are a few of the limitations and restrictions of ERISA.
ERISA does not compel employers to provide benefits, and the laws only apply to particular types of benefits offered by employers who fit the statutory standard. While a large number of employers must comply with ERISA requirements, these requirements do not apply to group health plans offered through government agencies, religious institutions or certain plans outside the U.S.
In addition, health plans which employers have established just to comply with laws governing workers’ compensation, unemployment insurance or disability coverage are also not generally covered by ERISA.
Even if an employer is of a type required to comply with ERISA, the ERISA provisions do not necessarily apply to all benefits offered by that employer. ERISA covers medical and healthcare benefits, including prescription drug benefits, flex spending accounts, and wellness and disease management programs. ERISA also covers many short and long term disability benefits, disability income plans and life insurance plans.
Beyond healthcare, ERISA covers pension plans including defined-benefit and defined-contribution retirement funds, and other benefits such as severance plans, housing assistance plans, scholarship plans, vacation plans, and pre-paid legal service plans.
However, ERISA does not cover sick pay and short term disability plans in certain situations such as where employees make no contributions and where funding comes from general accounts rather than insurance policies or pre-funded accounts.
It can be difficult to ascertain whether a particular benefit is covered by ERISA, so where coverage is in question, it is wise to consult a knowledgeable ERISA lawyer.
Another limitation that restricts the ability to bring a lawsuit to enforce ERISA provisions concerns that amount of time that elapses between a violation and the taking of legal action. If a participant or beneficiary seeks to allege that a fiduciary has breached a duty, obligation or responsibility, they must commence an action either:
With regard to lawsuits to enforce other provisions of ERISA, the statute is silent about the statute of limitations period. However, in many cases, the courts will use the state statute of limitations for actions such as breach of contract claims.
While ERISA offers some broad protections, there are other limitations and restrictions. ERISA contains no provisions for jury trials, so those filing lawsuits generally may only have their cases heard by a judge.
In addition, ERISA requires beneficiaries to exhaust their administrative remedies before filing a lawsuit, and federal courts have jurisdiction over ERISA cases so even if a case involves alleged breaches of both state law and ERISA provisions, the case may have to be tried in federal court.
ERISA encompasses a range of statutory provisions covering a number of different types of benefits, with different means of enforcing different types of protections. So those who seek to learn more about ERISA restrictions and limitations in Washington DC should consider consulting a dedicated Washington ERISA attorney who can provide information about the latest restrictions based on case law and recent legislative amendments.
