Employee Benefits, ERISA and FMLA

There are two laws pertaining to employee benefits that we often deal with – ERISA (“Employee Retirement Income Security Act”) and FMLA (“Family and Medical Leave Act”).  

ERISA is a complex statutory scheme that governs employee benefits plans, including your medical, disability and life insurance, your pension or retirement plans through your employer and similar benefits.  The types of cases Carothers & Mitchell can help you with include times when you do not receive the medical benefits to which you believe you are entitled or when short term or long term disability benefits have been denied. 

It is difficult to summarize the various factors surrounding how these situations are analyzed.  It very much depends upon the terms of your employee benefit plan, how the plan is funded and who governs the plan, i.e. who makes the decisions.  Is the plan self-funded (employer paid) or insured?  Does the employer, an insurance company, or a third party administrator make the decisions?  What are the terms of the plan documents?   When you call us with questions about health benefits or disability plans, we will need this information.

FMLA requires certain employers to allow certain employees up to 12 weeks unpaid leave for the birth, adoption or foster placement in order to care for a new child, to care for a child, spouse or parent with a serious health condition, or because a serious health condition incapacitates the employee.  A serious health condition is one that puts the person in the hospital or requires continuous attention from a health car provider. 

FMLA applies to employers with 50 or more employees, as well as state and local governments. The regulations allow these employers to impose notice requirements before the employee qualifies for FMLA leave.  Therefore, be sure you become aware of your employer's requirements and follow them, or you may be ineligible for the protections of FMLA.