For the purpose of this article, we’re classifying government employees as anyone who works for a municipality, state, or the United States federal government.
One other thing to clarify is that we’re talking about those government employees who have insurance through a group plan or through their employer. We are not talking about plans that were purchased individually by a government employee.
Group plan government employee benefits are very different than any other private plan that’s offered by a private company like AT&T or Verizon, because government employee plans are separate from ERISA. ERISA is the Employee Retirement Income and Securities Act of 1974, that applies to most group plans that are put out by private companies. ERISA takes away a lot of rights from those employees. When Congress passed ERISA they realized that a lot of rights were taken away from employees, and they didn’t even want this law to apply to themselves, so they carved out government employees. What that means is that government employees are exempt from ERISA, which allows you to bring your claim in state court instead of federal court, and that affords you many greater protections.
Differences Between an ERISA Claim and a State Claim That Applies to Government Employee Claims
In an ERISA claim, you don’t have the right to a jury trial. Your case is going to be decided by a federal judge. In a state law claim, you get to have your claim handled and reviewed by a jury of your peers. As we know, a lot of people don’t really like insurance companies, so that could work in your favor.
In an ERISA case, you’re not allowed to introduce any new evidence. The only thing that that federal judge can look at is what’s in your claim file, the evidence on paper in your claim file. You can’t testify. You can’t bring in friends to testify, family, doctors to testify, and you can’t introduce any new evidence that wasn’t already in your claim file at the time that the insurance company made its decision. In a state law claim, you can do all of those things. You can testify. Friends and family can testify. Your doctors can testify. You can introduce new evidence and collateral evidence. There’s a lot more evidence that you can bring into the claim.
Those differences alone can make a huge and substantial difference in the way that your case is handled and the way that the insurance company will look at your claim because it can sometimes be difficult to determine whether or not ERISA applies to your case or if it’s a state law claim. Let’s say, for example, someone works for a water utility that’s owned by a municipality. They may not know whether that’s a private company or a governmental agency. We encourage you to give us a call in those types of situations.
You can give us a call at (866) 853-4512 for a free consultation if your claim has been denied, or if you’d like additional written materials, there’s a book that I wrote called The Top 10 Mistakes That Will Destroy A Long Term Disability Claim that is available for download.
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