The Difference Between ERISA and Non-ERISA Claims, and Why It Matters for Legal Strategy

When your disability insurance claim is denied, one of the most critical questions our attorneys will ask is whether your policy is governed by the Employee Retirement Income Security Act of 1974 (ERISA). That single distinction determines not only how your claim must be handled but also what rights and remedies you have under federal and state law.

At Disability Insurance Law Group, our attorneys assist clients nationwide in navigating both ERISA and non-ERISA disability claims. Understanding the difference between these two systems can help you make informed decisions about your case and improve your chances of success.

What Is an ERISA Claim?

An ERISA claim typically involves a disability insurance policy provided through an employer. Most group disability plans are subject to ERISA, a federal law that sets strict rules for how claims must be filed, reviewed, and appealed.

ERISA was designed to protect employees by requiring employers and insurance companies to manage benefit plans in a responsible manner. However, over time, insurers have used the law’s technical requirements to their advantage. ERISA imposes significant procedural burdens on policyholders, limiting their ability to present new evidence or seek jury trials.

Because ERISA claims are federal matters, they are typically decided by a judge rather than a jury. Once the administrative appeal process ends, your right to add new information or testimony is severely restricted. That means every piece of medical evidence, every doctor’s statement, and every legal argument must be submitted before the final appeal deadline.

What Is a Non-ERISA Claim?

A non-ERISA claim involves a private disability insurance policy purchased directly from an insurer, rather than through an employer. These policies are governed by state law, not federal law, which offers broader legal protections for policyholders.

Non-ERISA claimants can often sue insurers for bad faith, which means the company acted unreasonably in delaying or denying benefits. State courts also allow jury trials, where a group of citizens, not a single judge, evaluates the evidence. In some cases, policyholders may even recover punitive damages or compensation for emotional distress caused by the insurer’s actions.

This flexibility makes non-ERISA claims far more favorable for individuals seeking fair treatment from their insurance providers. However, they still require careful preparation, detailed documentation, and skilled legal representation to succeed.

How ERISA and Non-ERISA Claims Differ Procedurally

While both types of claims deal with disability benefits, their procedures differ in several key ways:

Due to these differences, the legal strategy for an ERISA claim should focus on building a comprehensive and persuasive administrative record before litigation commences. For non-ERISA claims, our attorneys’ focus often shifts toward investigating insurer misconduct and preparing for trial.

Why the Difference Matters for Legal Strategy

Failing to recognize the distinction between ERISA and non-ERISA claims can have devastating consequences. For ERISA cases, missing an appeal deadline or leaving out key evidence can permanently prevent you from recovering benefits. For non-ERISA cases, not preserving communication records or documenting the insurer’s misconduct can weaken a potential bad-faith claim.

At Disability Insurance Law Group, our lawyers handle claims under both ERISA and state law. We prepare each case strategically from the beginning, ensuring that your claim is positioned adequately, whether it remains in administrative review or proceeds to litigation.

How Our Attorneys Protect Your Rights

Our legal team has decades of experience in managing disability insurance claims for clients across the nation. We understand how insurance companies interpret policy language, how they justify denials, and what evidence courts consider persuasive. Whether ERISA governs your case or not, we know how to protect your rights and pursue the outcome you deserve.

We guide clients through every step, including:

• Reviewing policies to determine ERISA applicability.
• Gathering complete medical and vocational documentation.
• Preparing detailed appeal submissions for ERISA-governed claims.
• Filing lawsuits and pursuing additional damages in non-ERISA cases.
• Negotiating fair settlements and restoring denied benefits.

Take Control of Your Disability Claim

If you have a disability insurance claim or a recent denial, it is vital to understand whether ERISA applies to your policy before taking any action. The attorneys at Disability Insurance Law Group can analyze your policy, explain your legal options, and create a strategy tailored to your unique situation.

Call 954-989-9000 today or contact us online to schedule a free and confidential consultation. We will help you protect your rights, pursue your benefits, and hold your insurance company accountable, wherever you live in the United States.