What to Do When My Employer Won’t Talk to Me About My Benefits?

ERISA requires communication about employees’ benefits. Unfortunately, sometimes that doesn’t happen. Employees might go to HR with questions about what health, disability, life, or other benefits their company provides, what the insurance policies require, and what procedures exist for them to claim their benefits, only to get inaccurate information or no meaningful response at all.

Here’s where ERISA comes in. ERISA requires that basically all of the employee benefit plan documents that provide information about what benefits employees have and how to claim those benefits be disclosed to participating employees.

So if you have a company health or disability insurance plan, for example, that falls under ERISA, the company is typically required to disclose information upon your request.

The devil is in the details, though. First, the disclosure rule only applies to plans governed by ERISA. If you get benefits through a non-ERISA plan (for example, public employer benefits often aren’t governed by ERISA), then ERISA can’t help you get information. You might have protection under some other law, but not ERISA.

Second, only written requests typically get the benefit of ERISA’s rule requiring disclosure. Asking HR over the phone might get you help voluntarily, but it usually won’t trigger ERISA’s requirement to disclose information.

Third, requests must generally go to the right person to trigger ERISA’s disclosure rule. That person is usually the “plan administrator.” This person (often a corporation) is usually identified in a Summary Plan Description or similar document. Plan administrators are also required to be identified in the annual reports that ERISA plans must file with the department of labor. A request sent to someone besides the plan administrator generally doesn’t trigger any duties under ERISA.

Fourth, only requests for specific information fall under ERISA’s disclosure requirement. ERISA requires that the benefit plan disclose (basically) the documents that say what your benefits are and what you have to do to get them. So if your claim is being processed by an insurance company, the insurer’s records about your claim probably don’t have to be disclosed by the ERISA plan itself. They likely have to be disclosed to you by the insurance company under a separate part of ERISA. For instance, if your claim is denied, ERISA would often require the insurance company or other entity that made the decision to provide all the information relevant to the decision. But that request typically goes to the decision maker, which is often a separate entity from the employer.

If this all seems confusing, you’re not alone! But the good news is that, when a request falls under ERISA’s disclosure provision, the rule has teeth.

ERISA plans that fail to disclose the appropriate documents in response to a proper request can have to pay the participating employee daily monetary penalties as well as the attorneys’ fees the employee incurred in bringing suit to obtain the documents that should have been disclosed.

In short, ERISA’s disclosure rule is an example of the statute at its best and worst: it provides employees with an important right–transparency–with a real enforcement mechanism, but tacks on enough exceptions and hoops to jump through that many folks find the rule almost as frustrating as the lack of disclosure the rule is supposed to remedy.