08222017Headline:

Northern Virginia, Virginia

HomeVirginiaNorthern Virginia

Email Ben Glass
Ben Glass
Ben Glass
Attorney • (703) 584-7277

American Dental Hygienist Disability Policy Not Covered by ERISA

Comments Off

When a dental hygienist sued because her disability insurance claim was denied, the insurance company contended that her claim, bought through the American Dental Hygienist Association, was covered by the federal law of ERISA.

Why?

Because ERISA gives the insurance company a HUGE advantage–(1) it’s decision given deference; (2) no jury trial; (3) no real trial at all; (4) no “real damages” except forcing the insurance company to do what it was supposed to do in the first place.

Thankfully, the court ruled otherwise.

The court ruled that the policy could not meet the definition of an employee benefit plan because the ADHA was not an employee organization.

The court focused on the following criteria:

ADHA does not require employment to be member; it does not deal with specificity towards any principal employer or group of employers, and its lobbying efforts, as articulated by Hartford, are industry-wide, not specific to employee issues.” The court further expressed concern that “[a] favorable ruling to Hartford on this issue would so greatly expand the scope of ERISA coverage as to make every member of the California State Bar, which also provides links to disability insurance, covered by ERISA as an employee organization. This type of coverage is outside the plain meaning of the scope of ERISA.