If I Convert my Former Employee Disability Policy to a Private Policy Does ERISA Govern?

Many employer welfare benefit plans offer employees who quit their employment the option of converting their disability insurance plan to a private plan. When a claim for disability benefits is filed, there may be a dispute over whether the conversion plan is governed by ERISA. If so, then ERISA preempts any state law claims a plaintiff may have. If not, the conversion policy is a private policy not subject to ERISA preemption.

The case of Paula Bates v. Hartford Life & Accident Ins. Co. (Hartford), provides guidance in how this issue has been resolved by courts. In that case, Plaintiff worked for about three years as an independent insurance agent for American Family Insurance (American). While working, she was covered by American Family’s long-term disability plan. When she quit her job, she exercised her option to convert the American Plan to a policy through the Group Long Term Disability Plan of Insurance (Group). The policy holder of the Group Plan was the Northern Trust Company (Northern). Hartford was the administrator for both the American Plan and the Northern Plan.

Hartford denied Plaintiff’s claim for disability. It also denied her claim again on appeal. When Plaintiff had exhausted her administrative remedies, she filed a lawsuit alleging, among other things, multiple state law claims, including breach of contract and bad faith. She alleged in her complaint that her Northern conversion plan was a private plan, not an employee benefit plan, and therefore not governed by ERISA. Hartford disagreed and asked the Court to dismiss her state claims as preempted by ERISA.

The U.S. District Court for the District of Idaho analyzed relevant clauses in the policies, ERISA law, and Ninth Circuit precedent and determined that the conversion plan did not meet the elements of an ERISA plan. Accordingly, the Plaintiff could pursue her state law claims since they were not preempted by ERISA.

Elements of an ERISA Disability Policy

The Court noted that “Whether an ERISA plan exists is a question of fact, requiring consideration of all the surrounding circumstances from the point of view of a reasonable person. The burden to establish the existence of an ERISA plan is on the party advocating its existence.”[citations omitted.]

An employee benefit plan is defined as “an employee welfare benefit plan” which has the following elements:

It is a plan, fund or program;

·        Established or maintained;

·        By an employer or by an employee organization, or by both;

·        Its purpose is to provide, among other things, disability benefits;

·        To the participants or their beneficiaries;

Further, an employee benefit plan must “cover at least one employee to constitute an ERISA benefit plan.”

When an Employee Benefit Disability Plan is Converted to a Private Policy and the Elements of An ERISA Plan are Not Met, ERISA no Longer Governs

In one court case, the “conversion” of an employee benefit plan occurred when an employee left his employment but remained insured under his employer’s plan. There was no conversion since the only thing that changed was the former employee now paid his own premiums instead of the premium’s being paid by his employer. In that case ERISA governed since nothing about the policy had changed, only who paid the premium. .

In the instructive case of Bates, the Ninth Court distinguished the situation where a former employee converts the policy to a brand-new policy when the employee no longer qualifies for coverage under the employee benefit plan. Plaintiff could not have continued coverage under the American Plan because she no longer qualified. She went through the conversion process, so she was covered under the Northern Plan. The Court found the Northern Plan was not a continuation of the American Plan, and the Northern Plan was a conversion plan.

The Court stated that, “What matters is not whether a plan is a group or individual plan, but whether it meets the elements of an ERISA plan.”

The Northern Plan Did not Meet the Elements of an ERISA Plan

Again, the Bates case provides guidance to courts when considering if a conversion plan is an ERISA plan. The Idaho Court considered the following elements:

The Plan was organized for the purpose of providing disability benefits. The parties agreed the Northern Plan was a “‘plan, fund, or program’ organized for the purpose of providing disability benefits.” This is likely to be true whenever a plan is at issue.

Northern Trust is not an employer for purposes of ERISA. The Court noted that the plan was between “the insurer and the insured and that the former employer had no administrative responsibilities.” The Northern Plan was established by the Northern Trust and Hartford decades ago of the purpose of providing conversion policies to those who qualified under their employer sponsored policies.

There was nothing in the record to indicate that Northern was acting for the benefit of anyone but itself and Hartford by establishing the Northern Plan. The Court concluded, “Considering all the circumstances surrounding the Northern Plan’s formation, administration, and the absence of meaningful involvement by American Family or any other employer, this Court finds that Northern Trust is not an ’employer’ for purposes of ERISA.”

Plaintiff is not a participant and the Northern Plan does not cover any employee

Hartford argued that the Northern Plan is governed by ERISA because it provides benefits to “participants or their beneficiaries.” A participant is defined as an employee or former employee who may become eligible to receive a benefit from an employee benefit plan which covers that employee.

The Court pointed out that only former employees are “participants” in the Northern Plan “because ‘current employees’ are beneficiaries of their current employers’ group benefits plan.” The Court said the answer is “straightforward. An employee benefit plan must cover at least one employee to constitute an ERISA benefit plan.” An employee is defined as “any individual employed by an employer.” The Court concluded that “the Northern Plan does not cover a single ’employee’ and thus cannot provide coverage to ‘participants’ for purposes of ERISA.”

The Court ultimately held “That Hartford has not met its burden to establish that the Northern Plan is governed by ERISA. The Northern Plan is a conversion plan. The Northern Trust is not an employer as defined by the statute. And, finally, the Northern Plan does not cover any employees as required by ERISA. Accordingly, the Court finds that the above captioned action is not governed by ERISA.”

This case was not handled by our office, but we believe it can be instructive to those who have converted their employer benefit plan for long term disability benefits (LTD) to an individual plan. If you have any questions about this case, or any other question about your own disability claim, contact one of our attorneys at Dell & Schaefer for a free consultation.


Did you find this helpful?
Unhelpful (0)

Resources to Help You Win Disability Benefits

Disability Benefit Denial Options
Submit a Strong Appeal Package

We work with you, your doctors, and other experts to submit a very strong appeal.

Learn more

Sue Your Disability Insurance Company

We have filed thousands of disability denial lawsuits in federal Courts nationwide.

Learn more

Protect Your Benefits
Get Your Disability Application Approved
We help claimants throughout the entire application process.

Learn more

Prevent a Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.

Learn more

Negotiate a Lump-Sum Settlement

Our goal is to negotiate the highest possible buyout of your long-term disability policy.

Learn more

Hartford Reviews
(642)

Policy Holder Rating

1.5 out of 5
Read 71 reviews
0%would recommend
5
0%
4
0%
3
1%
2
52%
1
46%
Timely Payments
1.9out of 5
Handling Claim
1.9out of 5
Customer Service
1.8out of 5
Dependable
1.8out of 5
Value
1.9out of 5
Showing 8 of 642 Reviews
Hartford

Former Hartford employee has had life insurance and accidental death policy's revoked for one late premium payment

Reviewed by Becky H. THOMAS on February 12th 2024   Verified Policyholder | February 2024 date of disability
Dislike how they are constantly interrupting the lives of their disabled EE's whom are entitled to benefit which they paid into out of there pay check every pay period onl... read more >
Reply
Sent on February 12th 2024 by Attorney Gregory Dell

Thank you for your review of Hartford and we appreciate you sharing.  It’s sad they don’t take care of their own employees.

Hartford

Bad Faith

Reviewed by Dustin G on October 12th 2023   Verified Policyholder | November 2020 date of disability
They kept asking my doctor for the same information that they did not need to process my claim. He kept sending in the same information, and they kept asking for it. My do... read more >
Hartford

Denied by Hartford after 20 years of Payments

Reviewed by Mary on October 11th 2023   Verified Policyholder
Hello,I am a Multiple Sclerosis patient. I also have Lymph-edema, Asthma, Blood-clot problems, Bi-Polar 1 Depression, and Head & Neck Injuries. And now, due to MS, Spast... read more >
Hartford

This company is a scam!

Reviewed by Hana K. on July 13th 2023   Verified Policyholder | December 2022 date of disability
The Hartford does not pay claims. The Hartford only collects premiums. The Hartford doesn’t care if you are terminally ill. I’ve been employed at my employer since 201... read more >
Hartford

Hartford Stopped Payments

Reviewed by Fed up in PA on April 13th 2023   Verified Policyholder | January 2023 date of disability
Worst company ever. Their analysts will go against your treating provider every single time. Horrible experience, just horrible.
Hartford

Hartford never paid me

Reviewed by Nanette M. on April 26th 2020   Verified Policyholder
I went on disability March 25, 2019 until Dec. 23, 2019 from my job FedEx. The Hartford insurance company didn’t pay me my disability check after the end of July. I appe... read more >
Reply
Sent on April 26th 2020 by Attorney Gregory Dell

Nanette, we are sorry to hear that your claim for benefits for the period of July through December was denied. Please feel free to contact us for a free consultation.read more >

Hartford

Hartford rep felt so guilty over how the company treated me that she quit

Reviewed by Delton on April 8th 2020   Verified Policyholder
It’s been since 1998 but they really screwed me over big time and caused my family and I much distress ~ first they required me to go to a psychiatric doctor before they... read more >
Reply
Sent on April 8th 2020 by Attorney Rachel Alters

Delton, I’m sorry to hear about the experience you had with Hartford. Unfortunately since your claim dates back to 1998 it would be too late to file suit as the statu... read more >

Hartford

Hartford ajuster won't return my calls. I might have to move back to California

Reviewed by Jesse on March 17th 2020   Verified Policyholder
I was awarded medical for life, for my back injuries at work by the court of Los Angeles in California years ago. I moved to Colorado two years ago and for the past few mo... read more >
Answered Questions by Our Lawyers
(66)
Showing 8 of 66 Answered Questions

Q: Disability company dropped my monthly benefits

Answered on February 28th 2024 by Attorney Rachel Alters
A: Since you went back to work full time you would not qualify for further benefits. You could file a new claim i... Read More >

Q: The Hartford stopped monthly benefits for repayment due to an overpayment. Once monthly benefits end do I still have to repay remaining overpayment balance?

Answered on February 28th 2024 by Attorney Rachel Alters
A: Yes, you will still be responsible for the overpayment even if your Hartford benefits end. Read More >

Q: Short term vs long term

Answered on February 14th 2024 by Attorney Jay Symonds
A: Nightwatcher, you and your treatment providers will be required to submit additional records and information a... Read More >

Q: Can I do anything to get my LTD ?

Answered on February 3rd 2024 by Attorney Gregory Dell
A: Jacqueline:You should call us to discuss your Hartford disability claim. It usually takes 60-90 days for Har... Read More >

Q: Lifetime disability policy with Hartford

Answered on January 29th 2024 by Attorney Gregory Dell
A: Deb,Thank you for your question about a Hartford lifetime disability policy. In order to support your pos... Read More >

Q: Can the Hartford reduce my long term disability payment due to a rental income?

Answered on January 25th 2024 by Attorney Cesar Gavidia
A: Usually non-work that is not described a deductible source of income the disability policy would not reduce th... Read More >

Q: Is there a specific video to help me prepare for a Hartford doctor appointment (IME)?

Answered on January 3rd 2024 by Attorney Gregory Dell
A: We have prepared a few videos on independent medical exams requested by disability insurance companies. Whethe... Read More >
Helpful Videos
(875)
Showing 12 of 875 Videos
Disability Benefit Tips
(330)
Showing 8 of 330 Benefit Tips

Does Hartford Pay Disability Insurance Claims?

At Dell & Schaefer, we get questions about Hartford long term disability policies on ne... Read More >

How Does Hartford Long Term Disability Work?

The most common questions for a disability attorney involve understanding how disability cove... Read More >

What Happens If My Hartford Short Term Disability Claim is Denied?

Understand your rights once your Hartford short term disability income claim has been denied.... Read More >

How Long Does a Hartford Short Term or Long Term Disability Claim Last?

Hartford disability income policy holders expect Hartford to pay their Short Term & Long-... Read More >

If I Convert my Former Employee Disability Policy to a Private Policy Does ERISA Govern?

Many employer welfare benefit plans offer employees who quit their employment the option of converting their disability insurance pl... Read More >

Is the Hartford Disability Purchase of Aetna Bad for Aetna LTD Policy Holders?

In October 2017 Hartford Insurance company agreed to purchase the disability and life insuran... Read More >

Hartford Disability Claim Problems

Hartford is requesting long term disability claimants to provide additional documentation fro... Read More >

How Can I Protect Myself At A Hartford IME Exam?

In this video, disability insurance attorneys Rachel Alters and Cesar Gavidia discuss what yo... Read More >
Dell Disability Cases
(373)
Showing 8 of 373 Dell Disability Cases

Nurse With Knee and Back Disorder Wins Hartford Disability Appeal

We represent a General Duty Nurse who was denied long term disability benefits as Hartford im... Read More >

Executive Director with Meniere's Denied Long Term Disability Insurance Benefits By Hartford

Our client, came to us when he was unjustly denied his claim for LTD benefits by Aetna, now Hartford, assert... Read More >

A Hartford Disability Benefit Lawsuit Victory for Truist Banker with Lupus

Our client found us after she was denied continued disability insurance benefits by the Hartf... Read More >

Hartford Denies Disability Benefits To Home Depot Employee 3 Weeks Before Change of Disability Definition

Our client was a former in-store merchandising associate responsible for the movement of merc... Read More >

Hartford Denies Long Term Disability Benefits After Paying for 22 Years

It is crazy that Hartford denied long term disability benefits to our client after paying for... Read More >

Hartford Overturns Denial of Disability Benefits on Appeal

Our client, a former clerk at a coal mine with severe lumbar back problems first, contacted our office and spoke with Attorney Stephen Jessup ... Read More >

Hartford Approves Disability Claim After Appeal Deadline

Prior to filing for disability our client worked as a registered nurse in a hospital setting, suffering from multiple chronic medical conditio... Read More >

Hartford overturned its previous denial of LTD benefits for Illinois Account Representative

Our client, Mr. K, formerly worked as an Account Representative for an international brokerage firm. In May 2017 a number of medical issues, i... Read More >
Disability Lawsuit Stories
(765)
Showing 8 of 765 Lawsuit Stories

Federal Court Overturns Aetna Denial Of Disability Benefits

In the recent case of Ferrin v. Aetna Life Ins. Co. a federal judge from the Northern District of Illinois determined that Aetna improperly te... Read More >

Hartford Admits to Improper Offset, Agrees to Reimburse 10 Years of Wrongfully Withheld Money

In August of 2019, the next of kin for a man currently incarcerated in Florida State Prison reached out to our firm as his relative had been d... Read More >

Court Finds Video Surveillance Renders Claimant’s Self-Reporting Unreliable and Upholds Hartford’s Termination of LTD Benefits

In Cummings v. Hartford Life & Accident Ins. Co. (Hartford), Plaintiff was employed by the Free-Port McMoran ... Read More >

Can Medical Records Created After the Eligibility Period Support a Claim for Disability Benefits?

In James s. Louis v. The Hartford Life and Accident Insurance Company (Hartford), Plaintiff was a Senior Principal Product... Read More >

Appeals Court Upholds Hartford's Termination of Disability Benefits

In Scott Griffin v. Hartford Life & Accident Insurance Company, Plaintiff was a medical transcriptionist who was initially awarded long te... Read More >

Hartford Disability Company Field Interview Request and Video Surveillance

Hartford Disability Company, and other disability insurers, use video surveillance and field interviews as a technique to deny claims. A recen... Read More >

Hartford Long Term Disability Benefit Denial Reversed by Minnesota Federal Judge

A long term disability insurance claimant had his benefits denied when a doctor made a mistak... Read More >

Federal District Court Overturns Hartford's Denial of Long Term Disability Benefits

In the recent decision of Tobin v Hartford Life & Acc. Ins. Co. a Michigan Federal District Court overturned Hartford’s denial of long t... Read More >

Reviews from Our Clients

Request a Free Consultation

Our Lawyers Respond Same Day

5 Ways We Help Get Your Benefits Paid

Get Your Disability Application Approved

Our goal is to get your application for disability income benefits approved. Applying for disability benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their "hired gun" doctor.

Through our experience of having helped thousands of disability insurance claimants, our lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

Submit A Strong Appeal Package

If your disability insurance benefits have been wrongfully denied, then our lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of "disability". We encourage you to contact any of our lawyers for a free immediate review of your disability denial.

Sue Your Disability Company

98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability lawyers have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the "little guy" against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

Prevent A Disability Benefit Denial

Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

Negotiate a Lump-Sum Settlement

Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

Questions About Hiring Us

Who are Dell Disability Lawyers?

We are disability insurance lawyers that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.

In more than 98% of our cases, our lawyers have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.

We welcome you to contact any of our attorneys for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 700 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our lawyers help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.

Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.

A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, GoToMeeting sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.