Differences Between COBRA and ERISA Claims: How to Sort Out Where and Whom to Report

ERISA is a benefit commonly given to employees who have been with the company for decades. Often this benefit covers retirement income, such as a pension, but it also covers certain medical and health-insurance benefits. COBRA, another health-benefit program, does some similar things, but it often gets confused with ERISA when there is a question of disability and medical coverage. Here is how to sort out to whom you should report and where you should report.

COBRA Covers You When There Are Lapses of Coverage Between Jobs

Unlike ERISA, COBRA covers you under healthcare lapses when you are between jobs and plan to go back to work. Typically, you have to be between employers and choose to accept COBRA coverage and the high monthly premiums that come with it. It does not typically cover short-term or long-term disability, although it can help with some of your medical bills and medications.

ERISA Is Granted Coverage After Retirement or Disabling Accidents

ERISA, as previously mentioned, is a company-sponsored benefit given to specific employees as part of their benefit packages. In terms of medical coverage, this can provide limited healthcare when you are unable to acquire Medicare or state-funded Medicaid insurance. As for ERISA disability claims, this benefit provides some additional funds to cover the costs of medical care, medicines, and daily living expenses until it can be determined that you are either fully disabled or can return to work. You retain your ERISA benefit until retirement, but it does exist to help you in the event that you are forced to retire early because of a work-related disabling condition.

ERISA Claims Are Handled Through Your Employer 

When you have COBRA and your injuries are covered, you simply call the COBRA number on your card. ERISA claims, when you are not retiring, need to be reported to and through your human-resources manager. He or she is responsible for filing your ERISA disability claims and getting the short-term financial benefits going for you. In the event that it is determined by HR that you are ineligible or the company providing the ERISA benefits denies your claim, you may have to repay that money or appeal the claim.

In either case (returning funds previously paid to you or appealing the claim), you may need a lawyer. ERISA claims are a little bit trickier to manage than a COBRA claim because the ERISA ones are not as straightforward. While your lawyer works on your case, look into filing for social-security disability benefits, which you may qualify for if you have been out of work with a disabling condition for at least three months.