Individual policies vs. group plans

A disability policy you bought yourself, outside of work, is generally not an ERISA plan at all.

ERISA does not just exempt certain employer plans. It only applies in the first place to a plan established or maintained by an employer or a union. If you bought your long-term disability policy directly from an insurance company or an agent, on your own, and not as a benefit through your job, that policy generally never meets ERISA's threshold definition at all, separate from any of the specific statutory exemptions covered elsewhere on this site.

This distinction matters because an individual policy generally follows your state's insurance law and contract law, not the federal 180-day appeal floor, the ERISA claims-procedure regulation, or the federal exhaustion rules described throughout this site. Your appeal rights and deadlines come from your policy document and your state's insurance regulations instead.

How to tell the difference

If your disability coverage is listed among your employee benefits, was enrolled in through your employer during open enrollment, or is described in a Summary Plan Description your employer distributed, it is very likely an employer group plan. If you applied for it yourself, pay the premium directly to the insurer without payroll deduction, and it was never part of your employee benefits package, it is more likely an individual policy. When in doubt, ask the insurer directly whether the policy is issued under a group employer plan or as an individual policy.

Sources

29 U.S.C. section 1003(a). Checked 2026-09-16.

See also

This page is about whether ERISA applies to your policy at all. For what that answer actually changes about your appeal deadline, exhaustion rule, and standard of review, side by side with the group-plan process, see group plan vs. individual policy: appeal rights. If ERISA does apply and you are wondering how a Social Security Disability Insurance (SSDI) claim interacts with your LTD claim, including the offset clause many LTD plans use, see LTD vs. SSDI: the offset explained.

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