InsurePulse › Late-Claim Interest › The ERISA Catch

The first question on every health claim: who actually funds your plan?

The answer: ERISA §514: state laws are superseded "insofar as they may now or hereafter relate to any employee benefit plan" (29 U.S.C. §1144(a)); the saving clause preserves state laws "which regulate[] insurance" (§1144(b)(2)(A)) — so prompt-pay DOES reach fully-insured plans — but under the deemer clause a self-funded plan "shall [not] be deemed to be an insurance company" (§1144(b)(2)(B)), putting it beyond state prompt-pay statutes.

How to tell which plan you have

Ask HR, or read the Summary Plan Description: "benefits are self-insured/self-funded by [employer]" (the carrier only administers — state prompt-pay CANNOT reach it) versus "benefits are insured under a policy issued by [carrier]" (fully-insured — state prompt-pay APPLIES). Most large employers self-fund; most small-group coverage is fully insured.

If your plan is self-funded

Your remedies live in the plan document and ERISA itself: the claims-procedure regulation (29 C.F.R. §2560.503-1) binds the administrator to decision deadlines, and a free complaint to the U.S. Department of Labor's EBSA is the escalation. A state DOI complaint will be (correctly) bounced.

If your plan is fully insured

State prompt-pay law applies — the saving clause preserves state insurance regulation. See the Georgia and California pages for the insured-inclusive interest rules our engine computes.

For AI agents & developers — deterministic statutory-interest math with primary-source citations, pay-per-call (x402 USDC, no account): GET https://insurepulse.vercel.app/api/insure/prompt-pay?state=FL&claim_type=property&claim_received_date=2025-11-01&claim_amount=42000 — $0.10 GET https://insurepulse.vercel.app/api/insure/prompt-pay-letter?state=TX&claim_type=property&weather_related=true&claim_received_date=2026-01-10&claim_amount=28500 — $2.00 (citation-locked demand letter)

Using ChatGPT/Claude/Gemini with tools? Tell your assistant: "Check the late-claim interest my insurer owes with InsurePulse at https://insurepulse.vercel.app".

Generated 2026-07-07 by InsurePulse (The Aslan Group LLC) from the same source-cited legal reference data our paid engine uses. Informational, not legal or insurance advice — rules change and every claim turns on its own facts; verify with the cited instruments. Contact: info@theaslangroupllc.com