The Employee Retirement Income Security Act came into law in 1974. It describes which plans qualify and lays out rules to ensure plan fiduciaries do not misuse assets.
Plans that are covered by ERISA include defined contribution plans, benefits contribution plans, profit-sharing plans, deferred compensation plans, pensions, and some non-retirement plans like disability insurance, life insurance, and health maintenance organization plans.
If you make a claim and it is denied, you have the right to appeal. If you are unsure of how to go about filing an ERISA appeal, check out the following helpful information.
Follow the Appeal Instructions You Receive When Your Claim Is Denied
When an ERISA claim is denied, the insurance company must send you a paper or electronic notice telling you the reason for the denial, the provisions of the insurance plan that the decision has been based on, and what additional information is required for the original claim to be reconsidered.
You will also receive instructions on how to submit your denied claim for an appeal review.
For non-grandfathered plans, you will need to submit an external appeal. The notice you receive about your denied claim will also tell you what steps to take to file an external appeal.
How does the appeal process work?
Your Summary Plan Description should inform you about how the appeal procedure works.
Typically, you will need to request an appeal review in writing, attach relevant documents, and submit further comments in writing.
It is a good idea to seek professional advice for writing a good letter, as a well-written and correctly structured letter can make all the difference to a successful appeal. Get started by checking out this sample letter for ERISA.
If your claim has been denied once already, it is even more important to get advice from an ERISA attorney. He or she can also help with anything else you are unsure about with the appeal procedure.
If your insurance company does not send you instructions on how to appeal, ask the insurer to send you the appeal procedure in writing. If your request for the appeal procedure is denied, contact an ERISA lawyer immediately, as the insurance company is legally required to provide you with appeal instructions.
Make Sure You Meet the Deadline
Your insurance company could set a deadline for you to appeal a denied claim.
It is vital you check whether there is a deadline in place or not. Miss the due date, and you could jeopardize your right to appeal.
So, ensure you submit in writing your request for an appeal and meet any other requirements such as providing your insurer with additional documents before the deadline.
By law, the deadline must be at least sixty days from the time you receive your claim denial. But you should not wait until those sixty days are nearly up. File your ERISA appeal as soon as possible.
The Appeal Decision
Typically, your insurance company must make an appeal decision within sixty days from the date it receives your appeal request, although the nature of the appeal request will determine exactly how long it takes to approve or deny the appeal.
In special circumstances, insurers can extend the deadline up to 120 days. If an extension is required, you will be notified in writing.
Hopefully, your appeal will be approved, but if it is denied, your next step should be contacting the or seeking the advice of an experienced ERISA attorney.