Many workers in the District of Columbia have benefits plans through their employers that are covered by ERISA. When workers apply for benefits from their ERISA plans and are denied, they can appeal the denials. However, the workers must exhaust the internal appeals within the plan before they can file lawsuits.
During the internal appeals process, the plan administrator will work to build the administrative record. Workers can secure additional evidence and ask for it to be added to it. For example, a worker might complete additional medical tests and submit those to the plan. In some cases, the additional evidence that workers add to the record helps them to win their internal appeals. In others, they will exhaust their internal remedies and be left with having to file a claim in court.
When a worker files a lawsuit after exhausting the internal remedies for an ERISA benefits claim, the worker will be limited to relying only on what is contained in the administrative record from his or her initial claim and subsequent internal appeals. If the worker has not supplemented the record with additional evidence during the claims and appeals process, he or she can be assured that the plan will have added plenty of evidence to the record to support its reasons for denying the claim. This means that the lawsuit could be dismissed by the court on a motion for summary judgment by the plan administrator.
People who need to make claims for benefits from an ERISA plan might want to consult with experienced attorneys before they file them. By submitting thorough documentation to support their claims from the outset, the attorneys might help their clients to secure approvals of their initial claims. If the workers receive denials, they should pay attention to the deadline for filing an internal appeal. An attorney might evaluate what types of evidence might be needed to support their appeal.