How to Appeal an Erisa Benefit Claim Decision

To protect the pensions of employees in Washington D.C. and all across the United States, The Employee Retirement Income Security Act (ERISA) was signed into law in 1974. Over the years, ERISA has been modified to cover many other types of workplace benefits, including medical insurance, dental insurance, vision plans, disability insurance, and severance agreements. These protections also apply to employees at non-profit organizations and small businesses. Unfortunately, it can be complicated for employees to exercise their rights under ERISA.

When a benefit claim is denied under ERISA regulation, a complex process where the insurance company has a lot of power takes place. This involves an administrative appeal where the insurance company decides whether or not its own decision was correct. This may seem unfair, but there are ways an employee can improve their chances of success. In addition, if an appeal is not filed in time the employee can permanently lose their ability to get the compensation they deserve.

The time it takes an insurance company to make a decision about an administrative appeal depends on the type of original claim type. In general, it shouldn’t take longer than 60 days, but the insurance company may try to file an extension in certain cases. Employees have the right to request the company’s decision in writing.

For employees who have had an ERISA claim denied, getting representation from an attorney may be the best option for appeals. An attorney might provide an initial consultation where they will evaluate the client’s benefits plan and discuss a strategy for reversing the denial. In the ERISA benefits claims appeals process, the administrative appeal is very important, and it’s the responsibility of a lawyer to help make a convincing case that may actually cause the insurance company to reverse their decision.