What Are the ERISA Claims & Appeals Procedures? 

If you get health and retirement benefits through work, ERISA is supposed to protect your rights regarding these programs. If you are considering making a claim to access any of the benefits available to you–such as disability, health insurance, or life insurance–you will need to follow specific procedures. Similarly, if your claim is denied, you might consider appealing it for a chance to get the benefits you’re entitled to. In that case, you will need to know how to start the appeals process, which an attorney can help with. In the meantime, look at the basic procedures you will need to follow to get the benefits you deserve.

How Do You Make a Claim for Benefits? 

First, you should note that the ERISA claims process differs depending on the type of benefit you need. This is why getting help from a lawyer who has assisted clients through the process is important. In general, you can expect to have to fill out several forms and attach any requested documentation to them, such as medical records.

At that point, the insurance company will investigate the claim to ensure you’re, in fact, eligible for benefits, so they will look over all of the forms and supporting documents you’ve sent. You may also have to undergo a physical exam or complete other insurance requests before the company makes a decision. You will either get your claim approved or denied. If it’s the latter, you can start your appeal.

How Can You Appeal a Decision? 

It’s not unusual for claims to be rejected, so it’s a good idea to know the basics of the ERISA appeals procedure. Remember that the denial letter from the insurance company should outline the steps you can take to appeal the rejection and what deadlines you need to meet.

The letter should also state why your claim was denied and what specific information the insurance company considered before deciding on the claim. As you start the appeals process, this can steer you in the right direction. When you hire an attorney to handle the ERISA appeal, show them the denial letter at your initial appointment.

Why Should You Hire a Lawyer?

Whether making a claim or appealing a rejection, you should talk to a lawyer with experience guiding clients through ERISA claims and appeals. As you can see, the process can be complicated, especially since it varies depending on what benefits you need, so don’t try to handle it on your own.

When you hire an ERISA attorney, they will tell you which documents you need to send in to support your claim. Your attorney will also meet all deadlines and answer your legal questions, giving you peace of mind. If you’re ready to hire a lawyer, contact our Philadelphia law firm at (215) 940-8900.

Written By: Chad Boonswang
Chad G. Boonswang, Esquire is a litigation lawyer based in Philadelphia, PA. Selected as an ASLA 2014, 2015, 2016, 2017 and 2018 Top 100 Litigation Lawyer, Mr. Boonswang plays to win. As a lawyer, athlete, and scholar, he has always put in the energy, time, and commitment to be the best. After working for several prominent law firms in Philadelphia, including Montgomery McCracken Walker & Rhoads LLP, he founded his own practice in 2002.  Since then Chad has recovered tens of millions of dollars on behalf of his clients from life insurance claims and catastrophic injury cases.  Year after year, he has earned a 10.00 Superb rating on Avvo.

Life Insurance Articles About

Not Getting Paid Your Life Insurance Benefits?

Talk to a life insurance lawyer at no cost.