The Employee Retirement Income Security Act, or ERISA for short, is a federal law that frames guidelines for retirement and health plans. The objective of ERISA is to protect the insurance holders from unfair claim rejections and other similar practices.

Not all ERISA claims are easy. Most claims have to go through multiple rejections. Sometimes, individuals who’ve suffered a disability or some type of work-related injury may stop fighting all together. It is at times like this, you will need the services of experienced ERISA lawyers. Their expertise, along with their knowledge of law, makes them the ideal people to rely on during this difficult time.

More on ERISA

Before exploring the steps for appealing a denial, it is important to understand what exactly an ERISA claim entails. As said before, ERISA is a federal law that sets guidelines for private-sector health and pension programs and protects employees participating in these plans.

When a worker submits a benefits claim under an ERISA-regulated plan, the employer or plan administrator must respond within 90 days. If the claim is rejected, the employee has 60 days to file an appeal. This appeal process involves submitting additional evidence and arguments to support your claim.

The Steps for Appealing a Denial

If your ERISA claim has been denied, here are the steps you should take when appealing the decision:

Step #1: Find Out Why Your Claim Was Rejected

The first step in appealing a denial is understanding the reasoning behind the decision. This can typically be found in the denial letter the employer or plan administrator sends. Common reasons for denial include missing or insufficient evidence, lack of medical necessity, and plan exclusions.

Step #2: Gather Additional Evidence

Once you have identified the reason for your claim denial, gathering any additional evidence that may support your case is important. This could include medical records, healthcare provider statements, and other relevant documents.

Step #3: Prepare Your Appeal Letter

The appeal letter is a crucial part of the process as it allows you to present your arguments and evidence in a written format. Clearly state why your claim should be approved and include relevant details or supporting evidence.

Step #4: Submit Your Appeal

It is important to submit your appeal letter within the designated time frame (usually 60 days) after preparing it. You should also follow any specific submission instructions provided by the plan administrator.

How Experienced ERISA Lawyers Can Help

Navigating the appeals process for an ERISA claim denial can be complex and overwhelming. This is where experienced ERISA lawyers come in. These legal professionals provide a wealth of information and expertise in handling ERISA claims and can provide valuable assistance throughout the appeals process.

Wrap Up!

Having an ERISA claim denied can be frustrating, but it is not the end of the road. Being aware of the procedures for appealing a rejection and having an expert ERISA attorney on your side can increase your chances of overturning the decision and getting the benefits you are entitled to.

Remember to always act promptly and provide strong evidence to support your claim. With determination and proper legal assistance, you can fight for your rights under ERISA.