Understanding ERISA Appeals & the ERISA Appeals Process

Aug.23.2021
ERISA Claims

If you’ve ever filed an ERISA claim, you know that the wait to hear whether your claim has been approved or denied can be challenging. Will they approve your claim for benefits? Will you need to provide more information? You may wait months to hear about the status of your claim, only to have it rejected. What happens now?

The most important way to assert your rights and collect the benefits you deserve is to file an ERISA appeal. And the best way to file an ERISA appeal is to have an experienced lawyer guide you through the process.

What Is an ERISA Appeal?

An ERISA appeal serves two primary purposes. It is your way to provide facts and evidence to try to overturn a denial of your claim. When you file a claim, you provide the basic information about the claim itself. It is therefore important during the appeals process to provide more detailed and complete information to support it.

Establishing a Factual Record

First, the ERISA appeals process is a way to establish a factual record about your claim. After your claim has been denied and you choose to appeal, you will need to supplement your claim information. You will need to do this even if you supplemented the information during the claim decision process.

Discovering Important Information

Second, you can use an appeal to discover important information in the unfortunate event that you must proceed to filing an ERISA complaint lawsuit. If you think that you may need to challenge the denial of a claim through an ERISA appeal, it is important to speak to an experienced ERISA attorney. The ERISA appeal process can be complex, and Peace Law Firm can help you navigate it.

Why Should Some Consider an ERISA Appeal?

If your valid and supported claim is denied, you should consider filing an ERISA appeal. Typically, ERISA claims cover a wide variety of benefits and benefit denials under an ERISA plan. These plans usually cover a range from health plans to pension and retirement plans. You can also file an ERISA claim if your employer has not properly disclosed ERISA plan information to you.

You should strongly consider filing an ERISA appeal if you believe that your benefit plan has been mismanaged. If you believe a fiduciary has mismanaged a pension plan governed by ERISA and your claim has been denied, contact an experienced ERISA lawyer right away. Peace Law Firm has nearly 20 years’ experience representing individuals like you in ERISA appeals. We can help you fight for the benefits you deserve.

How Do You File an ERISA Appeal?

To file an ERISA appeal, you need to follow the ERISA appeal procedure of your benefit plan. Usually, the plan will tell you what the appeal process is for your claim. You’ll typically be notified of this when they send you notice of the denial of your claim. Make sure that your insurance company has your most up-to-date contact information. You do not want to miss any important deadlines! If your plan does not provide you with notice of their appeal process, you should request a copy.

It is very important for you to understand what the timelines are for filing your appeal. Typically, plans provide you with either 60 or 180 days from the date of your denial letter to file your appeal. You are typically entitled to only one appeal once your claim is denied.

If you decide to go through the ERISA appeal process, hiring an experienced ERISA appeals attorney is essential to your success. The process can be very complicated, and our lawyers at Peace Law Firm can help you successfully file your appeal. That’s the first step in helping you get what you deserve!

What Is the ERISA Appeal Process Like?

The ERISA appeal process is time-sensitive and based on the strength of your documents. The process is much easier if you are able to submit a legal brief and have the assistance of counsel.

What Are Some Obstacles in Filing an ERISA Appeal?

Some of the obstacles you may encounter include:

Navigating the one chance to get it right in the single-appeal process;
Missing a deadline;
Providing a verbal statement of appeal to your insurance company and accidentally forfeiting your rights;
Failing to create a complete record of your claim; and
Forgetting to include information that you might want to include in a lawsuit and waiving your right to include it if your appeal is denied.

As you can see, the ERISA appeal process can be very technical. Waiting for an answer regarding your appeal can also be very hard.

What Is the Timing of a Response to an ERISA Appeal?

The timing for a response on your ERISA appeal can usually be anywhere from 60 to 120 days. The usual timing is 60 days. Your insurance company typically notifies you in writing if it is going to take any longer than 60 days. Again, it is very important for you to be aware of timelines. Watch out for any notices from your insurance company. If you have opted for electronic notices, make sure they are not going to spam! And ensure that any paper notices are being sent to the correct address. There is no grace period for filing an ERISA complaint lawsuit because the notices from your insurance company were sent to your spam inbox or an old mailing address.

Should I Hire a Lawyer for My ERISA Appeal?

While filing your initial claim is generally straightforward, having the assistance of dedicated ERISA appeal counsel is essential to your success in an ERISA appeal. Peace Law Firm has nearly two decades’ worth of experience representing individuals like you—NOT insurance companies.

We can help you understand the complex ERISA appeal process and fight for the benefits you deserve. Contact us today to request a case consultation and see how we can help you.