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Understanding the ERISA claims process

At The Law Office of Jessica Taylor PLLC in Texas, we know that while you love the retirement and insurance benefits your employer provides you through the Employee Retirement Income Security Act, you dread dealing with ERISA's stringent federal and state rules and regulations when you have to make a claim.

No one denies that ERISA law is incredibly complex and not easy to navigate on your own. But what good are your benefits if you cannot collect them? You deserve to have access to your ERISA benefits, and the first thing you need to understand is that you must do everything exactly right when you file an ERISA claim.

Stage 1: your initial claim

As FindLaw explains, your employer must tell you how to file your claim. Once you do, the plan’s insurance provider usually has between 45 and 90 days to accept or deny it. Check your insurance policy to see exactly how long the period is.

Stage 2: your appeal

If the insurance carrier denies your claim, it must notify you in writing and explain why it did so. You then have a certain period of time in which to file an appeal, and your insurance company has a period of time during which to approve or deny your appeal. Again, check your insurance policy to see exactly how long these time periods are.

Stage 3: your ERISA lawsuit

If the insurance carrier denies your appeal, your next step is to file an ERISA lawsuit claiming that your insurance company acted in bad faith by denying your claim. The only thing the judge can decide is whether or not the denial was an “abuse of discretion.” If he or she determines it was, you win. If he or she determines it was not, the insurance company wins.

The judge will decide your case based on the record; i.e., the documents that you accumulated during your initial claim and its appeal. Therefore, the more supporting evidence you provide, such as doctors’ reports, employer letters, etc., the better your chances. Without plenty of documentation, the judge may simply defer to your insurance company’s reasons, as stated in the denial letter they sent you, for denying your claim.

For more information on this subject, please visit this page on our website. 

 

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The Law Office of Jessica Taylor, PLLC

The Law Office of Jessica Taylor, PLLC
14100 San Pedro Avenue
Suite 602
San Antonio, TX 78232

Phone: 210-265-6759
Phone: (210) 402-4022
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