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What is the ERISA Claims Process?

What is the ERISA Claims Process?

The Employee Retirement Income Security Act (ERISA) claims process is complex and can be confusing to people who are not well-versed in these types of claims.

The Process

  1. Request the claims procedure in writing from your insurance company or your employer’s human resources department.
  2. You are provided with the written procedure for free from your insurance company.
  3. Your claim is filed depending on the type: urgent care, preservice, postservice, or disability.
    1. Your insurance company may request more information from you so that they can make a decision about your claim. You will be made aware of the deadline for sending further details.
  4. You receive a written decision from the insurance company that they have either approved or denied your claim. If your claim is denied, it is your right to appeal the decision. It is important to note that insurance companies are not always obligated to send a written announcement if the claim is approved.
    1. The time frame for the insurance company’s decision may vary depending on the type of claim.
  5. File an appeal prior to the deadline stated in your denial letter.
  6. Your appeal is reviewed by the insurance company. You are sent a written decision of approval or denial for the appeal.
    1. Similar to claim determinations, varied time frames exist for appeals as well, and they vary depending upon the type of the original claim.
  7. If your appeal is denied, you have the option to file an additional appeal through the U.S. Department of Labor by getting in touch with your regional U.S. Department of Labor Employee Benefits Security Administration (EBSA).

Do I Need an Attorney?

While the claims process may seem simple enough, in reality, it is quite complex. It is in your best interest to contact an ERISA experienced lawyer to assist with your claim. Having a knowledgable attorney from Delfino Green & Green on your side can make all the difference with the success of your claim.

Call Delfino Green & Green at (415) 466-8544 today about your potential ERISA case.

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