What is the ERISA Appeals Process?

It’s incredibly stressful to receive a notice of denial from your insurance company. The very idea that you might have to pay for a healthcare bill alone is terrifying. Thankfully, you have options.

The Employee Retirement Income Security Act (ERISA) protects those dependent on an employer’s self-insured plan. When insurance denies your claim, the ERISA appeals process can save you from a massive bill.

Filing an Appeal

If your employer’s self-insured plan denies your claim, you still have options. Under the law, you have the right to an appeal.

Start the process by requesting appeal information from your insurance company or employer’s human resources department. They should give it to you without any problems. If they don’t, hire an attorney immediately. You should never go against multi-million-dollar agencies (or their lawyers) alone.

The appeal instructions will come with a deadline. Your appeals form must be sent before that point. Make sure you keep documentation proving you sent the appeal, whether it’s through postal or email.

By law, filing an appeal must be free. If you’re insurance agency requests a filing fee, get your attorney on speed dial.

Once you send the appeal, the insurance company has 60 days to make a decision. If your claim is a special case, they can extend that period to 120 days.

Going to the Top

If your appeal to the insurance company fails, you might need to call upon the law to sort things out. If your benefits were denied, you can appeal the decision to the U.S. Department of Labor.

It’s important to be prepared before going all the way to the top. If the insurance company denied your claim, it’s a good idea to seek an experienced disability and benefits lawyer who can guide you through the process and strengthen your case.