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Claims rules for ERISA-covered retirement benefits plans

Many things can be impactful for retirees. For individuals who had a retirement benefits plan through their employer, one such thing is what happens when they make a claim for benefits under the plan.

Rules from the federal Employee Retirement Income Security Act typically are among the things that govern benefits claims made by an individual to an employer-provided retirement benefits plan. This federal law establishes various rules regarding what employers and their plan administrators have to do when it comes to benefits plans they have opted to provide to employees, including retirement benefits plans.

Among the claims-related rules present on ERISA-covered retirement benefits plans are rules:

  • On providing employees covered by a plan with information on what the claims filing process is for the plan.
  • On what plan administrators are required to do when they receive a benefits claim. For example, there is a time limit administrators are generally required to make accept/deny decisions by on a claim.
  • Regarding denying a claim, such as rules on what administrators have to do following a denial and rules on the internal appeal review process for denials.

Given how much a retiree may be relying on an employee-provided retirement benefits plan when it comes to their retirement financial situation, it can be a remarkably disheartening thing for a retiree when they receive a denial of a claim for benefits they made to such plan. In such a situation, understanding one's options can be vital. Attorneys experienced in ERISA matters can help individuals in such situations with understanding what ERISA rules apply to their situation, whether their employer/plan administrator is complying with these rules, what the process of challenging a denial involves and whether they would have grounds for contesting the denial.

Source: Employee Benefits Security Administration, "Filing A Claim For Your Retirement Benefits," Accessed April 11, 2016

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