The Employee Retirement Income Security Act (ERISA)is a federal law that governs employer-provided insurance plans. One of the key provisions of ERISA is that you have the right to appeal a denied claim for benefits under the plan.
However, not all appeals sail through. Appealing a denied ERISA claim is a complex process, and slip-ups during the appeals process could jeopardize your chances of a successful outcome. The good news is that most of these mistakes are avoidable, as discussed below.
One of the most common mistakes people make when appealing a denied ERISA claim is missing the deadline to file the appeal. ERISA sets a strict time limit for filing an appeal, typically 180 days from the date of the denial letter.
It’s crucial to ensure you file the appeal on time. Otherwise, you could lose your right to appeal. At the same time, you should not rush and present a poorly crafted appeal.
Failing to provide the necessary information
When you file an appeal for a denied ERISA claim, be sure to provide all the necessary information that supports your case. This includes medical records, doctor’s notes and any other documentation that backs your claim for benefits.
Failure to provide such information could result in an unsuccessful appeal since there will be no basis to overturn the initial decision.
It is worthwhile to understand how everything works when appealing a denied claim. For instance, you must go through your plan’s appeal procedures before taking the case to court. That said, you still need to be prepared for such an eventuality.
Learning more about the appeals process will help you prepare accordingly and avoid delays or other inconveniences.
Failing to seek legal help
ERISA law is complex, and it can be difficult to navigate the appeals process. Having informed guidance can help you understand your rights and obligations under ERISA, guide you through the appeals process, and ensure you have the best chance of success.