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Filing A Claim For Benefits

Federal retirement law requires all plans to have a reasonable written procedure for processing your benefits claim and appeal if your claim is denied. The Summary Plan Description (SPD) should include your plan’s claims procedures. Usually, you fill out the required paperwork and submit it to the plan administrator, who then can tell you what your benefits will be and when they will start.

Filing A Claim And Filing An Appeal

If there is a problem or a dispute about whether you qualify for benefits or what amount you should receive, check your plan’s claims procedure. Federal law outlines the following claims procedures requirements:

  • Once your claim is filed, the plan can take up to 90 days to reach a decision, or 180 days if it notifies you that it needs an extension.

  • If your claim is denied, you must receive a written notice, including specific information about why your claim was denied and how to file an appeal.

  • You have 60 days to request a full and fair review of your denied claim, using your plan's appeals procedure.

  • The plan can take up to 60 days to review your appeal, as well as an additional 60 days if it notifies you of the need for an extension. The plan must then send a written notice telling you whether the appeal was granted or denied.

  • If the appeal is denied, the written notice must tell you the reason, describe any additional appeal levels, and give you a statement regarding your rights to seek judicial review of the plan’s decision.

If you believe the plan failed to follow ERISA’s requirements, you may decide to seek legal advice if the plan denies your appeal. You also can contact the Department of Labor concerning your rights under ERISA by calling toll free at 1.866.444.EBSA (3272).

For more information on claims procedures, see the Department of Labor publication, Filing a Claim for Your Retirement Benefits at www.dol.gov/ebsa  or call toll free at 1.866.444.EBSA (3272).

Action Items

  • Contact your plan administrator to get the paperwork that you need to file a claim to start receiving retirement benefits.

  • Contact the Department of Labor (EBSA) by calling toll free at 1.866.444.EBSA (3272) if you have questions about your plan or your rights under ERISA.

Source: U.S. Department of Labor

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Information is provided for review and consideration only. Please consult legal and tax advisors for practical advice pertaining to your business and personal situations.

This page was last reviewed and/or updated on Monday, December 19, 2011 04:18 PM

 
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