Pension plans and associated benefits from private employers are protected by the Employee Retirement Income Security Act (ERISA). If your benefits claim is denied for some reason, ERISA protections may apply.
Before Claiming Benefits: What to Expect from the Pension Plan?
First, you have to claim your pension benefits in order to receive some response from the pension plan administrator. But even before claiming the pension benefit, read the summary plan description, which must have been provided by your pension plan administrator. You should read this summary especially if you want to file a claim for pension benefit because, among other things, the summary plan description contains:
- Procedures for filling pension benefits claim
- The types of benefit your pension plan (and welfare benefit plan) provides
- How the benefits may be obtained and under what circumstances they may be lost
- A summary of ERISA protections applicable to your plan
It may be the case that the summary plan description for your pension benefit plans doesn’t list appropriate procedures for filing a pension benefits claim. In such situation, you may notify your employer or notify your pension plan administrator.
Formalities of a Pension Plan Denial
After you file the claim, the pension plan may respond by denying your claim. In such case, the denial of the pension benefit must be in writing, must state the grounds for denial, and must provide for a fair review.
Even if these requirements are met, that does not mean that the decision to deny you your pension benefit has reasonable grounds.
What’s the Timeline for a Pension Benefits Claim Review?
When you file a claim, your pension plan’s review and response are guided by certain time limits. In general:
- The Pension plan has 90 days to respond to your benefits claim.
- If the evaluation of your claim requires more time, your pension plan must notify you within 90 days.
- When the evaluation takes more time, the plan must explain why and state an expected timeframe.
- If your pension plan doesn’t inform you of its decision within 90 days (or in 180 days through an extension) you may consider your pension benefits denied.
How to Get a Full and Fair Review for Your Denied Claim?
After your pension claim had been denied, you may submit it to full and fair review by the pension plan. The plan’s administrator needs to inform you about the steps you have to take to receive such a review. You must submit the denied claim for review by your pension plan within at least 60 days.
Similar to the first claim you’ve made, the appeal has a set timeline and the final decision must be in a certain form. The following rules apply:
- With some exceptions, the final decision on appeal must be made within 120 days of appealing.
- If more than 60 days is required, your pension plan must tell you.
- Written notice with an explanation of the decision on appeal must be provided.
- The explanation must be in clear, unequivocal language that a reasonable person can understand.
- The notice must state if there are any additional levels of appeal and state that you may sue in court.
- If no notice is provided, you may assume that your pension claim was denied on appeal.
What If You Don’t Agree with the Decision on Appeal?
If you disagree with the pension plan’s internal appeal process and decision, you may still pursue the case through the court system. You may have a special claim under the Employee Retirement Income Security Act (ERISA).
Seeking Help from an Attorney
When dealing with pension plans, you may face many rules and regulations that are confusing and overwhelming. An experienced employment lawyer can provide you with expert assistance for securing employment-related benefits you are entitle to.