Filing a Claim for Retirement Benefits

The Employee Retirement Income Security Act (ERISA) requires private employers who offer pension plans and other retirement benefits to their employees to comply with specific disclosure and reporting requirements. For instance, ERISA requires companies to have a clear, written policy available to employees on how to file a claim for benefits.

The Summary Plan Description

Before filing a claim, it is important for employees to review a document known as the summary plan description (SPD). SPD’s provide a detailed overview of an employer’s specific plan and include important information, including:

• The benefits provided;
• The procedures for filing a claim;
• How to transfer the money in a plan to another employer’s retirement account;
• Whether there are special rules for obtaining early retirement benefits;
• The employee’s rights and responsibilities under ERISA;
• The eligibility requirements that an employee must meet to receive benefits; and
• The procedure for filing an appeal, including where to file, what to file, and who to contact with questions and concerns.

Employers are required by law to provide these documents, so if you don’t have a copy of your plan’s SPD, you can obtain one by sending a written request to the plan’s administrator.

Filing a Claim

Once an employee has ensured that he or she meets the plan’s requirements and understands the necessary procedures, he or she can begin the process of filing a claim for retirement benefits. However, if that information is not contained in the SPD, the employee should write to the plan’s administrator, the employer’s human resource department, or the employer’s office to notify them that he or she is filing a claim. Under ERISA, a plan’s administrator has 90 days to evaluate the claim and respond to a request.

If a claim is denied, the administrator must send a written notice that contains certain information, including:

• A clear explanation of the reasons for the denial;
• A reference to the plan provisions on which the decision is based;
• What information is needed from the claimant to resolve the claim, including an explanation of why the information is needed; and
• The plan’s procedures and deadlines for submitting an appeal for a full and fair review.

Filing an Appeal

Whatever the reason for denial, an employer or administrator must give employees at least 60 days to file an appeal. Again, employees should refer to their SPDs and their denial letters for specific details about filing an appeal. ERISA also requires that employers provide claimants with all documents, records, and information relevant to their claim upon request and free of charge.

Once an appeal has been submitted, plan officials have 60 days to review it, although this deadline can be extended an additional 60 days in certain circumstances. However, if a committee or board of trustees reviews appeals and that entity only meets on a quarterly basis, the appeal may take longer. Once a decision has been made, the reviewer will send a written explanation of the decision that must include the following information:

• The specific reasons for the denial of the claim on appeal;
• A reference to the plan provisions on which the decision was based;
• Whether there are any additional or voluntary levels of appeal;
• An explanation of the claimant’s rights to receive all documents related to the claim free of charge; and
• A description of the claimant’s rights to seek review of the plan’s decision in court.

At this point, it is important to contact an experienced ERISA attorney and the Department of Labor’s Employee Benefits Security Administration (EBSA) if the claimant believes that a plan failed to follow ERISA’s requirements.

Contact a Skilled ERISA Attorney

If you are attempting to file a claim for retirement benefits or have had your claim denied, please contact Bartolic Law at (312) 635-1600 to speak with an experienced ERISA attorney today.