Federal and state laws require employers to offer certain benefits, such as Workers’ Compensation and unemployment insurance. Most benefits offered by employers are voluntary, rather than required. However, when voluntary benefits are offered, the way in which those benefits plans are handled is governed by a federal law called The Employee Retirement Income Security Act (ERISA), which applies to far more than retirement plans despite the title. If you have been denied benefits to which you believe you are entitled you may have a claim under ERISA. An employment attorney can help you understand and pursue your rights.
ERISA covers retirement plans and welfare benefit plans. Examples of benefits provided under welfare plans include:
- Health benefits
- Vacation benefits
- Day care services
- Death benefits
- Disability benefits
- Prepaid legal services
- Apprenticeship and training
After you file a claim for benefits, your plan has 90 days to respond with approval or denial, or to notify you that it needs more time to make a decision which can tack on another 90 days. If you do not receive an answer within the time limit, it is considered a denial by default.
If you are denied benefits your plan’s administrator is required to notify you in writing and provide a detailed and clear explanation of why you were denied, as well as instructions for how to appeal the denial. You have at least 60 days to submit your claim for review, and some plans give you more time.
Once you have submitted your appeal for review, your plan must respond within 60 days with a decision or a notification that it needs more time to make a decision, which can extend the time to up to 120 days after you submitted your appeal. Again, if you are still denied the denial must be fully and clearly explained in writing.
Once you have completed the appeals process and either received a denial or no response at all, you can begin legal action under ERISA. An employment law attorney can help you determine if your denial was in violation of ERISA and what you should do next.