FILING A

CLAIM FOR YOUR

RETIREMENT

BENEFITS
This publication has been developed

by the U.S. Department of Labor,

Employee Benefits Security Administration,

and is available on the Web at

www.dol.gov/ebsa.

For a complete list of the agency’s

publications, call our toll free number at

1-866-444-EBSA (3272)

This material will be made available

in alternate format upon request:

Voice phone: 202-693-8664 TTY: 202-501-3911

Reprinted October2008

This booklet constitutes a small entity compliance guide for purposes of the Small Business

Regulatory Enforcement Act of 1996.
INTRODUCTION

f you have participated in a traditional pension plan, a

401(k), or other employment-based retirement plan,

you will want to know how to file a claim for your

benefits. The steps outlined below describe some of

your plan’s obligations and briefly explain the procedures

and timelines for filing a claim for retirement benefits.

Before you file, however, be aware of the Employee

Retirement Income Security Act of 1974 (ERISA), a

law that protects your retirement benefits and sets

standards for those who administer your retirement

plan. Among other things, the law includes requirements

for the processing of benefit claims, the timeline for a

decision when you file a claim, and your rights when

a claim is denied.

You should know that ERISA does not cover

some employee benefit plans (such as those

sponsored by government entities and most

churches). If, however, you are one of the millions

of participants and beneficiaries who depend on

retirement benefits from a private-sector,

employment-based retirement plan, take a few

minutes and read on before filing a claim.
Reviewing The

Summary Plan

Description

A key document related to your retirement

benefits is the summary plan description

(SPD) for your plan. The SPD provides a

detailed overview of the plan – how it

works, what benefits it provides, and the

plan’s procedures for filing a claim. It also describes your rights as

well as your responsibilities under ERISA and your plan. For some

single employer collectively bargained plans, you should also check

the collective bargaining agreement’s claim filing, grievance and

appeal procedures as they may apply to claims for retirement

benefits.

Before you apply for retirement benefits, review the SPD to

make sure you meet the plan’s requirements and understand the

procedures for filing a claim. Sometimes claims procedures are

contained in a separate booklet that is handed out with your SPD. If

you do not have a copy of your plan’s SPD or claims procedures, make

a written request for one or both to your retirement plan’s

administrator. Your plan administrator is required to provide you

with a copy.

If you are not retiring but are changing jobs and wish to roll

over the money in your plan to an IRA or another employer’s

retirement plan, the SPD will tell you if and how this transfer can be

made. Plans that do permit rollovers will specify the process for

requesting a transfer. Your SPD will also tell you if there are special

rules for benefits such as those for early retirement benefits.

2

FILING A CLAIM FOR YOUR RETIREMENT BENEFITS
Filing A Claim

An important first step is to check your

SPD to make sure you meet your plan’s

eligibility requirements to receive

benefits. Your plan might say, for

example, that you must have worked a

certain number of years and/or be a

certain age before you can start

receiving benefits. Also, be aware of

what your plan requires to file a claim. The SPD or claims

procedure booklet must include information on where to file, what

to file, and who to contact if you have questions about your plan,

such as how to estimate your retirement benefits. Plans cannot

charge any filing fees or costs for filing claims and appeals.

If, for any reason, that information is not in the SPD or

claims procedure booklet, write your plan administrator, your

3 U.S. Department of Labor Employee Benefits Security Administration

 An important

 first step is to read the

 Summary Plan

 Description for your

plan.
employer’s human resource department (or the office that normally

handles claims), or an office of your employer to notify them that you

have a claim. Keep a copy of the letter for your records. You may also

want to send the letter by certified mail, return receipt requested, so

you will have a record that the letter was received and by whom.

If it is not you, but an authorized representative or your

beneficiary who is filing the claim, that person should refer to the

SPD and follow your plan’s claims procedure. The procedure may

require other documents when this type of claim is filed.

When a claim is filed, be sure to keep a copy for your records.

Waiting Period

Your plan has 90 days in which to evaluate

your claim and to tell you whether or not

you will receive the retirement benefits. It

may not take this long.

If, because of special circumstances,

your plan needs more time to decide your

claim, it must tell you within the 90-day

period that more time is needed, why it is

needed, and the date by which you can expect a decision. Plans can

have up to 90 additional days to decide your claim. Make a note of

when you file your claim.

Usually, claims are decided within the 90-day period (or 180

days if an extension applies). If you are entitled to benefits, check

your SPD for how and when benefits are paid.

If your claim is denied, the plan must send you written notice

within 90 days (or 180 days if an extension applies). This notice

must be in plain language that can be understood. It must include all

the specific reasons for the denial, refer you to the plan provisions on

4

FILING A CLAIM FOR YOUR RETIREMENT BENEFITS
which the decision is based, and tell you if more information is

needed from you to decide the claim, what that information is,

and why it is needed. It also must describe the plan’s procedures

and deadlines for submitting an appeal of your claim for a full

and fair review.

Appealing A

Denied Claim

Claims are denied for various reasons.

Perhaps you haven’t been a participant

in the plan long enough. Or you may

not be old enough to meet the plan’s

age requirements. Or perhaps the plan

simply needs more information about

5 U.S. Department of Labor Employee Benefits Security Administration

 When a claim

 is filed, be sure to keep

 a copy for your

records.
your claim. Whatever the reason, the plan must give you at least 60

days to file an appeal (check your SPD or claims procedure booklet

to see if your plan provides a longer time period).

Use the information in your claim denial notice in preparing

your appeal. You should also be aware that the plan must provide

claimants, on request and free of charge, copies of all documents,

records, and other information relevant to the claim for benefits. Be

sure to include all information related to your claim, particularly any

additional information or evidence, and get it to the person specified

in the denial notice before the end of the 60-day period.

Reviewing

An Appeal

Plan officials have 60 days to review your

appeal. If it is going to take longer, they

must notify you in writing of the delay.

Plan officials can extend the decision due

date an additional 60 days, for a total of 120

days. There is one exception. When a

committee or board of trustees reviews your appeal and that entity

meets only quarterly, your appeal may take longer.

Once a final decision on your claim is made, the plan must

send you a written explanation of the decision. The notice must be in

plain language that can be understood. It must include all the

specific reasons for denial of your claim on appeal, refer you to the

plan provisions on which the decision is based, tell you if the plan has

any additional or voluntary levels of appeal, explain your right to

receive all documents that are relevant to your benefit claim free of

charge, and describe your rights to seek judicial review of the plan’s

decision.

6

FILING A CLAIM FOR YOUR RETIREMENT BENEFITS
If Your

Appeal Is

Denied

If the plan’s final decision denies your

claim, you may want to seek legal

advice regarding your rights to bring an

action in court to challenge the denial.

You also may want to contact the

nearest office of the Department of Labor’s Employee Benefits

Security Administration (EBSA) about your rights if you believe

the plan failed to follow any of ERISA’s requirements in handling

your benefit claim.

7 U.S. Department of Labor Employee Benefits Security Administration

 If your claim is

 denied, the plan must

 give you notice with a

 detailed explanation

 and a description of

the appeal process.
Resources

Contact EBSA if you don’t receive a written

notice of the decision on your claim or

appeal, if you have tried to reach a plan

official to file or inquire about a claim and

received no response, or if you have other

questions about filing a claim or about your

retirement plan.

You can reach the EBSA regional

office nearest you by calling 1-866-444-EBSA (3272)

For more information about the claims procedure rules and

retirement plans go to EBSA’s Web site, www.dol.gov/ebsa. You may

also wish to consult the following EBSA publication:

What You Should Know About Your Retirement Plan

Taking The Mystery Out Of Retirement Planning

8

FILING A CLAIM FOR YOUR RETIREMENT BENEFITS
FILING A CLAIM – SUMMARY

—Check your eligibility for benefits before filing a claim. Read

your SPD and contact your plan administrator if you have

questions.

—Once your claim is filed, the maximum allowable waiting

period for a decision is 90 days (180 days if an extension applies).

Usually, you will receive a decision within this timeframe.

—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. Use your plan’s appeals procedure and gather and submit

new evidence or information to help the plan in reviewing its

initial decision.

—Reviewing your appeal can take up to 60 days, and up to an

additional 60 days, if you have been notified of the need for an

extension. The plan must 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 it was denied, describe any voluntary appeal levels, and

contain a statement regarding your rights to seek judicial review

of the plan’s decision.

—You may decide to seek legal advice if your claim’s appeal is

denied. If you believe the plan failed to follow ERISA’s

requirements, you may want to contact the nearest EBSA office

concerning your rights under ERISA.

9 U.S. Department of Labor Employee Benefits Security Administration
U.S. Department of Labor

Employee Benefits Security Administration