Opinion ID: 1998251
Heading Depth: 1
Heading Rank: 11

Heading: ERISA Claims Procedure

Text: ERISA provides that an employer must advise employees of a claims procedure to be followed if any employee believes that she or he has been denied appropriate benefits. Under ERISA's claims procedure, benefit claims must be made in writing to your supervision. If you elect to submit a claim under ERISA, you should describe the benefit you're claiming, the period of time for which you're claiming it, and the amount of payment you expect. If your claim doesn't include the right information, you'll be told about it in writing. You'll also be told what you need to do to get your claim processed. If your claim is denied, you'll be told in writing within 90 days after your claim is received. That reply will include:  the specific reasons for the denial;  reference to the provisions of the VTI program;  a description of what additional information is necessary and why; and  a copy of this procedure or comparable information about the steps you need to take to resubmit the claim. If the reply can't be made within 90 days, you'll be given a written notice explaining the reasons. An extension will not be for more than another 90 days. If your claim for a benefit is denied, you may write to your supervision requesting a review. You'll need to do that within 60 days of the denial. In your request, you'll want to list the issues and comments you'd like to have considered. If you prefer, you can have an authorized representative send in the request on your behalf. You or your representative may, at a reasonable time and place, inspect relevant documents which may affect your claim. Within 60 days after your request for review is received, you'll get the decision in writing. In the case of a continued denial, you'll be given the specific reasons and the provisions on which the denial is based. If the review can't be made within 60 days, you'll be notified in writing. Again, that notification will outline the reasons behind the delay.