ERISA AND THE SELF-INSURED COMPANY PLAN
Is your group health, life or disability plan that your employer provides self-insured? Self-insured means that your employer is assuming all the risk for plan members and if you file a claim you have to follow the rules set up by the U.S. Department of Labor (DOL). It also means that your plan is governed by the Federal Employee Retirement Income Security Act (ERISA). If you have questions or problems, you must contact the DOL.
Like most governmental procedures, you must follow the DOL’s strict rules for filing a claim. If you have questions, you can contact the DOL or an ERISA Claim Attorney who is trained in all the ins and outs of filing a claim. Your ERISA Claim will be more successful if the follow these steps:
Make sure you read the Summary Plan Description of your policy – Your plan administrator is required by law to give you a copy. This summary contains all you need to know about your rights and what protection ERISA gives you. It describes just how your health, life or disability plan works and how benefits are provided.
Make sure you go by the rules of filing your claim – The Summary will tell you how to file a claim. Procedures must be followed to the last degree or you run the risk of your claim getting denied.
Waiting period requirements – You should be informed within 90 days of your filing whether benefits will be coming your way or if more time is needed to consider the claim. If they need more time, they have to explain why and give you a date they expect to reach a decision. If you receive no answer in 90 days or if and extension was necessary and 180 days has passed, some courts suggest you may file suit others say you have to appeal.
Dealing with an ERISA denial – You must be notified if your claim is denied and why it was denied. Your administrator will also tell you how your can appeal this decision. ERISA cases are not an easy to win, so it would be wise for you to seek the help of a qualified ERISA Claim Attorney before you appeal. The ERISA CLAIM Attorney will help you submit the proper and timely appeal and compile all the necessary documents required under ERISA rules. Because your appeal must first go through and internal review process, this could take some time so be sure you know how long they get and what to do. An appeal can take anywhere from 2 – 4 months. Only after your appeal has gone through this internal process can a lawsuit be filed.
Tags: Disability Insurance Coverage, Employee Benfits Laywer
Disability Insurance Coverage Employee Benfits Laywer
