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What should an ERISA denial letter tell you?

On Behalf of | Dec 14, 2023 | Long Term Disability Claim Denial

There are cases in which you may apply for benefits under an ERISA plan, but you are denied. You should get a letter in the mail informing you of this denial.

But what should that letter contain? It’s more than just an indicator that your claim is being denied. Below or a few other things it should also tell you.

Why the denial happened

First of all, the notice should tell you why the claim was denied in the first place. For instance, perhaps a vocational expert or a medical professional disagreed with the assessment. You deserve to know why your claim for benefits was turned down. 

Informational statements

The letter should also give you certain information, such as telling you about the different documents that you’re entitled to request if you would like. It should also tell you about the provisions of the plan, which can explain why the denial took place. Within this area, the plan’s standards, protocols, guidelines or rules should be explained. You need to know what the criteria are under that plan when looking into why your claim was not approved.

The appeals process

Finally, the denial letter that you get should tell you about the appeals process. There may be time limits, and it should inform you of any deadlines in filing your appeal. The letter should also simply tell you that you do have this right and that the initial denial is not necessarily a final decision.

After all, you may feel that the benefits were erroneously denied and that you still deserve to have your claim approved. You can appeal that initial denial, and you just need to know exactly what steps to take to do so.