Oakbrook ERISA Lawyers Assisting Chicagoland Clients

If you have been denied benefits under your health care plan or pension plan, then it may seem like time to pursue legal action against your employer or plan administrator under the Employee Retirement Income Security Act of 1974, also known as “ERISA”. But that is not quite the case.

ERISA provides legal remedy against those who owe you a legal duty of care in both maintaining your benefit plan and advising you in regards to it. The process of asserting an ERISA claim is very technical and if you do not follow the process appropriately, a judge may dismiss your claim altogether. Accordingly, seeking legal counsel from attorneys focusing on ERISA proceedings is the best way to regain what you’re entitled to per your benefit plan.

What is the Claims Review Process Under ERISA?

An employment benefit plan is the plan between you and your employer that sets forth each party’s rights and obligations regarding your health care or pension plan benefits. To be compliant with ERISA, a benefit plan must set for the procedure for claims process in the event that benefits are denied. Each plan must set forth procedures for the following actions:

  • Filing of benefit claims;
  • Notification of benefit determinations; and
  • Appeal of adverse benefit determinations.

Accordingly, if you are denied benefits, then you must be notified of the reason for the benefit denial in writing and if you contest the rationale for the deprivation of benefits, then you are entitled to the opportunity to receive a fair and complete review of the reason for denial. To summarize, claims procedures must be considered “reasonable” under ERISA and will only be considered so if they meet the following standards:

  • Claims procedures must set forth the timeline for filing and notices of all aspects of the claims process;
  • Claims procedures cannot be unreasonably burdensome in the application of initiating or processing a claims benefit determination;
  • Claims procedures must be consistent with similar claimants and must contain safeguards to ensure and to verify that benefit claim determinations are made in accordance with governing plan documents

If you have exhausted your benefits claim process, only then may you proceed to court.

Oak Brook’s ERISA Attorneys Know the Process

A plaintiff may only pursue a lawsuit in court if the plaintiff has legal standing to sue. A plaintiff will only have standing if their cause of action has accrued and a court may only recognize the accrual of the claim once their claim for benefits has been formally denied. Accordingly, if you do not carefully follow the claims process set forth in your benefit plan, then a judge is likely to dismiss your legal action which results not only in extra cost for you, but you will still be without the benefits you seek.

Oak Brook’s ERISA attorneys at Roberts Bartolic LLP are skilled on understanding and adhering to the uniquely tailored claims process requirements in each benefit plan. During any step of the process, we can help you, but seeking legal assistance in the beginning is the most assured way to find the solution you are seeking. Please do not hesitate to call us today for a free consultation of your case.