If you have a traditional pension plan, a 401 (k) or other retirement plan for employees want to know how to file a claim for benefits. The steps outlined below describe some of the duties of his plan and briefly explains the procedures and deadlines for filing a claim for retirement benefits.
Filing Complaint About Employee Retirement Benefits
Before you file, however, 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 processing benefit claims, the deadline to make 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 by government entities and most churches sponsored). However, if you’re one of the millions of participants and beneficiaries who depend on retirement benefits plan for employees in the private sector, take a few minutes and read before filing a claim.
Review summary plan description of retirement plan
A key document related to retirement benefits is the summary plan description (SPD) from your plan. The SPD provides a detailed overview of the plan – how it works, what benefits it provides and the procedures for filing a claim for benefits. It also describes your rights and responsibilities under ERISA and plan. For some plans of a single employer collectively bargained, you should also review the procedures for filing claims, complaints and appeals of the collective bargaining agreement, as they may relate to claims for retirement benefits.
Before applying for retirement benefits, review the SPD to ensure that it meets the requirements of the plan and understand the procedures for filing the claim.Sometimes claims procedures are in a separate booklet that came with your SPD. If you do not have a copy of your plan’s SPD or claims procedures, request in writing to the administrator of your retirement plan. This is required to supply a copy.
Moving Retirement Plan Money
If you are not retiring but are changing jobs and want to transfer money from your plan to Individual Retirement Account (IRA) or other retirement plan your employer, the SPD will tell you if you can make this transfer and how you can do. Plans that allow transfers specify the process to apply for them. Your SPD will also tell you if there are special rules for benefits such as the anticipated retirement.
How to complain about retirement plan
An important first step is to check your SPD to make sure it meets the eligibility requirements for benefits plan. Your plan might say, for example, that must have worked a certain number of years and / or be a certain age before you can begin receiving benefits. Also note what your plan requires to file a claim. The SPD or claims procedure booklet should include information on where to file, how to present and who to contact if you have questions about your plan, such as how to calculate your retirement benefits. Plans may not charge any fee or cost for filing claims and appeals.
If, for some reason, that information is not in the SPD or claims procedure booklet, write your plan administrator, the human resources department of your employer (or the office that normally handles claims), or an office your employer, notifying you have a claim. Keep a copy of the letter for your records. You’ll also want to send the letter by certified mail, return receipt requested, to have proof that the letter was received and by whom.
Filing Claim About Retirement Plan
If the person filing the complaint is not you, but an authorized representative or your beneficiary, that person should refer to the SPD and follow the procedure for claims of his plan. The process may require other documents when this type of claim is filed.
When a claim is made, be sure to keep a copy for your records.
Waiting Period for filing claim against Retirement Plan
The plan has 90 days to evaluate your claim and inform you whether or not you receive retirement benefits. You may not take so long.
If, due to special circumstances, your plan needs more time to make a decision about your claim, has an obligation to inform within 90 days you need more time, why do you need and the date you can expect receive a decision. Plans can take up to 90 additional days to make a decision about your claim. Enter the date you filed your claim.
Generally, decisions on complaints are taken within the period of 90 days (or 180 days if applicable extension). If you qualify for benefits, check your SPD for how and when to pay.
What to do if ERISA Claim denied?
If your claim is denied, the plan must give written notice within 90 days (or 180 days if applicable extension). The notice must be in plain, understandable language. You must include all the specific reasons for denial, refer you to the plan provisions on which the decision was based and indicate whether it is necessary to present more information to make a decision, what information is and why it is necessary. It must also describe the procedures and deadlines plan to file an appeal with the goal of full and fair review of your claim is made.
How to appeal a denied ERISA claim
Claims are denied for various reasons. Maybe he did not participate in the plan long enough. Or not old enough to meet the age requirements of your plan. Or perhaps the plan simply need more information about your claim. Whatever the reason, you have at least 60 days to file an appeal (check your SPD or the booklet with the claims procedure to see if your plan provides a longer term).
Use the information in your claim denial notice to prepare his appeal. It should also be noted that the plan must provide claimants, on request and free of charge, copies of documents, records and other information relevant to the claim for benefits. Be sure to include all information related to your claim, especially any additional information or evidence, and take it to the person specified in the notice of refusal before the end of the period of 60 days.
How to review an appeal
Those responsible for the plan have 60 days to review your appeal. If they take longer, they must notify you in writing. They may extend the deadline for deciding an additional 60 days, for a total of 120 days. There is one exception. When a committee or board review your appeal and that body only meets every three months, your appeal may take longer.
Once a final decision on your claim is made, the plan must send you a written explanation thereof. The notice must be in plain, understandable language. You must include all the specific reasons for the denial of his claim on appeal, refer you to the plan provisions on which the decision was based, say if the plan has some level of additional or voluntary appeal, explain your right to receive all documents relevant to your claim for benefits for free and describe your rights to seek judicial review of the decision of the plan.
If your appeal is denied
If the final decision of the plan denies your claim, you can seek legal advice regarding their rights to take legal action to challenge the denial. You can also contact the Office of Security Administration Employee Benefits Department of Labor (EBSA) closest to inquire about your rights if you think the plan has not complied with any of the requirements of ERISA in handling your claim for benefits.