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Can you appeal an ERISA denial?

On Behalf of | Mar 24, 2021 | ERISA

New Jersey workers who have become disabled may file an ERISA claim. ERISA stands for the Employee Retirement Income Security Act. This law works to enact standards for self-funded private health care benefit plans, including how they’re administered, how financial information is disclosed and how the actual claims process works.

Self-funded insurance

Some businesses opt for self-funding their insurance plans for many different reasons. First, the employer doesn’t have to follow state health insurance regulations when they have their own self-funded plan. They can also work to customize their plans to meet the needs of their employees. One major benefit of self-funded insurance plans is that employers can enjoy the capitalization on the reserve funds as they won’t have to pre-pay for any type of insurance coverage.

What happens if my claim is denied?

As part of the standards established under ERISA, those who were denied benefits may undergo the ERISA appeals process. Many people who were denied claims may ask for the assistance of their medical professional to appeal the claim. If you choose to do so, you’ll need to file the appropriate paperwork to ensure that your doctor is considered an authorized representative for your claim.

Remember, there is a filing deadline for the appeals process. For most self-funded insurance plans, this is 60 days. The 60-day period starts from the date of your claim denial. If you don’t file your ERISA appeal within the 60 days that you are given, you will give up your rights to file an appeal for that claim in the future.

ERISA brings up many new questions regarding insurance coverages and what to do about the denial of a claim. It’s a good idea to work with your medical professional and a licensed lawyer to appeal your case if you’ve been denied benefits.