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Understanding your employer-provided benefits can be confusing. Unfortunately, many plan participants don’t investigate the exact benefits they are entitled to or eligible for until it comes time to file a claim. Most employee benefit plans are governed by a federal law called The Employee Retirement Income Security Act of 1974, or ERISA. While this law does outline certain rights for beneficiaries, it is also a complex and often confusing set of rules and regulations. The East Bay ERISA attorneys at Kantor & Kantor have spent decades helping employees, retirees, and their loved ones receive the benefits to which they are entitled. If you’re dealing with an insurance appeal or denied claim, call our office to learn how we may be able to assist you.
ERISA requires employers to disclose the various types of benefits they provide in documents known as summary plan descriptions. The law also requires employers to provide copies of those summary plans to employees on request. The following highlights some of the key points to look for in these documents.
Summary plan descriptions are intended to give employees a clear idea of the benefits offered through their employers’ plan, as well as offer guidance in understanding eligibility requirements for those benefits. Having these documents at hand is an important step in holding your employer accountable if your benefits are denied, delayed, or mismanaged. The law requires a summary plan description for all benefits offered. This may include:
Copies of summary plans and other important documents must be provided by employers free of charge at the employee’s request. If you are unsure of your coverage, working through the claim process, or simply want to learn more about your benefits, it is your right to request these documents at no cost. In the event that you file a claim for benefits, and it is denied, your first step in the appeals process should be obtaining a copy of the summary plan description.
If you’ve reviewed the summary plan description and cannot find a logical reason why your claim was denied, you should consider filing an appeal. In many cases, insurers set a time limit of 180 days for filing this appeal, and missing the deadline may limit your ability to obtain benefits. And just as there are regulations for employers, employees are also required to follow the claims process. For these reasons, many people choose to seek the help of an experienced ERISA lawyer in preparing or filing their appeal.
Your rights to employer-provided benefits are protected by ERISA, and in the case of a denied claim, it also protects your rights in filing appeals. Receiving a denied claim is frustrating, but with help, obtaining benefits may still be possible. At Kantor & Kantor, we can guide you through the complex state and federal insurance laws and how they apply in your particular case. To schedule a consultation, call or contact us online today.
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