ERISA Claims & 5 Mistakes Made When Filing - Mistake #3
Over the next few weeks, we'll be discussing five mistakes individuals make when filing ERISA claims for long term disability and short term disability, life insurance, pension or retirement, and sometimes large medical benefit claims.
The third mistake is failing to ask for documents.
ERISA has some disclosure obligations in connection with claims for benefits. Many people fail to ask for critical information in connection with their claim because they don't know about those disclosure obligations.
Documents to Request
1. Your Claim Record.
If your claim has been denied or adverse action has been taken on your claim, you are entitled to a complete copy of the claim record, so you can see all of the documents that were considered in connection with that claim denial.
2. Your Full Plan Document.
You must request your full plan document because it is the only document that outlines the full rules related to your claim, not the benefits booklet or the summary plan description.
3. Your Claim Manual.
If there was some sort of guideline or protocol utilized in connection with a claim and that was relied upon to make a decision, you are entitled to a copy of that guideline or protocol, so you understand why your claim has been denied.
ERISA claims must be handled in a very systematic and methodical manner. You must know all the rules and exactly why your claim has been denied to prepare an effective appeal. Letters denying claims sometimes do not contain the necessary specificity to understand why a claim was denied. Therefore, it's incumbent upon the claimant to make a request for these documents, and failure to do so is a critical mistake.