The Employee Retirement Income Security Act of 1974 is designed to protect retirees who are entitled to collect employee benefits. However, the insurer has the right to deny any claim if the applicant cannot show proof of a qualifying medical condition or if the claim amount exceeds the maximum coverage limit. Every denied claim can be appealed by following these steps.
Who handles the process?
The ERISA provides a beneficiary with the right to appeal a claim according to the Summary Plan Description. Either the patient or an authorized representative can begin the appeal process. To become a representative, the patient has to sign an Assignment and Designation of Authorized Representative form.
What forms are needed?
The patient or representative must file an authorization form to the ERISA plan administrator and obtain a copy of the Summary Plan Description, which describes the ERISA benefits plan. Also required are the medical documents that were prepared and signed by the doctor and reviewed during the initial denial.
The appeal should be sent by certified mail to the plan administrator with extra copies being saved in the patient’s file. Another option is to file an appeal with the regional Employee Benefits Security Administration office. If the appeal process fails, the beneficiary should be able to sue the ERISA provider in a federal court.
How the ERISA benefits people
The ERISA has regulations in place to protect the retirement assets of qualifying Americans. Every recipient must qualify when filing a claim, but if it’s denied, he or she can file an appeal if certain requirements are met. Overall, the ERISA system works, has helped many employees and will help millions more.
