If your employer denied your benefits, don’t assume they followed the rules correctly. The Employee Retirement Income Security Act (ERISA) creates strict standards for how benefit claims must move through the system.
Employers and plan administrators have a legal duty to apply these rules fairly and consistently. If they break those rules, you may have grounds to take further action.
Your denial letter leaves out key information
ERISA requires benefit plans to give you a clear and specific explanation when they reject your claim. If your denial letter seems vague, confusing, or incomplete, you have reason for concern. The letter must list the exact reasons for the denial, point to the plan rules they used, and explain how you can challenge the decision.
Some denial letters also leave out your right to appeal or fail to mention the deadline. Under ERISA, plans must give you at least 60 days to appeal a decision and must tell you how to do it.
The plan changes the rules during your claim
Employers and plan administrators must follow the plan’s written terms from start to finish. They cannot make up new rules or add new requirements after you file a claim. If your employer promised one set of terms when you signed up for benefits, but then denied your claim using different standards, they may have broken ERISA rules.
The plan denies access to important documents
ERISA gives you the right to review the documents that affect your benefits. You can request the full plan document, the Summary Plan Description, and any records used to decide your claim. If your employer refuses to give you those documents or gives you only part of what you requested they may have something to hide. ERISA requires them to send the documents within 30 days of your request.
The timeline doesn’t follow legal standards
ERISA sets firm deadlines for claim decisions. For example, plans must decide disability claims within 45 days, or 90 days if they need more time. If your employer took much longer, or never responded at all, they likely ignored ERISA requirements.
Recognizing these warning signs can help you stand up for your rights. ERISA exists to keep benefit plans fair, but that only works when employees know what to expect and when to push back.