You may have many reasons to dispute your benefit plan, such as 401k or pension. You may disagree with the facts used to calculate your benefits, the formula used to calculate your benefits, an investment option or distribution opportunity denied. ERISA lays out a specific set of rules that plans must follow. You must comply as required by ERISA before the next step occurs. You cannot simply hire a Texas employment attorney and sue the plan. Also, you have to give the plan administrator an opportunity to review the decision and confirm its accuracy.
Assuming you inquired about the focus of your dispute and received a dissatisfactory answer, the first step is generally to ask again. The plan administrator’s staff may have overlooked important details. An informal second request is easier than moving on to the formal process. If you are unable to obtain satisfactory response then it is time to move to the formal process.
Erisa claims and appeal process for employee benefit plans
The Summary Plan Description (SPD) for the plan should explain the claims and appeal process. This is the formal process to challenge a plan decision. You will first file a claim with the plan. The SPD should detail who to address this claim. Often it is not the normal service provider. If you send the claim to any other party but the one in the SPD, you have not begun the claims process. The claim should include specific information to refute the initial decision. It is not enough to allege that the initial decision was unfair or dissatisfactory. You must allege specific wrongdoing in the initial decision. You must show that the plan is not following its own rules, failing to consider the right facts – with proof of the right facts, not following the law, the plan is discriminating in its application or interpretation of plan rules, etc.
After filing a claim the plan administrator will provide a written response. If you disagree with the response on legitimate grounds, you may appeal the decision, in writing, to the plan administrator. The plan administrator will provide a written response to the appeal. Based upon the outcome of the claim and appeal, it may be time to bring the dispute to court. If you do not file both the claim and appeal properly with the plan, then any complaint filed in court will most likely be dismissed.