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If you have participated in a traditional pension plan,
a 401(k), or other employment-based retirement plan, you
will want to know how to file a claim for your benefits.
The steps outlined below describe some of your plan’s
obligations and briefly explain the procedures and
timelines for filing a claim for retirement benefits.
Before you file, however, be aware of the Employee
Retirement Income Security Act of 1974 (ERISA), a law that
protects your retirement benefits and sets standards for
those who administer your retirement plan. Among other
things, the law includes requirements for the processing
of benefit claims, the timeline for a decision when you
file a claim, and your rights when a claim is denied.
You should know that ERISA does not cover some employee
benefit plans (such as those sponsored by government
entities and most churches). If, however, you are one of
the millions of participants and beneficiaries who depend
on retirement benefits from a private-sector
employment-based retirement plan, take a few minutes and
read on before filing a claim.
A key document related to your retirement benefits is
the summary plan description (SPD) for your plan. The SPD
provides a detailed overview of the plan – how it works,
what benefits it provides, and the plan’s procedures for
filing a claim. It also describes your rights as well as
your responsibilities under ERISA and your plan. For some
single employer collectively bargained plans, you should
also check the collective bargaining agreement’s claim
filing, grievance and appeal procedures as they may apply
to claims for retirement benefits.
Before you apply for retirement benefits, review the
SPD to make sure you meet the plan’s requirements and
understand the procedures for filing a claim. Sometimes
claims procedures are contained in a separate booklet that
is handed out with your SPD. If you do not have a copy of
your plan’s SPD or claims procedures, make a written
request for one or both to your retirement plan’s
administrator. Your plan administrator is required to
provide you with a copy.
If you are not retiring but are changing jobs and wish
to roll over the money in your plan to an IRA or another
employer’s retirement plan, the SPD will tell you if and
how this transfer can be made. Plans that do permit
rollovers will specify the process for requesting a
transfer. Your SPD will also tell you if there are special
rules for benefits such as those for early retirement
benefits.
An important first step is to check your SPD to make
sure you meet your plan’s eligibility requirements to
receive benefits. Your plan might say, for example, that
you must have worked a certain number of years and/or be a
certain age before you can start receiving benefits. Also,
be aware of what your plan requires to file a claim. The
SPD or claims procedure booklet must include information
on where to file, what to file, and who to contact if you
have questions about your plan, such as how to estimate
your retirement benefits. Plans cannot charge any filing
fees or costs for filing claims and appeals.
If, for any reason, that information is not in the SPD
or claims procedure booklet, write your plan
administrator, your employer’s human resource department
(or the office that normally handles claims), or an office
of your employer to notify them that you have a claim.
Keep a copy of the letter for your records. You may also
want to send the letter by certified mail, return receipt
requested, so you will have a record that the letter was
received and by whom.
If it is not you, but an authorized representative or
your beneficiary who is filing the claim, that person
should refer to the SPD and follow your plan’s claims
procedure. The procedure may require other documents when
this type of claim is filed.
When a claim is filed, be sure to keep a copy for your
records.
Your plan has 90 days in which to evaluate your claim
and to tell you whether or not you will receive the
retirement benefits. It may not take this long.
If, because of special circumstances, your plan needs
more time to decide your claim, it must tell you within
the 90-day period that more time is needed, why it is
needed, and the date by which you can expect a decision.
Plans can have up to 90 additional days to decide your
claim. Make a note of when you file your claim.
Usually, claims are decided within the 90-day period
(or 180 days if an extension applies). If you are entitled
to benefits, check your SPD for how and when benefits are
paid.
If your claim is denied, the plan must send you written
notice within 90 days (or 180 days if an extension
applies). This notice must be in plain language that can
be understood. It must include all the specific reasons
for the denial, refer you to the plan provisions on which
the decision is based, and tell you if more information is
needed from you to decide the claim, what that information
is, and why it is needed. It also must describe the plan’s
procedures and deadlines for submitting an appeal of your
claim for a full and fair review.
Claims are denied for various reasons. Perhaps you
haven’t been a participant in the plan long enough. Or
you may not be old enough to meet the plan’s age
requirements. Or perhaps the plan simply needs more
information about your claim. Whatever the reason, the
plan must give you at least 60 days to file an appeal
(check your SPD or claims procedure booklet to see if your
plan provides a longer time period).
Use the information in your claim denial notice in
preparing your appeal. You should also be aware that the
plan must provide claimants, on request and free of
charge, copies of all documents, records, and other
information relevant to the claim for benefits. Be sure to
include all information related to your claim,
particularly any additional information or evidence, and
get it to the person specified in the denial notice before
the end of the 60-day period.
Plan officials have 60 days to review your appeal. If
it is going to take longer, they must notify you in
writing of the delay. Plan officials can extend the
decision due date an additional 60 days, for a total of
120 days. There is one exception. When a committee or
board of trustees reviews your appeal and that entity
meets only quarterly, your appeal may take longer.
Once a final decision on your claim is made, the plan
must send you a written explanation of the decision. The
notice must be in plain language that can be understood.
It must include all the specific reasons for denial of
your claim on appeal, refer you to the plan provisions on
which the decision is based, tell you if the plan has any
additional or voluntary levels of appeal, explain your
right to receive all documents that are relevant to your
benefit claim free of charge, and describe your rights to
seek judicial review of the plan’s decision.
If the plan’s final decision denies your claim, you
may want to seek legal advice regarding your rights to
bring an action in court to challenge the denial. You also
may want to contact the nearest office of the Department
of Labor’s Employee Benefits Security Administration (EBSA)
about your rights if you believe the plan failed to follow
any of ERISA’s requirements in handling your benefit
claim.
Contact EBSA if you don’t receive a written notice of
the decision on your claim or appeal, if you have tried to
reach a plan official to file or inquire about a claim and
received no response, or if you have other questions about
filing a claim or about your retirement plan.
You can reach the EBSA regional office nearest you by
calling 1.866.444.EBSA (3272)
For more information about the claims procedure rules
and retirement plans go to EBSA’s Web site, www.dol.gov/ebsa.
You may also wish to consult the following EBSA
publication: What You Should Know About Your Retirement Plan
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Check your eligibility for benefits before filing a
claim. Read your SPD and contact your plan administrator
if you have questions.
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Once your claim is filed, the maximum allowable waiting
period for a decision is 90 days (180 days if an extension
applies). Usually, you will receive a decision within this
timeframe.
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If your claim is denied, you must receive a written
notice, including specific information about why your
claim was denied and how to file an appeal.
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You have 60 days to request a full and fair review of
your denied claim. Use your plan’s appeals procedure and
gather and submit new evidence or information to help the
plan in reviewing its initial decision.
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Reviewing your appeal can take up to 60 days, and up to
an additional 60 days, if you have been notified of the
need for an extension. The plan must send a written
notice, telling you whether the appeal was granted or
denied.
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If the appeal is denied, the written notice must tell
you the reason it was denied, describe any voluntary
appeal levels, and contain a statement regarding your
rights to seek judicial review of the plan’s decision.
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You may decide to seek legal advice if your claim’s
appeal is denied. If you believe the plan failed to follow
ERISA’s requirements, you may want to contact the
nearest EBSA office concerning your rights under ERISA.
This publication has been developed by the U.S. Department of Labor, Employee Benefits Security Administration. For a complete list of the agency's publications, call
our toll free number at 1.866.444.EBSA (3272). This material will be made available in alternate format upon request: Voice phone: 202.693.8664, TTY: 202.501.3911.
This booklet constitutes a small entity compliance guide for purposes of the Small Business Regulatory Enforcement Act of 1996.
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