How To File A Claim For Your Retirement Benefits (UPDATED)

Table of Contents

For the purposes of the Small Business Regulatory Enforcement Fairness Act of 1996, this article serves as a small entity compliance guide.

How To Claim Your Retirement Benefits (UPDATED)

Claiming Your Retirement Benefits

If you have a typical pension plan, a 401(k), or any type of employer-sponsored retirement plan, you will need to know how to collect your benefits. The steps mentioned below clarify some of your plan’s responsibilities as well as the procedures and dates for making a retirement benefit claim.

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Be informed of the Employee Retirement Income Security Act of 1974 (ERISA), which protects your retirement benefits and establishes criteria for people who administer your retirement plan, before you file. The law establishes rules for the processing of benefit claims, the timing for a decision once you file a claim, and your rights if your claim is denied, among other things.

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Some employee benefit plans (such as those sponsored by government agencies and most churches) are not covered by ERISA. Take a few minutes to read on if you are one of the millions of participants and beneficiaries who rely on retirement benefits from a private-sector, employment-based retirement plan before filing a claim.

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How To Claim Your Retirement Benefits Below

Studying the Summary Plan Description
Claim Submission
Waiting Time
If Denied, Appeal
Examining an Appeal
If Your Appeals Is Declined

STEP 1: Studying the Summary Plan Description

The summary plan description (SPD) for your plan is an important document relating to your retirement benefits. The SPD gives a comprehensive description of the plan, including how it operates, what benefits it offers, and how to file a claim. It also explains your ERISA rights and duties, as well as your plans.

You should also verify the claim filing, grievance, and appeal procedures in the collective bargaining agreement for some single employer collectively bargained plans, as they may apply to requests for retirement benefits.

Review the SPD before applying for retirement benefits to ensure you satisfy the plan’s requirements and are aware of the claim procedures.

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How To File A Claim For Your Retirement Benefits (UPDATED)

Claim procedures are sometimes included in a separate document that comes with your SPD. Make a formal request to your retirement plan’s administrator for a copy of your plan’s SPD or claims procedures if you don’t already have them. A copy must be provided to you by your plan administrator.

If you aren’t retiring but are moving employment and want to roll your money over to an IRA or another company’s retirement plan, the SPD will inform you if and how you can do so. The process for seeking a rollover will be specified in plans that allow it. Your SPD will also notify you if any benefits have unique rules, such as early retirement benefits

STEP 2: Claim Submission

Checking your SPD to see if you fulfil your plan’s eligibility standards for benefits is a crucial first step. For example, your plan may stipulate that you must have worked for a specific number of years and/or be a certain age before collecting benefits. Also, be aware of the requirements for filing a claim under your plan.

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The SPD, or claims procedure pamphlet, must include instructions on how to submit, what to file, and who to contact if you have questions about your plan, such as how to calculate your retirement benefits. Plans are not allowed to charge any fees or costs for filing claims or appeals.

If the information you need isn’t in the SPD or claims procedure booklet, write to your plan administrator, your employer’s human resource department (or the office that typically handles claims), or another office to let them know you have a claim. For your records, keep a copy of the letter. You might also want to send the letter certified mail with the return receipt requested so that you can keep track of who received it.

How To File A Claim For Your Retirement Benefits (UPDATED)

If the claim is being filed by someone other than you, such as an authorized agent or a beneficiary, that person should refer to the SPD and follow your plan’s claims procedure. When filing this type of claim, the procedure may require additional documents. Keep a copy of your claim for your records after you’ve submitted it.

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STEP 3: Waiting Time

Your plan has 90 days to assess your claim and determine if you will be eligible for retirement benefits. It might not take as long as you think. If your plan needs additional time to decide your claim due to exceptional circumstances, it must notify you within the 90-day period that more time is required, why it is required, and when you might expect a decision.

Plans can take up to 90 days to make a decision on your claim. Keep track of the date you filed your claim.
Typically, disputes are resolved within 90 days (or 180 days if an extension applies). If you are eligible for benefits, look over your SPD to see how and when they will be paid.

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If your claim is denied, the insurance company must notify you in writing within 90 days (or 180 days if an extension is granted). This notice must be written in easy-to-understand language. It must include all of the precise reasons for the denial, direct you to the plan terms upon which the decision is based, and advise you whether additional information from you is required to decide the claim, what that information is, and why it is required.

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It must also outline the plan’s procedures and deadlines for filing an appeal for a complete and fair evaluation of your claim.

STEP 4: If Denied, Appeal

For a variety of reasons, claims are denied. Maybe you haven’t been a part of the plan for long enough. Alternatively, you may not be old enough to qualify for the plan’s age restrictions. Alternatively, it’s possible that the plan merely needs additional information about your claim.

The plan must offer you at least 60 days to file an appeal, regardless of the cause (check your SPD or claims procedure booklet to see if your plan provides a longer time period). Prepare your appeal using the information from your claim denial notification.

How To File A Claim For Your Retirement Benefits (UPDATED)

You should also be aware that the plan is required to provide claimants with free copies of all documents, records, and other information relevant to their benefit claim upon request. Make careful to include all relevant material, especially any additional information or evidence, and send it to the individual listed in the denial notice before the 60-day time expires.

STEP 5: Examining an Appeal

Officials from the plan have 60 days to consider your appeal. They must notify you in writing if it will take longer than expected. Officials from the plan can extend the decision deadline by another 60 days, for a total of 120 days. One exception exists. Your appeal may take longer if it is reviewed by a committee or board of trustees that meets just once a quarter.

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The plan must send you a written explanation of the decision once it has made a final decision on your claim. The message must be written in easy-to-understand language.

It must include all of the specific reasons for the plan’s denial of your appeal, direct you to the Plan provisions upon which the decision is based.

Also, inform you if the plan offers any additional or voluntary levels of appeal, explain your right to receive all documents relevant to your benefit claim free of charge, and describe your rights to seek judicial review of the plan’s decision.

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STEP 6: If Your Appeals Is Declined

If the plan’s final decision refuses your claim, you should obtain legal counsel about your legal options for challenging the refusal in court. If you believe the plan failed to follow any of ERISA’s rules in handling your benefit claim, you should call the nearest office of the Department of Labor’s Employee Benefits Security Administration (EBSA).

How To File A Claim For Your Retirement Benefits

Summary of How to File a Claim

Before you file a claim for benefits, make sure you’re eligible. If you have any questions, read your SPD and contact your plan administrator.
The longest time you can wait for a decision after filing a claim is 90 days (180 days if an extension applies). Within this timeframe, you should usually receive a decision.
If your claim is denied, you must get written notification that includes precise information about why your claim was denied as well as instructions on how to pursue an appeal.
You have 60 days to ask for a full and fair review of a claim that has been denied. Utilize your plan’s appeals mechanism to gather and present fresh evidence or information that will assist the plan in reconsidering its initial decision.
It can take up to 60 days for your appeal to be reviewed, plus another 60 days if you’ve been advised that you’ll require an extension. The plan must send you a written notification informing you of the outcome of your appeal.
If your appeal is denied, you must receive a written notice that explains why describes any voluntary appeal levels and informs you of your rights to seek judicial review of the plan’s decision.
If your claim’s appeal is denied, you may want to seek legal advice. If you believe the plan does not comply with ERISA’s standards, you should contact the local EBSA office to discuss your ERISA rights.

PLEASE NOTE:

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 1-866-444-3272.

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