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What to do when an ERISA claim is denied

If a District of Columbia resident files a claim for disability benefits under an ERISA plan, that claim may be denied. If it is, the exact reasons for the denial will be sent to the applicant. This will be done either electronically or in writing, and electronic notices will be provided in a way that conforms with the law. In addition to the reason for the denial, a notice will include information as to what information may be needed to overturn it.

Applicants generally have the right to appeal a denial, and the notice should tell them how to do so. They should also be told how long they have to appeal if they choose to do so. A request to review the denied claim must be made no more than 180 days after learning of the denied application. The person who reviews the appeal will not be the same person who made the original determination.

A decision on the appeal request could be made within 45 days. It is also possible that the review period will be extended by 45 days if there isn't enough information to make a ruling. The extended review period will not begin until the applicant provides medical records or other documents needed to rule on an appeal.

If a benefit claim has been denied in part or in full, it may be worthwhile to consult with an attorney who could contact the plan administrator to learn more about why this happened. If necessary, legal counsel may represent an individual to resolve an ERISA benefits claim in the applicant's favor.

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