What to do when your ERISA claim gets denied in New Jersey

On Behalf of | May 23, 2022 | ERISA

ERISA is a federal law that regulates employee benefit plans. If you have been denied benefits under an ERISA-covered plan in New Jersey, here are some of your options.

ERISA in New Jersey

ERISA is the Employee Retirement Income Security Act of 1974. This law regulates employee benefit plans, including health insurance, disability insurance, and pension plans. If an ERISA-regulated plan covers you, the law requires your employer to provide you with certain information about the program, including a summary plan description (SPD). This SPD should contain information about who is eligible, what benefits are available, and how to file a claim.

What to do if your claim is denied

If your ERISA claim is denied in New Jersey, you will receive a written notice from your insurer explaining the reasons for the denial. This notice will also inform you of your right to appeal the decision.

You have a limited time to file an appeal, typically 180 days from the date you receive the denial notice. To appeal a claim denial, you must submit written documentation to your insurer that supports your case for benefits. Be sure to include your medical records, employment records, and other relevant documentation.

If your appeal is denied, you may file a lawsuit against your employer or plan administrator in federal court. However, before doing so, ensure that you gathered all the evidence you needed in your initial appeal because the federal court will only consider the evidence in your insurance company’s file.

Reasons for ERISA denial in New Jersey

ERISA disability denials can occur when an employer fails to provide the employee with the necessary information about the plan. If you don’t have an SPD, it may be difficult to prove that you are eligible for benefits. Another reason for denial is if your employer incorrectly classified you as an employee or independent contractor. This can happen if you work for a small company or are a seasonal worker. Finally, your claim may be denied if you fail to meet the plan’s eligibility requirements, such as having worked for the company for a certain number of years.

Sufficient relevant evidence is vital when applying for ERISA for the first time or appealing. This is because ERISA laws strictly limit the evidence a federal judge can consider during a claim.