benefit plan appeals

posted by Doris Dabrowski  |  Nov 25, 2009 10:32 AM [EST]  |  applies to Pennsylvania

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The Employee Retirement Income Security Act (ERISA) applies to retirement plans and

"welfare benefit" plans, e.g., disability and health plans sponsored by employers or unions.

ERISA plans must provide an internal review procedure for claimants who wish to challenge

a denial of benefits.  In the course of the plan appeal, Claimants have a right to review all evidence relevant to the decision.  Claimants must produce evidence in support

of their claim during the plan review.  If the plan fiduciaries have discretion to interpret the plan, a court typically determines whether the plan fidicuaries abused their discretion when evaluating the plan and when conducting the plan review.  The Claimant may not even be allowed to

introduce evidence in court, unless the evidence was already part of the record in the plan review process.  It is essential to make a complete record in the plan review process.

It is wise to engage an attorney familiar with ERISA appeals at the plan appeal stage, which is critical to the success of the entire case.


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