ERISA is Exhausting

Exhaustion of administrative remedies is also very important under ERISA. If your ERISA benefits require you to go through certain administrative remedies in order to dispute a claim denial, then you must exhaust those remedies before you can go to court. For example, in the case of an ERISA life insurance claim, the insurance policy may require you to submit a claim within a certain number of days. If that claim is denied, then you are often required to appeal to the claims handler who denied your claim and ask them to reconsider that denial before you file a lawsuit. If you don’t go through that process or you fail to appeal within the appropriate timeframe, a court may later find that you failed to exhaust administrative remedies. This is very bad because it could be the end of the road for your claim.

Your case will very likely be dismissed by the court if exhaustion has not occurred. Although most claims will involve an initial decision and an appeal, some plans may allow additional administrative remedies that should be utilized before you can file suit. The plan can also specify the statute of limitations, so this whole process can easily cause disaster.

The ERISA benefit plan may also require sending each claim to a different entity, so it is important to know exactly what to do and what the deadlines are for each step. It is also important to know when the insurance company has missed a deadline, because you may be able to file suit and strip them of one of their biggest defenses to your claim; the arbitrary and capricious standard of review.