Claims Procedure ERISA Requirements Checklist (General Rules)

Summary

These checklists describe the generally applicable standards for a benefit plan's internal claims procedure under the Employee Retirement Income Security Act (ERISA). The ERISA rules essentially require covered plans to establish and maintain a process reasonably designed to ensure a full and fair review of benefit claims and claimant appeals of adverse determinations. They apply to all types of ERISA plans—including retirement, welfare, fringe benefit, and other plans (see ERISA Coverage of Benefit Plans). However, there are enhanced rules for group health plans and for claims involving disability benefits, which are covered in separate checklists.