A Denied ERISA Claim: The Appeal Deadline, the Plan's Deadlines and When to Call an ERISA Lawyer

What an ERISA claim is

The regulation defines it: “a claim for benefits is a request for a plan benefit or benefits made by a claimant in accordance with a plan's reasonable procedure for filing benefit claims.” (29 C.F.R. § 2560.503-1(e)) So the first step is the plan's own claim process, under the plan's own rules.

A suit to recover benefits can be brought in either court system: “State courts of competent jurisdiction and district courts of the United States shall have concurrent jurisdiction of actions under paragraphs (1)(B) and (7) of subsection (a) of this section.” (29 U.S.C. § 1132(e)(1))

What a denial notice must tell you

The Act requires every plan to “provide adequate notice in writing to any participant or beneficiary whose claim for benefits under the plan has been denied, setting forth the specific reasons for such denial, written in a manner calculated to be understood by the participant,” (29 U.S.C. § 1133(1))

The regulation adds that the notice must include “A description of the plan's review procedures and the time limits applicable to such procedures, including a statement of the claimant's right to bring a civil action under section 502(a) of the Act following an adverse benefit determination on review;” (29 C.F.R. § 2560.503-1(g)(1)(iv))

For disability benefits, “the statement of the claimant's right to bring an action under section 502(a) of the Act shall also describe any applicable contractual limitations period that applies to the claimant's right to bring such an action, including the calendar date on which the contractual limitations period expires for the claim.” (29 C.F.R. § 2560.503-1(j)(4)(ii)) Read the denial notice for that date. It is the plan's deadline to sue, and this page cannot count it for you.

The deadline to appeal a denied ERISA claim

A plan's procedures must “Provide claimants at least 60 days following receipt of a notification of an adverse benefit determination within which to appeal the determination;” (29 C.F.R. § 2560.503-1(h)(2)(i)) A group health plan's must “Provide claimants at least 180 days following receipt of a notification of an adverse benefit determination within which to appeal the determination;” (29 C.F.R. § 2560.503-1(h)(3)(i))

For disability claims the longer period applies too: “The claims procedures of a plan providing disability benefits will not, with respect to claims for such benefits, be deemed to provide a claimant with a reasonable opportunity for a full and fair review of a claim and adverse benefit determination unless, in addition to complying with the requirements of paragraphs (h)(2)(ii) through (iv) and (h)(3)(i) through (v) of this section,” (29 C.F.R. § 2560.503-1(h)(4)) which brings in the group health rule quoted above.

Say you received a denial of disability benefits on June 15, 2026. Appeal by December 12, 2026 to be safe. For a pension or life insurance claim denied the same day, appeal by August 14, 2026. Your plan may give more time; its denial notice states its time limits.

What a full and fair review includes

The Act requires every plan to “afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim.” (29 U.S.C. § 1133(2))

The regulation fills that in. A plan's procedures must “Provide claimants the opportunity to submit written comments, documents, records, and other information relating to the claim for benefits;” (29 C.F.R. § 2560.503-1(h)(2)(ii)) They must “Provide that a claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits.” (29 C.F.R. § 2560.503-1(h)(2)(iii)) And they must “Provide for a review that takes into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination.” (29 C.F.R. § 2560.503-1(h)(2)(iv))

For health plans, and so for disability plans, the review must “Provide for a review that does not afford deference to the initial adverse benefit determination and that is conducted by an appropriate named fiduciary of the plan who is neither the individual who made the adverse benefit determination that is the subject of the appeal, nor the subordinate of such individual;” (29 C.F.R. § 2560.503-1(h)(3)(ii))

For disability claims, “before the plan can issue an adverse benefit determination on review on a disability benefit claim, the plan administrator shall provide the claimant, free of charge, with any new or additional evidence considered, relied upon, or generated by the plan, insurer, or other person making the benefit determination” (29 C.F.R. § 2560.503-1(h)(4)(i)), in time for you to respond. So the appeal is the time to send the medical records, statements and other evidence you want considered.

How long the plan has to decide

On a claim, the plan must decide within a reasonable period, “but not later than 90 days after receipt of the claim by the plan,” (29 C.F.R. § 2560.503-1(f)(1)) unless special circumstances require more time. “In no event shall such extension exceed a period of 90 days from the end of such initial period.” (29 C.F.R. § 2560.503-1(f)(1))

For disability benefits, the plan must decide within a reasonable period, “but not later than 45 days after receipt of the claim by the plan. This period may be extended by the plan for up to 30 days,” (29 C.F.R. § 2560.503-1(f)(3)) with notice; and “the period for making the determination may be extended for up to an additional 30 days,” (29 C.F.R. § 2560.503-1(f)(3)) with notice again.

A group health plan must decide a claim for past care within a reasonable period, “but not later than 30 days after receipt of the claim. This period may be extended one time by the plan for up to 15 days,” (29 C.F.R. § 2560.503-1(f)(2)(iii)(B)) and a claim for approval before care within a reasonable period appropriate to the medical circumstances, “but not later than 15 days after receipt of the claim by the plan.” (29 C.F.R. § 2560.503-1(f)(2)(iii)(A))

On an appeal, the plan must decide within a reasonable period, “but not later than 60 days after receipt of the claimant's request for review by the plan,” (29 C.F.R. § 2560.503-1(i)(1)(i)) unless special circumstances require more. “In no event shall such extension exceed a period of 60 days from the end of the initial period.” (29 C.F.R. § 2560.503-1(i)(1)(i)) For disability, “claims involving disability benefits (whether the plan provides for one or two appeals) shall be governed by paragraph (i)(1)(i) of this section, except that a period of 45 days shall apply instead of 60 days for purposes of that paragraph.” (29 C.F.R. § 2560.503-1(i)(3)(i))

For a group health plan with one level of appeal: “In the case of a group health plan that provides for one appeal of an adverse benefit determination, such notification shall be provided not later than 30 days after receipt by the plan of the claimant's request for review of an adverse benefit determination.” (29 C.F.R. § 2560.503-1(i)(2)(ii)) That is for approval before care. For care already received: “In the case of a group health plan that provides for one appeal of an adverse benefit determination, such notification shall be provided not later than 60 days after receipt by the plan of the claimant's request for review of an adverse benefit determination.” (29 C.F.R. § 2560.503-1(i)(2)(iii)(A))

When you can take an ERISA claim to court

The plan's appeal comes first. But the regulation says that “in the case of the failure of a plan to establish or follow claims procedures consistent with the requirements of this section, a claimant shall be deemed to have exhausted the administrative remedies available under the plan” (29 C.F.R. § 2560.503-1(l)(1)) For disability, the rule is stricter: “In the case of a claim for disability benefits, if the plan fails to strictly adhere to all the requirements of this section with respect to a claim, the claimant is deemed to have exhausted the administrative remedies available under the plan,” (29 C.F.R. § 2560.503-1(l)(2)(i))

In court, “the court in its discretion may allow a reasonable attorney's fee and costs of action to either party.” (29 U.S.C. § 1132(g)(1)) The court may award fees to either side, so ask any lawyer how fees and costs are handled.

Asking for plan documents, and the daily penalty

The Act backs a request for documents with a penalty. An administrator “who fails or refuses to comply with a request for any information which such administrator is required by this subchapter to furnish to a participant or beneficiary (unless such failure or refusal results from matters reasonably beyond the control of the administrator) by mailing the material requested to the last known address of the requesting participant or beneficiary within 30 days after such request may in the court's discretion be personally liable to such participant or beneficiary in the amount of up to $100 a day from the date of such failure or refusal,” (29 U.S.C. § 1132(c)(1)) and the court may order other relief. The regulation adjusts that amount: “the maximum amount of the civil monetary penalty established by section 502(c)(1) of the Employee Retirement Income Security Act of 1974, as amended (ERISA), is hereby increased from $100 a day to $110 a day.” (29 C.F.R. § 2575.502c-1)

Say you asked in writing on July 1, 2026 and the documents came on August 20, 2026. The period ran to July 31, 2026, so they came 20 days after it, and the adjusted amount allows up to $2,200.00 for those days. Whether a court awards any of it is in its discretion.

Talking to an ERISA lawyer

This site is not a law firm, does not refer anyone to a lawyer, and cannot say whether a plan owes a benefit or what a court would award. The questions that decide a claim are a lawyer's: what the plan says, what the appeal should put in the record, whether the plan followed the regulation, and when the plan's deadline to sue runs out.

Bring the denial notice, the plan document and summary plan description, your claim file, the medical or other records you sent, and the dates of the claim, the denial, any appeal and any request for documents.

What this page does not cover

It reads no plan, and a plan can give more time than the regulation requires and sets its own deadline to sue. It does not cover the urgent care or concurrent care rules, a plan with two levels of appeal, a government or church plan, or state insurance law.

It applies the statute as the 2024 edition of the United States Code prints it and the regulations as the eCFR printed them on October 1, 2026. It read no Department of Labor web page, which this site's research could not open.