Run the pension-benefit claims timetable under the claims-procedure regulation
Key facts
- Human involvement
- YellowClose supervision
- How AI is used
- From the claim and the plan's claims register, record the date the plan received the claim, whether the plan has classified it as a pension benefit claim, a disability claim or a group health claim, and the dates of any extension notice and any request for review. For a claim the file treats as a pension benefit claim, count 90 days from receipt for the adverse-benefit notice, and 60 days from a request for review for the decision on review, unless the file shows the quarterly-meeting rule. Do not classify the claim, and do not write the notice.
- What the lawyer must review
- The lawyer classifies the claim and writes any adverse benefit determination. For a pension benefit claim that is not a disability claim and not a group health claim, 29 CFR 2560.503-1(f)(1) requires notice of a wholly or partly denied claim within a reasonable period, and not later than 90 days after the plan receives the claim. Special circumstances allow one extension of up to 90 days from the end of that period, if written notice is given before the initial period ends and states the special circumstances and the date a decision is expected. Paragraph (g) requires a written or electronic notice with the specific reasons, the plan provisions relied on, any further information needed to perfect the claim, the review procedure and its time limits, and the right to bring a civil action under section 502(a) of ERISA after an adverse determination on review. Paragraph (h)(2) gives at least 60 days to appeal. Paragraph (i)(1) requires a decision on review within a reasonable period, and not later than 60 days after the request for review, with one extension of up to 60 days on the same kind of written notice. If a committee or board that meets at least quarterly is the named fiduciary, the decision is tied to that meeting calendar instead. Disability claims and group health claims use the different periods in paragraphs (f)(2), (f)(3) and (i)(2) and (i)(3). The lawyer does not use the 90-day pension period for those claims. There is no Australian internal-dispute scheme and no external complaints body in this regulation.
- Written for / version
- United States versionUS
Who does what
| Role | What they do |
|---|---|
| Assistance | Potential support includes extracting and organising information and identifying points for review. Confirm the tool’s capability and permitted scope. |
| Lawyer | Set the scope, supervise the work closely, verify every part relied on, resolve omissions and exceptions, and approve the exact output. |
Checklist
- Calculate operative dates independently from the current rule and actual triggering event. Check exceptions and record the verified deadline.
- Verify the applicable jurisdiction and the version of each relevant law, rule or instrument in force at the material time.
- Confirm the output against the client’s instructions and the complete relevant source material, including omissions or contradictions.
- Resolve exceptions and record the responsible lawyer’s approval of the exact output and intended use.