Employer Guides
Appealing employer-sponsored plan denials, ERISA rules, self-funded plans, and workplace benefits navigation.
75 articles in this topic
ERISA Appeals Explained: Your Complete Guide
How ERISA governs employer plan appeals and your rights.
ERISA vs. State Insurance Law: Which Applies to You
Understanding when federal law preempts state protections.
ERISA Full and Fair Review Standard
What your employer plan must provide during an appeal.
ERISA Arbitrary and Capricious Standard of Review
The legal standard courts use for ERISA appeal cases.
ERISA De Novo Review Explained
When courts review your claim from scratch.
Building the ERISA Administrative Record
Why every document matters in an ERISA appeal.
ERISA Exhaustion of Remedies Requirement
Why you must complete internal appeals before going to court.
ERISA Statute of Limitations for Appeals
Deadlines for filing ERISA lawsuits after denied appeals.
ERISA Fiduciary Duty and Conflicts of Interest
How insurer conflicts affect your appeal rights.
Self-Funded Plan Appeals: How They Differ
Why self-funded plan appeals follow different rules.
Fully Insured vs. Self-Funded Plans: Appeal Differences
How your plan type affects your appeal options.
How to Find Out if Your Plan Is Self-Funded or Fully Insured
Steps to determine which rules apply to your appeal.
How to Read Your Summary Plan Description (SPD)
Finding coverage rules and appeal procedures in your SPD.
Plan Document vs. Summary Plan Description
When these documents conflict and which one controls.
How to Request Plan Documents from Your Employer
Your ERISA right to plan information.
Navigating Your HR Department During an Appeal
How to work with HR to support your appeal.
Getting Your HR Department to Intervene on Your Behalf
When and how HR can help overturn a denial.
Filing a Complaint with Your Employer About the Insurer
How to escalate when your employer's insurer is not cooperating.
Union Help with Insurance Appeals
How your union can assist with denied claims.
Taft-Hartley Plan Appeals
Appealing denials from multiemployer union plans.
Church Plan Appeals: Special Rules
How church plan exemptions affect your appeal rights.
Government Employee Insurance Appeals
Appeal processes for federal, state, and local government workers.
FEHB Appeals for Federal Employees
The Federal Employees Health Benefits appeal process.
TRICARE Appeals for Military Families
How the military health system appeal process works.
Retiree Health Plan Appeals
Appealing denials from employer retiree coverage.
COBRA Continuation Coverage Appeals
When COBRA claims are denied and how to respond.
Open Enrollment Mistakes That Lead to Denials
Coverage gaps from enrollment errors and how to fix them.
New Employee Waiting Period Denials
When claims are denied during your coverage waiting period.
Employer Wellness Program Coverage Issues
When wellness incentives create coverage problems.
Employee Assistance Program (EAP) and Insurance Appeals
How EAP benefits interact with your health coverage.
Small Business Health Plan Appeals
Appeal rights for employees of small companies.
Large Employer Plan Appeals
How big company plan appeals work.
HMO vs. PPO Appeal Process Differences
How your plan type affects the appeal process.
EPO Plan Appeal Process
Appealing denials from Exclusive Provider Organization plans.
POS Plan Appeals
Point of Service plan denial appeals.
High Deductible Health Plan Appeal Process
Appealing denials from HDHPs.
MEWA Plan Appeals
Multiple Employer Welfare Arrangement appeal rights.
PEO Plan Appeals
Professional Employer Organization plan denial appeals.
Association Health Plan Appeals
Appealing denials from AHP coverage.
Short-Term Disability Denial Appeals
When STD claims are denied by your employer's insurer.
Long-Term Disability Denial Appeals
Fighting LTD claim denials under ERISA.
Leave of Absence and Insurance Coverage Issues
Coverage problems during medical leave.
FMLA and Insurance Appeals
How Family Medical Leave Act interacts with claim denials.
Job Termination and Insurance Coverage Appeals
Protecting your coverage when you lose your job.
Dependent Coverage Denials on Employer Plans
When coverage for your spouse or children is denied.
Age 26 Dependent Coverage Denials
Appealing when your adult child is dropped from coverage.
Domestic Partner Coverage Denials
Fighting denials for unmarried partner benefits.
Qualifying Life Event Enrollment Denials
When your mid-year enrollment change is rejected.
Retroactive Coverage Termination Appeals
Fighting when your coverage is canceled retroactively.
Insurance Rescission: When Your Policy Is Canceled
Your rights when an insurer tries to void your coverage.
Mid-Year Plan Amendments and Your Rights
When your employer changes benefits during the plan year.
Disputing Coverage Based on SPD Language
Using plan document language to support your appeal.
ERISA Claims Procedure Violations
When your plan fails to follow required appeal procedures.
Deemed Exhaustion Under ERISA
When procedural failures let you skip to court.
ERISA Breach of Fiduciary Duty Claims
When the plan administrator acts in bad faith.
Plan Administrator Duties Under ERISA
What your plan administrator is required to do.
ERISA Document Production Penalties
Consequences when your plan fails to provide documents.
ERISA Attorney Fees: Can You Recover Legal Costs
When you can get your attorney fees paid by the plan.
ERISA Court Remedies for Denied Claims
What relief courts can grant in ERISA lawsuits.
ERISA Preemption Exceptions
When state law still applies despite ERISA.
Negotiating with Third-Party Administrators
How to work with TPAs that manage your employer's plan.
Utilization Review in Employer Plans
How UR companies affect your coverage decisions.
Second Opinion Rights Under Employer Plans
Your right to a second opinion before accepting a denial.
Appeal Rights During Open Enrollment Period
Timing your appeal around open enrollment.
Changing Plans After a Denial: What to Know
Switching coverage and how it affects pending appeals.
How Employer Stop-Loss Insurance Affects Your Claim
When stop-loss policies create additional denial pressure.
The Role of Pharmacy and Benefit Managers in Denials
How PBMs influence medication coverage decisions.
Your Employer's Fiduciary Responsibility for Health Benefits
What your employer owes you regarding plan management.
Class Action Lawsuits Under ERISA
When individual appeals become class-wide disputes.
Appeals for Executive Health Plan Denials
Special considerations for executive-level benefit plans.
International Employee Coverage Denials
Appealing denials for treatment received abroad.
Remote Worker Coverage Issues by State
When your work state and plan state create conflicts.
Contractor vs. Employee: Insurance Appeal Differences
How your employment classification affects coverage rights.
Severance Package Health Coverage Appeals
Navigating coverage during severance periods.
Employer Bankruptcy and Your Health Coverage
Protecting your benefits when your employer goes bankrupt.