Benefits Denials ERISA Section 1133 Requirements

Section 1133 of ERISA (29 U.S.C. § 1133) requires that a notice of a denial of benefits sent to a plan participant or that participant's beneficiary provide adequate notice of the denial containing the specific reasons for the denial that are written in a manner calculated to be understood by the recipient of the notice.

Section 1133 also requires that the employee benefit plan provide such plan participant or beneficiary a reasonable opportunity for a full and fair review of the decision to deny the claim by the appropriately named fiduciary.

It is recommended that the benefit denial should provide notice of the plan participant's opportunity to appeal the denial, submit additional information, and what type of information is needed for the appeal.