How to file a formal claim under ERISA

Claims should be filed with the Claims Administrator
control room

Formal claims and appeals process

If you are not satisfied with the results of your inquiry to BP Retirement Services at Fidelity at 1-877-272-3334, you may file a formal claim. If you are still not satisfied with this decision regarding your formal claim, you may then file a formal appeal of this decision. Your formal claim for benefits is reviewed by the Claims Administrator — and if you file an appeal of that decision it is reviewed by the Appeals Administrator. ERISA Claims and Appeals is a unit that assists the Claims Administrator and the Appeals Administrator in processing your claim and appeal. A more detailed description of this claims and appeals process is provided below.

Claims process

You have the right to file a formal claim for benefits if you disagree with the response you received on your benefits inquiry from BP Retirement Services at Fidelity. This would include decisions you disagree with regarding your eligibility to participate in the plan, your eligibility for benefits, the amount of your benefits, or other issues impacting your benefits.

Your formal claim must be submitted in writing and must be filed with the plan's Claims Administrator, in care of ERISA Claims and Appeals, at the following address:

ERISA Claims and Appeals
P.O. Box 941644
Houston, TX 77094-8644

Please include a copy of any written response you received from BP Retirement Services at Fidelity and the information you submitted in support of your inquiry. To expedite receipt of your claim, please do not send your claim by certified mail. Receipt of your claim will be acknowledged as soon as administratively feasible, typically within 5-10 business days.

The Claims Administrator will consider the applicable benefit plan provisions, all of the information and evidence you present, and any other information deemed relevant, including any information that the Claims Administrator may request from you to perfect your claim (i.e., establish your right to the benefit) and complete the review.

The Claims Administrator may require you or the company to submit additional facts, documents or other evidence as the Claims Administrator, in his sole discretion, deems necessary or advisable in making such a review. The timeframe to make a determination will be tolled (suspended) from the date notification is sent until the earlier of the date a response is received or the expiration of the tolling period established by the Claims Administrator. If you do not respond, a decision will be made based on the information on file. On the basis of the review, the Claims Administrator will make an independent determination of your claim.

If your formal claim for benefits is denied, you will be provided with a written or electronic notice of the adverse benefit determination that contains:

  • The specific reason for the denial.
  • Reference to the plan provision(s) on which the denial is based.
  • A description of any additional information that is necessary to perfect your claim and an explanation of why this information is necessary.
  • A description of the plan's appeal review procedure, applicable time limits and a statement of your right to bring a civil action following an adverse benefit determination on appeal.

If your claim is denied in whole or in part, you will receive an adverse benefit determination within 90 calendar days of the date your formal claim is received by the plan, unless special circumstances require up to an additional 90 calendar days to process your claim. If an extension of time is required, you will be given written notice prior to the beginning of the extension period. The notice will indicate the special circumstances that require an extension of time and the date by which the plan expects the final decision to be rendered.

Appeals process

If your claim is denied in whole or in part, you may appeal this adverse benefit determination by submitting an appeal to the Appeals Administrator, in care of ERISA Claims and Appeals, at the following address:

ERISA Claims and Appeals
P.O. Box 941644
Houston, TX 77094-8644

To expedite receipt of your appeal, please do not send it via certified mail. Receipt of your appeal will be acknowledged as soon as administratively feasible, typically within 5-10 business days.

Your appeal must be delivered to the Appeals Administrator at the address listed above by first class mail within 60 calendar days of your receipt of the claim denial and should include a written statement:

  • Requesting a review of the Claims Administrator's decision;
  • Setting forth any new or different information upon which the appeal of the denial is based, and all facts in support thereof; and
  • Including all issues or comments which you feel are relevant to the appeal.

If the Appeals Administrator does not receive your appeal within 60 calendar days, you will be unable to file an appeal thereafter. Failure to appeal within 60 calendar days will be deemed a failure to exhaust all administrative remedies under the plan.

You may review pertinent documents to prepare your appeal at no charge to you. Upon your request, you may receive, free of charge, reasonable access to and copies of all documents, records, and other information relevant to the decision on your claim. In addition, the Appeals Administrator may request additional information from you to perfect your appeal and complete the review. 

The Appeals Administrator may require you or the company to submit additional facts, documents or other evidence as the Appeals Administrator, in his sole discretion, deems necessary or advisable in making such a review. The timeframe to make a determination will be tolled (suspended) from the date notification is sent until the earlier of the date a response is received or the expiration of the tolling period established by the Appeals Administrator. If you don't respond, a decision will be made based on the information on file. On the basis of the review, the Appeals Administrator will make an independent determination of your appeal.

You will receive a written or electronic decision on your appeal within 60 calendar days of the plan's receipt of your appeal, unless special circumstances require an extension of time for processing. In that event, a decision will be rendered as soon as possible, but not later than 120 calendar days after receipt of your appeal. If an extension of time is required, you will be given written notice prior to the beginning of the extension period. The notice will indicate the special circumstances that require an extension of time and the date by which the plan expects the decision to be rendered.

The decision on your appeal will include the reasons for the decision, a reference to the specific plan provision(s), as applicable, and other relevant information related to the decision. Generally, if you do not receive notice of the appeal decision within 120 calendar days after receipt of your appeal, your appeal is deemed denied.

Effect of the Appeals Administrator's decision

The decision of the Appeals Administrator on your appeal is final, conclusive, and not subject to further review. The Appeals Administrator (who is also the Plan Administrator) has complete discretionary authority to interpret and administer the plan and make factual decisions regarding eligibility, payment of benefits, and other plan-related issues.

After the claims and appeals process has concluded

If your claim is denied on appeal, following exhaustion of the plan's claims and appeals procedures, you may file a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974, as amended ("ERISA").

Time limits and venue for bringing suit

Any civil action for benefits that is not timely filed may be dismissed by the court for that reason. In any lawsuit you file, you must comply with both the statute of limitation applicable pursuant to ERISA and with the specific provisions of the plan that govern when lawsuits must be filed.

The plan has a provision which governs when lawsuits must be brought. Any civil action for benefits must be brought no later than two years following the earliest of: (i) in the case of any lump sum payment, the date on which the payment was made, (ii) in the case of a periodic payment, the date of the first in the series of payments, or (iii) for all other claims, the date on which the action complained of occurred. This statute of limitations will be extended by any tolling period(s) during the claim or appeal proceedings.

Any civil action for benefits under the plan must be brought in the United States District Court for the Southern District of Texas, Houston Division, as required by the provisions of the plan.

Importance of exhausting the administrative review process

If you do not file a claim, follow the claims process, or appeal on time, you will give up legal rights, including the right to file a civil action in federal court because you will not have exhausted your internal administrative appeal rights. Generally, you must exhaust your internal administrative appeal rights before you can bring a civil action in federal court. For this purpose, an inquiry or request for reconsideration made under the plan's established administrative procedures will not constitute a claim.

 

Publication date: July 2019

 

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