U.S. Code » Title 29 » Chapter CHAPTER 18— EMPLOYEE RETIREMENT INCOME SECURITY PROGRAM › Subchapter SUBCHAPTER I— PROTECTION OF EMPLOYEE BENEFIT RIGHTS › Subtitle Subtitle B— Regulatory Provisions › Part part 5— administration and enforcement

29 U.S.C. § 1133

Claims procedure

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In accordance with regulations of the Secretary, every employee benefit plan shall—(1) 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, and(2) 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.(Pub. L. 93–406, title I, § 503, Sept. 2, 1974, 88 Stat. 893.)Statutory Notes and Related SubsidiariesRegulations

Secretary authorized, effective Sept. 2, 1974, to promulgate regulations wherever provisions of this subchapter call for the promulgation of regulations, see section 1031 of this title.

Notes of Decisions
Cited in 1,466 cases (267 in the last 5 years), 1977–2026 · leading case: Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355 (2002).
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Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355 (2002). · cites it 8× “It simply requires plans to afford a beneficiary some mechanism for internal review of a benefit denial, 29 U. S. C. § 1133 (2), and provides a right to a subsequent judicial forum for a claim to recover benefits, § 1132(a)(1)(B).”
Summers v. Touchpoint Health Plan, Inc., 2008 WI 45 (Wis. 2008). · cites it 34× “¶ 3 There are two principal issues upon review: 1) Whether the termination decision itself, which denied the resubmitted request for benefits under an ERISA-governed plan, as well as the termination letter, were both arbitrary and capricious when, as here, the termination letter…”
Gagliano v. Reliance Stand. Life Ins., 547 F.3d 230 (4th Cir. 2008). · cites it 8× “The Initial Termination Letter included the requisite notice required by ERISA, 29 U.S.C. § 1133 , informing Gagliano of her right to appeal the denial of her claim.”
Cooper v. Hewlett-Packard Co., 592 F.3d 645 (5th Cir. 2009). · cites it 8× “29 U.S.C. § 1133 (2). To comply with the "full and fair review" requirement in deciding benefit claims under ERISA, a claim administrator must provide the specific grounds for its benefit claim denial.”
Massachusetts Mut. Life Ins. v. Russell, 473 U.S. 134 (1985). · cites it 4× “893 -894, 29 U. S. C. §§ 1133 , 1135, appear at 29 CFR § 2560.”
Vaught v. Scottsdale Healthcare Corp. Health Plan, 546 F.3d 620 (9th Cir. 2008). · cites it 6× “See 29 U.S.C. § 1133 (2). While the ERISA statute and regulations do not explicitly describe these procedures as nonadversarial, we recognized in Amato that the institution of these review procedures "was apparently intended by Congress to," among other things, "provide a…”
Moffett v. Halliburton Energy Servs., Inc., 291 F.3d 1227 (10th Cir. 2002). · cites it 4× “setting forth the specific reasons for (the) denial, written in a manner reasonably calculated to be understood by the participant” as required by 29 USC § 1133 (1); C. ... fail[ure] to provide “opportunity .”
Omega Hosp., LLC v. United Healthcare Servs., Inc., 345 F. Supp. 3d 712 (M.D. La. 2018). · cites it 9× “Count II: Failure to Provide Full and Fair Review Under ERISA, 29 U.S.C. § 1133 In Count II of the First Amended Complaint , Omega alleges that United failed to provide Omega and the ERISA Class members a full and fair review of denied claims as required under 29 U.”
Glista v. Unum Life Ins. Co. of Am., 378 F.3d 113 (1st Cir. 2004). · cites it 5× “29 U.S.C. § 1133 (2003). In 2000, the Department of Labor promulgated regulations interpreting “full and fair review” to require that claimants be given access to all “relevant” documents.”
Aetna Health Inc. v. Davila, 542 U.S. 200 (2004). · cites it 2× “" 29 U. S. C. § 1133 (2). This strongly suggests that the ultimate decisionmaker in a plan regarding an award of benefits must be a fiduciary and must be acting as a fiduciary when determining a participant's or beneficiary's claim.”
Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003). · cites it 2× “See 29 U. S. C. § 1133 ; 29 CFR §2560.503-1 (2002).”
Pens. Plan Guide P 23925i Faith Wilczynski v. Lumbermens Mut. Cas. Co., 93 F.3d 397 (7th Cir. 1996). · cites it 7× “29 U.S.C. § 1133 . In order to permit such a review, she must be given the opportunity to “review pertinent documents.”
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— 29 U.S.C. § 1133(1) — 1 case
Vicki Jordan v. Northrop Grumman Corp. Welfare Benefit Plan Metro. Life Ins. Co., 370 F.3d 869 (9th Cir. 2004).
— 29 U.S.C. § 1133(2) — 3 cases
Sage v. Automation, Inc. Pension Plan & Trust, 845 F.2d 885 (10th Cir. 1988).
Young v. Sun Life & Health Ins. Co., 285 F. Supp. 3d 1109 (E.D. Cal. 2018).
Gray v. Minnesota Life Ins. Co. (S.D. Tex. 2021).
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