29 U.S.C. § 1132(a)
ERISA § 502(a): denied benefits, breached fiduciary duties, and why there are no damages
A federal claim in United States district courts · Last verified August 26, 2026
If your employer's health plan denied a treatment, or your disability insurer cut off payments, or your 401(k) was loaded with expensive funds, ERISA is the statute that governs — and it governs to the exclusion of nearly everything else.
That exclusivity is the point. A claim that would be an ordinary bad-faith insurance suit in state court, with a jury and punitive damages, becomes a federal ERISA claim with no jury, no punitive damages, and often no more relief than the benefit that should have been paid in the first place.
What the claim is
Three claims live in this provision, and they behave differently.
Benefits claims. A participant or beneficiary sues to recover a benefit the plan owed — a denied surgery, terminated long-term disability payments, a miscalculated pension.
Fiduciary breach claims. Someone managing plan assets did it badly or disloyally. The modern version is the 401(k) fee case: a plan retained costly funds or paid excessive recordkeeping fees and the participants absorbed the difference.
Claims for other equitable relief. A residual category for wrongs the first two do not reach.
Where the right comes from
The private right of action is express. The benefits claim reaches a participant or beneficiary:
to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan;
Read that carefully, because the limitation is inside it. The claim is under the terms of the plan. ERISA does not ask whether the denial was unfair, cruel, or medically wrong. It asks whether the plan document entitled you to the benefit.
Separate subsections carry fiduciary-breach claims and claims for other appropriate equitable relief.
What a plaintiff has to prove
For a benefits claim: that the plan is governed by ERISA, that the plaintiff is a participant or beneficiary, and that a benefit due under the plan's terms was denied.
Then comes the question that decides most of these cases — the standard of review. If the plan document grants the administrator discretionary authority to determine eligibility, the court reviews the denial only for abuse of discretion, and the administrator wins unless the decision was unreasonable. If the plan contains no such clause, review is de novo and the court decides for itself. That framework comes from Firestone Tire & Rubber Co. v. Bruch, and nearly every professionally drafted plan now includes the clause.
For a fiduciary breach claim: fiduciary status, a breach of the duty of prudence or loyalty, and a resulting loss to the plan.
There is a live circuit split on who must prove that the breach caused the loss. The Ninth, Tenth, and Eleventh Circuits put that burden on the plaintiff. The First, Second, Fourth, Fifth, and Eighth shift it to the fiduciary once a breach and a loss are shown. Which side of that line you are on can decide the case.
How long you have to file
Benefits claims have no federal deadline. Courts borrow the most closely analogous state limitations period, usually the one for written contracts. The claim accrues on a clear repudiation — the final denial after appeals.
But check the plan document before relying on any of that. Plans routinely impose their own contractual limitations period, and the Supreme Court held in Heimeshoff v. Hartford Life that a reasonable one is enforceable even where it starts running before the internal appeal process finishes. A plan can shorten your window to something far tighter than state law would give.
Fiduciary breach claims have an express deadline. Six years from the last act constituting the breach, or three years from the earliest date the plaintiff had actual knowledge of it. The six-year period operates as an outer limit.
"Actual knowledge" means what it says. In Intel Corp. Investment Policy Committee v. Sulyma the Court held that a participant who received the disclosures but did not read them does not have actual knowledge, which pushed many claims back to the six-year period.
What has to happen before you file
Exhaust the plan's internal claims and appeals process. This requirement is not in the statute — courts created it — but it is close to universal and it is enforced.
Two escapes exist. Exhaustion is excused where it would be futile. And where the plan fails to follow the claims-procedure regulation, the claim is deemed exhausted and the participant may go to court.
Exhaustion is an affirmative defense, not a jurisdictional requirement. The plan has to raise and prove the failure.
There is a practical reason to take the internal appeal seriously beyond the legal requirement: under deferential review, courts generally decide the case on the administrative record built during that process. Evidence you did not submit to the plan is often evidence the judge will never see.
Who can be sued — and who cannot
The plan itself and the plan administrator are the standard defendants for a benefits claim. Circuits disagree about whether the employer or a third-party claims administrator is also a proper defendant.
Fiduciaries — anyone exercising discretionary authority over the plan or its assets — for breach claims. Fiduciary status turns on function, not title.
Government plans and genuine church plans are exempt from ERISA entirely. A teacher's pension or a church hospital's plan may fall outside this statute, which changes everything about the claim.
Common defenses
Failure to exhaust the plan's appeal process.
Deferential review, the most effective defense there is: the denial was a reasonable reading of the plan, and reasonableness is all that is required.
The plan's own contractual limitations period.
The relief sought is not available — a recurring winner, because plaintiffs often ask for money the statute does not allow.
Preemption, which is a defense to the state-law claims a plaintiff would rather bring.
What the claim pays
The benefit itself. Declaratory and injunctive relief. Certain traditional equitable remedies against fiduciaries — surcharge, reformation, and estoppel became more clearly available after CIGNA Corp. v. Amara.
No extracontractual damages. No compensatory damages for consequential harm. No punitive damages. That has been the rule since Massachusetts Mutual Life Insurance Co. v. Russell.
No jury trial, because the relief is equitable.
Attorney's fees are discretionary and may go to either party. A claimant needs only "some degree of success on the merits" to be eligible, under Hardt v. Reliance Standard Life Insurance Co.
The consequence is stark. If a plan wrongly denies a $200,000 surgery and the patient dies waiting, ERISA's remedy is the $200,000. The statute is built to protect plan assets and predictability, and Congress chose that trade knowingly.
What people get wrong
"I'll sue the insurer for bad faith and get punitive damages." ERISA preempts the state-law bad faith tort. That route closed in Pilot Life Insurance Co. v. Dedeaux.
"I can get damages for what the denial did to me." No. Extracontractual and punitive damages are unavailable.
"I'll go straight to court." Exhaust the plan's appeals first.
"The judge will look at my case fresh." Only if the plan has no discretionary clause. Most do, and then the question is whether the administrator was reasonable, not whether it was right.
"I have years to sue." Check the plan document. It may impose a much shorter period, and it is probably enforceable.
"I get a jury." No.
"I didn't read the disclosures, so I couldn't have known." That is correct, and it helps you — this is the rare misconception that runs in the participant's favour.
Where it came from
ERISA passed in 1974 after a series of pension collapses left workers with nothing, most notoriously when a large automaker's plant closure wiped out benefits employees had counted on for decades. Congress set out to guarantee that promised benefits would be there.
The preemption clause it wrote to keep plans from facing 50 different state regimes is among the broadest in federal law, and its practical effect has been to strip remedies rather than add them. A comprehensive statute with deliberately limited make-whole relief is the anomaly at ERISA's center.
The most recent change came in Cunningham v. Cornell University (2025), where the Court held unanimously that a plaintiff pleading a prohibited transaction need only allege the elements of the prohibition; the statutory exemptions are affirmative defenses the fiduciary must plead and prove. That lowered the pleading bar and a wave of filings followed.
Common questions
Can I get punitive damages for a wrongful denial of benefits?
No. ERISA allows recovery of the benefit itself and certain equitable relief. Extracontractual, compensatory, and punitive damages are unavailable, and ERISA preempts the state-law bad-faith claims that would provide them.
Do I have to appeal to the plan before suing?
Yes. Courts require exhaustion of the plan's internal claims and appeals process, excused only for futility or where the plan failed to follow the claims regulation. Under deferential review the court will usually consider only the record built during that appeal.
How long do I have to sue over a denied benefit?
There is no federal deadline for benefits claims, so courts borrow the state limitations period for written contracts. But the plan document may impose a shorter contractual period, and a reasonable one is enforceable.
Will a judge decide my claim from scratch?
Only if the plan does not grant the administrator discretionary authority. Where it does — as most plans do — the court asks only whether the denial was reasonable.
Is my employer's plan even covered by ERISA?
Most private-sector employer plans are. Government plans and genuine church plans are exempt, which changes the available claims and remedies entirely.