New Regulations Under the Employee Retirement Income Security Act (ERISA)
On December 19, 2016, the Employee Benefits Security Administration of the U.S. Department of Labor (DOL) issued final regulations relating to the processing of disability benefit claims under the Employee Retirement Income Security Act (ERISA). The purpose of these amendments are to “promote fairness and accuracy in the claims review process” and “alleviate the financial and emotional hardship suffered by many individuals when they are unable to work after becoming disabled and their claims are denied.”
The final regulation was based on a proposed regulation published for comment on November 18, 2016, and over 100 comments that were timely submitted thereafter. Andalman & Flynn submitted comments on behalf of claimants.
How Has the Disability Benefit Claims Filing Process Changed?
Important changes for claimants reflected in the final regulations include, among other things:
- Claims and appeals must be adjudicated in a manner designed to ensure independence and impartiality of the persons involved in the making the benefit determination;
- Benefit denial notices must contain a complete discussion of why the plan denied the claim, including the basis of disagreeing with the views of health care professionals, vocational professionals or with disability determinations by the Social Security Administration (SSA);
- The Plans must disclose internal rules, guidelines, protocols, standards or other similar criteria relied upon in making an adverse benefit determination with the adverse decision;
- Claimants must be given notice and a fair opportunity to respond before denials at the appeals stage when the denials are based on new or additional evidence or rationales;
- Denial notices on appeal must now also specify a date within which any lawsuit must be filed.
The new regulations become effective on January 18, 2017.
Contact the Disability Lawyers at Andalman & Flynn in Maryland
The disability team at Andalman & Flynn makes it a practice to stay up to date on new regulations and case law to provide the most effective representation to our clients. We normally provide free consultations for clients looking to file for disability insurance benefits or appeal the denial or termination of those benefits, whether the claim is covered by ERISA or not. Contact Andalman & Flynn for a free consultation today.
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