ERISA regulations image

Without wasting any time in the New Year, on Friday, January 5th, the United States Department of Labor (DOL) announced that the ERISA claims handling regulations that were effective January of last year and delayed until April 1, 2018, will indeed be applicable to disability claims filed on or after April 1, 2018. The DOL did not make changes to the regulations.

Background information regarding the ERISA Regulation Amendments can be found here, including ReedGroup’s webinar. The DOL’s fact sheet also provides further information.

As a reminder, the final regulatory changes impact initial disability claim determinations and appeals administration processes, as well as benefit denial notifications. The regulatory changes include:

  • Conflict of interest criteria: adds specifics addressing the impartiality and independence of claims adjudicators, service providers, and vendors; for example, financial incentives and employment decisions cannot be tied to claim outcomes;
  • Expand benefit denial notice information: requires benefit denial notices to expand upon the reasons and criteria relied upon when denying benefits, including detailed explanation for disagreeing with the claimant’s treating physician or a Social Security Administration determination;
  • Provide claimant a right to review and respond to new information, such as a physician review report or transferrable skills assessment, as soon as it is available and determined to be relied upon during the appeal process and before an appeal-level denial is issued;
  • Consequences if the plan does not adhere to the claims processing rules or if plans are retroactively rescinded, requiring a detailed explanation from the plan of the claim processing violation;
  • Non-English language notices: the plan must make translation services available to certain claimants who speak languages other than English, such as oral languages services to assist with claim and appeal filing, translated notices upon request, and information to claimants about how to receive these language services; and
  • Contractual limitations period: if the plan sets forth a limitation period in which the claimant can bring suit for a denial of benefits, then the benefit denial notification must include a description of the contractual limitations period and the expiration date.

Reed Group has already implemented many of the changes. Remaining changes will be finalized by April 1, 2018 for disability claims filed on or after the April 1, 2018, effective date.