Updated Department of Labor Rules: Disability Claims Procedures

On January 1st, 2018, the Department of Labor updated their rules affecting disability claims procedures for benefits based on the determination of disability. Although some may think these rules only apply to short-term disability and long-term disability plans, these rules actually have a much broader impact as they apply to any employee benefit plans subject to ERISA if the benefits are based on the determination of disability. This could include a retirement plan, life insurance plan, or profit-sharing plan, just to name a few examples.

With the updated rules going into effect on April 1st, 2018, it is crucial for employers, insurers, and third party administrators (TPAs) nationwide to be aware of the updated rules and to understand the impact. The updated rules will effect:

  • The content of benefit denial notices
  • The appeals process for benefit denials
  • The impact of benefit denials on employees who are involved in processing claims (for example, tying compensation to the amount of benefit denials issued)
  • The process for how claims are handled if a plan does not follow the processing rules and the remedies available for employees
  • Rescissions of coverage (other than for non-payment of premiums)
  • Notices provided to employees who may not speak or read English



Do not delay, it’s important to review the language in your Summary Plan Description (SPD) in order to ensure compliance! Here at BASIC, we provide our ERISA Essentials clients with updated Plan Documents as necessary. This include updating the language and advising our clients on the necessary distribution of updated plan documents. Clients have secured online access to their plan documents 24/7, and they also have email access to our regulatory compliance experts 24/7. Our compliance team has been in existence for over 20 years, and contains experts with over 200 years of combined HR/Compliance experience.

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