DOL Announces ERISA Disability Claims Handling Rules Will Go into Effect AS IS on April 1, 2018

Posted on: January 8, 2018 0

BY MARTI CARDI, VP-PRODUCT COMPLIANCE & GAIL COHEN, DIRECTOR-EMPLOYMENT LAW/COMPLIANCE 

On Friday, January 5, 2018, the U.S. Department of labor issued a press release announcing that the Final Rule amending the regulations governing claims handling procedures for ERISA disability claims will go into effect on April 1, 2018, without changes from the original.  The Final Rule was originally issued by the DOL on December 16, 2016, with an effective date of January 1, 2018.  That effective date was postponed until April 1, 2018, in order to “solicit additional public input and examine regulatory alternatives” to the Final Rule.  The DOL accepted comments until December 11, 2017.   

The DOL press release states: 

The Department announced a 90-day delay of the applicability date of the final rule – from Jan. 1, 2018, through April 1, 2018 – to give stakeholders the opportunity to submit data and information on the costs and benefits of the final rule.   . . .

The information provided in the comments did not establish that the final rule imposes unnecessary regulatory burdens or significantly impairs workers’ access to disability insurance benefits.

We wrote in detail about the ERISA changes when the final Rule was first issued and provided suggestions for employer actions.  We urge you to read that post here.  Below we provide a brief recap of the changes.

  1. Independence and impartiality of claims adjudicators. Claims and appeals must
    be decided in a manner designed to ensure independence and impartiality of the
    persons involved in making the benefit determination. 
  2. Improvements to disclosure requirements. Benefit denial notices must contain the following:
  • A complete discussion of why the plan denied the claim and the standards
    applied in reaching the decision.
  • The basis for disagreeing with the views of health care or vocational
    professionals whose opinions were provided by the claimant or obtained at
    the behest of the plan.
  • The basis for disagreeing with a finding of “disability” by the Social Security
    Administration (SSA), if applicable.
  • The specific internal rules, guidelines, protocols, standards or other similar
    criteria of the plan relied upon in making the adverse determination or, alternatively,
    a statement that such guidelines etc. do not exist.
  • If the denial is based on a medical necessity or experimental treatment or similar
    exclusion or limit, either an explanation of the scientific or clinical judgment for the
    determination, or a statement that such explanation will be provided free of charge
    upon request.
  1. Claimant’s right to access entire claim file. An initial adverse benefits determination
    must contain a statement that the claimant is entitled to receive, upon request and
    without charge, the documents relevant to the claim for benefits.
     
  2. Notice of new or additional evidence or rationales before adjudication. A claimant
    must be notified of and provided an opportunity to respond to any new evidence or
    rationales developed by the plan during the pendency of the appeal.  However, the new
    regulations do not extend the time deadlines for the plan’s determination (45 days from
    the filing of the appeal, with a possible 45-day extension).
     
  3. Claimant is deemed to have exhausted administrative remedies if a plan fails to
    comply with claims procedure requirements.
    A claimant can seek court review of a
    claim denial based on a failure to exhaust administrative remedies under the plan if
    the plan failed to comply with the claims procedure requirements, unless a detailed
    exception applies.
  4. Expanded definition of “adverse benefit determination” that triggers
    appeals procedures.
    Under the new rule, rescissions of coverage, including retroactive
    terminations due to alleged misrepresentation of fact (e.g., errors in the application
    for coverage) must be treated as adverse benefit determinations, thereby triggering
    the plan’s appeals procedures.  Rescissions for non-payment of premiums are
    not covered by this provision.
     
  5. Notices and denials must be written in a “culturally and linguistically
    appropriate” manner.
    If a disability claimant’s address is in a county where 10
    percent or more of the population is literate only in the same non-English language,
    benefit denial notices must include a prominent statement in the relevant non-English
    language about the availability of language services.  Such services must include assistance
    with filing claims and appeals in the non-English language.  The plan must provide written
    notices in the applicable non-English language upon request.

What is Matrix Doing to Comply with the New Regulations?

Not to worry – Matrix’s disability claims handling procedures will embrace the new rules and will
continue to be best in class!  We will be ready to administer our clients’ disability plans in compliance
with the new regulations by April 1, 2018.  Indeed, we originally marched toward the January 1, 2018,
compliance date. 

If you have questions, please contact your account manager or practice leader, or send us an email at ping@matrixcos.com.

DOL Announces 90-Day Delay of ERISA Disability Claims Rules Change

Posted on: November 27, 2017 0

By Marti Cardi, VP-Product Compliance & Gail Cohen, Director-Employment Law/Compliance

On Friday the U.S. Department of Labor today announced a 90-day delay – from January 1 to April 1, 2018 – of the applicability date for ERISA plans to comply with the December 16, 2016, “Final Rule” amending the claims procedure requirements applicable to disability benefits.  As explained below, further delay of the applicability date beyond April 1 is not out of the question.  The official notice will be published in the Federal Register on November 29, 2017, but an unofficial version can be reviewed here. 

According to a press release issued by the DOL:

               . . .  [T]he delay of the applicability date announced is intended to give interested stakeholders the
opportunity to submit, and for the Department to consider, data and information related to concerns
by some insurance industry and employer groups, and some members of Congress, that the claims
procedure amendments will drive up disability benefit plan costs, cause an increase in litigation and,
in so doing, impair workers’ access to disability insurance benefits.

The DOL published a notice in the Federal Register on Oct. 12, 2017, seeking comments on the proposed 90-day delay of the applicability date of the Final Rule. That comment period ended on October 27 and on November 24 the DOL announced its adoption of the delay.  Also on October 12 the DOL also asked for comments that “provide data and information germane to a re-examination of the merits of repealing, replacing, modifying, or retaining the rule.”  That comment period ends on Dec. 11, 2017.  Comments can be submitted by clicking on the “Comment Now!” button at this link.

The 108 public comments in support of and in opposition to the 90-day delay can be reviewed here.  Some of the commenters expressed concern that a 90-day delay was not sufficient to allow the DOL to review and consider all data and comments submitted regarding whether any changes (other than the delay) should be made to the Final Rule.  According to the DOL, however:

       . . . [V]arious stakeholders made a commitment to provide such data and information to the
Department. 
 . . .  If the Department receives such supporting data and information, the Department
will provide 
interested stakeholders with a reasonable opportunity for notice and comment on that
data and information.
Only at that point would the Department be in a position to seriously consider
any further delay of some or all of the requirements of the Final Rule beyond April 1, 2018.

We will continue to watch for developments regarding this subject.  However, it took the DOL over four weeks to determine whether to extend the applicability date for 90 days.  Given the more substantive issues now pending regarding the Final Rule and the comment closure date of December 11, it is unlikely that the DOL will make any significant announcements no sooner than late January 2018 at best.

 What is Matrix Doing?  At Matrix we have been working diligently to prepare for the new rules.  Regardless of the outcome of the DOL review, Matrix will be ready to administer our clients’ disability plans in compliance with the new regulations by April 1, 2018, or other new effective date.  To this end, we have assembled a task force of experts in disability plans, claims handling procedures, ERISA, and customer service.  Our practice leaders and account managers will keep clients, producers, and others apprised of our work during the lead-up to the effective date – whatever it is!  If you have questions in the meantime, contact your account manager or sales representative, or send us an email at ping@matrixcos.com.

More ERISA: Update on the DOL’s Proposed Delay of the Disability Claims Handling Rules

Posted on: November 3, 2017 0

By Marti Cardi, VP-Product Compliance & Gail Cohen, Director-Employment Law/Compliance

Hello, all you ERISA folks.  How many of you are losing sleep over the new ERISA rules for disability claims handling?  As we previously discussed here, the DOL has proposed delaying the effective date of these rules (the “Final Rule”), which are currently scheduled to go into effect for claims filed on or after January 1, 2018.  But, as we previously reported, the US Department of Labor announced that it is “reviewing these amendments for questions of law and policy” and solicited public comments on its proposal to delay the effective date of the Final rule by 90 days (until April 1, 2018).

The public comment period on this proposal ended on October 27, and today the DOL posted the 108 comments received.  They can be reviewed here.  Not surprisingly, comments from claimants and attorneys for claimants oppose the delay, and claims handling and insurance companies  favor the extension.

Also today, I had a discussion with a DOL representative working on this issue to inquire when we could expect the DOL’s decision on the delay.  I was unable to obtain any specific information (not surprised!) but received assurances that the DOL is aggressively reviewing and considering the comments received.  They are very aware that affected parties are waiting eagerly – or anxiously – for the ruling.  We will provide immediate updates of any new developments on this blog.

For a refresher on the requirements of the changes to ERISA disability claims handling requirements, as set forth in the Final Rule, review our prior blog post http://matrix-radar.com/2017/01/a-game-changer-ERISA-releases-new-ERISA-disability-claims-rules/.

Tired of reports on ERISA, NY Paid Family Leave, and all things California?  Check out our recent blog posts on other topics:

The Headless Horseman – An ADA Halloween Tale

Lucky Employer Skates on ADA Liability

7th Circuit Rules that Extended Leave is not a Reasonable ADA Accommodation

And feel free to suggest any FMLA, ADA, disability, or other absence management challenges as topics for future blog posts!

What is Matrix Doing?  At Matrix we have been working diligently to prepare for the new rules.  Regardless of the outcome of the DOL review, Matrix will be ready to administer our clients’ disability plans in compliance with the new regulations by January 1, 2018, or other new effective date.  To this end, we have assembled a task force of experts in disability plans, claims handling procedures, ERISA, and customer service.  Our practice leaders and account managers will keep clients, producers, and others apprised of our work during the lead-up to the effective date – whatever it is!  If you have questions in the meantime, contact your account manager or sales representative, or send us an email at ping@matrixcos.com.

DOL Proposes to Delay the Effective Date of ERISA Disability Claims Handling Rules and Seeks More Public Comment

Posted on: October 10, 2017 0

By Marti Cardi, VP-Product Compliance& Gail Cohen, Director-Employment Law/Compliance

 

It’s a moving target, but we’re watching!  The amended ERISA disability claims handling rules  (the “Final Rule”) are set to go into effect for claims filed on or after January 1, 2018.  But, as we previously reported, the US Department of Labor announced in July that it is “reviewing these amendments for questions of law and policy.”  Today the DOL issued a Proposed Rule that will be published in the Federal Register on October 12, 2017.  You can read an advance copy of the Proposed Rule here.

The DOL proposes to delay the effective date of the ERISA disability claims handling rules by 90 days, to April 1, 2018 (some irony there).  The reason for the delay is to allow the DOL time to “solicit additional public input and examine regulatory alternatives” to the Final Rule.  Here are some important dates:

  • Comments on the proposal to extend the applicability date for 90 days must be submitted to the Department
    on or before October 27, 2017 (15 days after publication of the Proposed Rule in the Federal Register)
  • Comments providing data and otherwise germane to the examination of the merits of rescinding, modifying,
    or retaining the rule must be submitted to the Department on or before December 11, 2017
    (60 days after publication of the Proposed Rule in the Federal Register)

We will provide immediate updates of any new developments on our blog, http://matrix-radar.com/ – please sign up!

For a refresher on the changes to the ERISA disability claims handling requirements, as set forth in the Final Rule, review our prior blog post http://matrix-radar.com/2017/01/a-game-changer-dol-releases-new-erisa-disability-claims-rules/.

What is Matrix Doing?  At Matrix we have been working diligently to prepare for the new rules.  Regardless of the outcome of the DOL review, Matrix will be ready to administer our clients’ disability plans in compliance with the new regulations by January 1, 2018, or other new effective date.  To this end, we have assembled a task force of experts in disability plans, claims handling procedures, ERISA, and customer service.  Our practice leaders and account managers will be in touch with clients during the lead-up to the effective date – whenever it is! – to discuss changes to plan notifications, procedures, and more.  If you have questions in the meantime, contact your account manager or sales representative, or send us an email at ping@matrixcos.com.

 

DOL Announces it will Review ERISA Claims Disability Handling Rules Slated for 1/1/2018

Posted on: August 3, 2017 0

By Marti Cardi, VP-Product Compliance &

Gail Cohen, Director-Employment Law/Compliance

 

As we all know, the ERISA disability claims handling rules were revised by the US Department of Labor, to be effective for claims filed on or after January 1, 2018.  As part of the ever-changing governmental landscape under our current President, the DOL has now announced it is “reviewing these amendments for questions of law and policy.” 

The DOL announcement indicates it will issue a Notice of Proposed Rulemaking in September (09/00/2017 to be exact!), but there is no indication as to the scope of its review or potential subjects within the amended rules that will be reviewed.  Possibilities include repealing the amendments entirely, modifying or repealing parts them, and/or simply delaying the effective date.  

A Notice of Proposed Rulemaking (NPRM) is a public notice issued by law when one of the independent agencies of the United States government (like the DOL) wishes to add, remove or change a rule or regulation as part of the rulemaking process. It is a process for announcing proposed regulatory changes and subsequently taking public comment.  So, we may be in limbo for a while.  Even once the NPRM is issued, there will still be unanswered questions as we go through the period of public comment and await any revisions and finalization.

For a refresher on the requirements of the new ERISA rules, review our prior blog post http://matrix-radar.com/2017/01/a-game-changer-dol-releases-new-erisa-disability-claims-rules/.

So what to do now?  If the rules go into effect in their present or similar form for claims filed on or after January 1, there is not enough time to put all preparations on hold.  Moreover, we need to remember that many of the changes made to the ERISA claims handling rules are based on federal court rulings in cases where claimants challenged the plan’s decision and procedures.  As a result many aspects of the new rules, as currently written, are still good guidance on how to manage disability claims. 

Employers with ERISA disability plans should consult with their legal counsel for advice with respect to their specific plans and procedures.  In the meantime, here are some suggestions on where employers might want to place focus while the regulatory process runs its course:

Revamp denial letters to clearly and adequately explain why the employee’s medical condition (or other factors) does not qualify the claimant for disability benefits under the employer’s plan.

Review claims handling procedures and revise as necessary to ensure impartiality and avoid conflicts of interest.

Provide updated refresher training for claims management personnel to ensure good practices and consistency in determining claims.

WHAT IS MATRIX DOING?

At Matrix we have been working diligently to prepare for the new rules.  Regardless of the outcome of the DOL review and NPRM, Matrix will be ready to administer our clients’ disability plans in compliance with the new regulations by January 1, 2018; or a new effective date.  To this end, we have assembled a task force of experts in disability plans, claims handling procedures, ERISA, and customer service.  Our practice leaders and account managers will be in touch with clients during the remainder of 2017 to discuss changes to plan notifications, procedures, and more.  If you have questions in the meantime, contact your account manager or sales representative, or send us an email at ping@matrixcos.com.

 

Hat tip to Megan Holstein for breaking the news about this hard-to-find announcement, which you can link to here:  https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201704&RIN=1210-AB39 .

 

MATRIX CAN HELP!  Matrix provides leave, disability, and accommodation management services to employers seeking a comprehensive and compliant solution to these complex employer obligations. We monitor the many leave laws being passed around the country and specialize in understanding how they work together. For leave management and accommodation assistance, contact us at ping@matrixcos.com.