The U.S. Department of Labor (the “DOL”) has revised the ERISA claims procedures which apply to claims for disability benefits, in a Final Rule which changes the ERISA claims procedures regulations and which was published on December 16, 2016. The revisions generally become effective after 2017. Plans which provide disability benefits (both pension and welfare plans) will have to revise their summary plan descriptions, and change internal procedures for handling disability claims, prior to the end of 2017 to comply with the Final Rule. The DOL has issued a Fact Sheet which describes the Final Rule. Here is what the Fact Sheet says.
Background. Section 503 of ERISA generally requires employee benefit plans to provide written notice to any participant or beneficiary whose claim for benefits has been denied, and to provide the claimant a full and fair process for review of the claims denial. The Fact Sheet notes that proposed regulations-now finalized under the Final Rule- was published on November 18, 2015.
Overview of Final Regulation. The Final Rule amends the DOL’s current claims procedure regulation at 29 C.F.R. §2560.503-1 for disability benefits to require that plans, plan fiduciaries, and insurance providers comply with additional procedural protections when dealing with disability benefit claimants. Specifically, the Final Rule includes the following improvements in the requirements for the processing of claims and appeals for disability benefits: