On Dec. 16, 2016, the Department of Labor (DOL) released a final rule to strengthen the claims and appeals requirements for plans that provide disability benefits. According to the DOL, these new protections will ensure that disability claimants receive a full and fair review of their benefit claims, as required by the Employee Retirement Income Security Act of 1974 (ERISA).
The new requirements provide disability claimants with protections that are similar to those that apply to claims for group health benefits. They are intended to protect disability claimants from conflicts of interest, increase transparency and allow claimants to respond more effectively to benefit decisions.
ERISA plans that include disability benefits must comply with the new procedural protections, effective for claims that are submitted on or after Jan. 1, 2018. Entities that administer disability benefit claims, including issuers and third-party administrators, will need to revise their claims procedures to comply with the final rule. Although the DOL has recently indicated that it may delay or amend the final rule, it is possible that the rule’s new requirements will still take effect as scheduled.
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