Wednesday, November 29, 2017

Disability Claims and Appeals Delay

On Dec. 16, 2016, the Department of Labor (DOL) issued a final rule amending the claims and appeals requirements for plans providing disability benefits. The final rule was scheduled to apply to claims that are filed on or after Jan. 1, 2018. However, on Nov. 24, 2017, DOL delayed the final rule for 90 days—until April 1, 2018.

The final rule provided disability claimants with protections that are similar, but not identical to, those under the Affordable Care Act (ACA) for non-grandfathered group health plans. While not affecting the timing for responding to disability claims and appeals, the final rule provided further protections for disability claimants regarding conflicts of interest, the opportunity to respond to evidence, and the reasoning behind the benefit decision.

According to DOL, after the final rule was published, concerns were raised that its new requirements will impair workers’ access to these benefits by driving up costs.

The delay in the effective date did not change the December 11, 2017 deadline for submitting comments, data and information to DOL regarding the merits of rescinding, modifying or retaining the final rule. DOL believes the 90 day delay allows it sufficient time to complete the comment solicitation process, perform a reexamination of the information and data submitted, and take appropriate next steps. DOL did not rule out a further extension if it received reliable data and information that reasonably supported assertions that the final rule will lead to unwarranted cost increases and related diminution in disability coverage benefits.

Sponsors of plans that provide benefits for disability, including retirement plans, should continue to monitor the status of the final rule. The final rule, and any modifications to the final rule, may require an update of not only internal procedures but also plans documents, summary plan descriptions as well as all forms and letters used in the claims and appeals process.

Our Legislative Alert provides more detail on the delay in the effective date of the final rule as well as the requirements of the final rule as currently constituted.