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New ERISA Disability Claim Regulations – Part 5by Andrew Whiteman

Disability Insurance Benefits

New ERISA Disability Claim Regulations – Part 5

On April 1, 2018, a new disability claim regulation came into effect. The regulation was promulgated by the United States Department of Labor (referred to herein as “DOL”) under the authority of the Employee Retirement Income Security Act of 1974 (“ERISA”) and applies to all employee benefit plans that provide disability benefits.

This is the fifth in a series of nine blog posts that will summarize important features of the new regulation. The new regulation amended existing regulation in the following eight areas:

  1. Conflicts of interest involving claims adjudicators and medical and vocational consultants.
  2. Additional disclosures required with denial notices.
  3. Disclosure of plan criteria.
  4. Requires notifications to be made in a “culturally and linguistically-appropriate manner.”
  5. Disclosure of new evidence and new rationales prior to denial on review.
  6. Disclosure of contractual limitations period deadline.
  7. Enhanced remedy for a plan’s violation of the regulation.
  8. Expansion of the definition of “adverse benefit determination.”

The last blog post discussed the requirement that plans disclose “specific internal rules, guidelines, protocols, standards or other similar criteria” the plan relied upon in making the adverse benefit determination or provide a statement that such rules, guidelines, etc. do not exist. This blog will discuss the requirement that notifications be made in a “culturally and linguistically-appropriate manner.”

I.     Summary of the Changes to the 503 Regulation

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D.      Notifications Must be Made in a “Culturally and Linguistically-Appropriate Manner”

The new Regulation requires that plan notices be provided in a “culturally and linguistically appropriate manner.” The guidance for this requirement is contained in Section 503-1(o) and requires oral language services (such as a customer telephone assistance hotline), assistance with completing claims and appeals, and written notices in applicable non-English languages. An “applicable non-English language” is determined by the county of the recipient and is one in which ten percent or more of the population residing in the recipient’s county is literate.

© Andrew Whiteman 2019

 

Whiteman Law Firm specializes in cases involving claims for disability insurance and other employee benefits. These cases typically involve application of a federal law, the Employee Retirement Income Security Act of 1974, known by the acronym ERISA, and are usually resolved through the benefit plan’s appeal process or federal court. We have helped hundreds of individuals with their claims for short-term and long-term disability insurance benefits.

Contact us for more information about our ERISA disability benefits practice.

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