New ERISA Disability Claim Regulations – Part 9

New ERISA Disability Claim Regulations – Part 9

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 last 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.”

This post will address the new regulation’s expansion of the term “adverse benefit decision.”

I.     Summary of the Changes to the 503 Regulation

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H.     The Term “Adverse Benefit Determination” Expanded

Section 503-1(m)(4) expands the definition of “adverse benefit determination” to include a decision to rescind disability coverage with respect to a beneficiary or participant, whether or not, in connection with the rescission there is an adverse effect on any particular benefit at that time. “Rescission” includes a cancellation or discontinuance of coverage that has a retroactive effect, except for one that is attributable to a failure to timely pay required premiums or contributions.

© Andrew Whiteman 2019

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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.