by Marti Cardi, Esq. - Senior Compliance Consultant and Legal Counsel
& Gail Cohen, Esq. - Assistant General Counsel,
August 03, 2017
As we all know, the ERISA disability claims handling rules were revised by the US Department of Labor, to be effective for claims filed on or after January 1, 2018. As part of the ever-changing governmental landscape under our current President, the DOL has now announced it is “reviewing these amendments for questions of law and policy.”
The DOL announcement indicates it will issue a Notice of Proposed Rulemaking in September (09/00/2017 to be exact!), but there is no indication as to the scope of its review or potential subjects within the amended rules that will be reviewed. Possibilities include repealing the amendments entirely, modifying or repealing parts them, and/or simply delaying the effective date.
A Notice of Proposed Rulemaking (NPRM) is a public notice issued by law when one of the independent agencies of the United States government (like the DOL) wishes to add, remove or change a rule or regulation as part of the rulemaking process. It is a process for announcing proposed regulatory changes and subsequently taking public comment. So, we may be in limbo for a while. Even once the NPRM is issued, there will still be unanswered questions as we go through the period of public comment and await any revisions and finalization.
For a refresher on the requirements of the new ERISA rules, review our prior blog post http://matrix-radar.com/blogs/2017/01/a-game-changer-dol-releases-new-erisa-disability-claims-rules/.
So what to do now? If the rules go into effect in their present or similar form for claims filed on or after January 1, there is not enough time to put all preparations on hold. Moreover, we need to remember that many of the changes made to the ERISA claims handling rules are based on federal court rulings in cases where claimants challenged the plan’s decision and procedures. As a result many aspects of the new rules, as currently written, are still good guidance on how to manage disability claims.
Employers with ERISA disability plans should consult with their legal counsel for advice with respect to their specific plans and procedures. In the meantime, here are some suggestions on where employers might want to place focus while the regulatory process runs its course:
Revamp denial letters to clearly and adequately explain why the employee’s medical condition (or other factors) does not qualify the claimant for disability benefits under the employer’s plan.
Review claims handling procedures and revise as necessary to ensure impartiality and avoid conflicts of interest.
Provide updated refresher training for claims management personnel to ensure good practices and consistency in determining claims.
WHAT IS MATRIX DOING?
At Matrix we have been working diligently to prepare for the new rules. Regardless of the outcome of the DOL review and NPRM, Matrix will be ready to administer our clients’ disability plans in compliance with the new regulations by January 1, 2018; or a new effective date. To this end, we have assembled a task force of experts in disability plans, claims handling procedures, ERISA, and customer service. Our practice leaders and account managers will be in touch with clients during the remainder of 2017 to discuss changes to plan notifications, procedures, and more. If you have questions in the meantime, contact your account manager or sales representative, or send us an email at email@example.com.
Hat tip to Megan Holstein for breaking the news about this hard-to-find announcement, which you can link to here: https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201704&RIN=1210-AB39 .
MATRIX CAN HELP! Matrix provides leave, disability, and accommodation management services to employers seeking a comprehensive and compliant solution to these complex employer obligations. We monitor the many leave laws being passed around the country and specialize in understanding how they work together. For leave management and accommodation assistance, contact us at firstname.lastname@example.org.