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Proposed Changes to Rules Governing ERISA Long Term Disability Claims

Proposed Changes to Rules Governing ERISA Long Term Disability Claims

Recently the Department of Labor (DOL) proposed some amendments to Section 503 of ERISA (Employee Retirement Income Security Act), to improve the current rules governing Long Term Disability claims and appeals. Joe sent his comments and recommendations to the DOL with the hope of improving the disability claims process for all of our clients.

Here are just a few highlights of Joe’s recommendations to the Department of Labor (which you can read in full here:  http://www.dol.gov/ebsa/pdf/1210-AB39-00062.pdf):

“ERISA was originally designed to secure the position of American workers and to enhance the likelihood that they would receive the benefits that they were entitled to. Hiding the statute of limitations inside the plan document or positioning it in unusual terms relative to the original “proof of claim” or original “proof of loss”, is dubious and confusing to beneficiaries. There is no harm done in having the plan administrator or insurance company define in their initial adverse benefit decision when the statute of limitations will run. “

“After a claimant submits an administrative appeal, it is not uncommon for the insurance company to either have the claimant examined or to hire a “peer review” physician to analyze the medical records. The report from the IME doctor and/or peer reviewer should be forwarded to the claimant before a final denial is issued.  I do not think ERISA was designed to have a “surprise” feature. Too frequently, claimants (and occasionally their attorneys) are placed at a disadvantage by peer review reports that drop out of the sky when the claim reaches a final denial. ”

“In the case of a plan providing disability benefits, the plan and its agents, contractors, or vendors (such as entities who supply consulting experts to plans) must ensure that all claims and appeals for disability benefits are adjudicated in a manner designed to ensure the independence and impartiality of the persons involved in making the decisionor who are consulted in the process of making the decision.  Accordingly, decisions regarding hiring, compensation, termination, promotion, or other similar matters with respect to any individual, (such as a claims adjudicator, vocational expert, accounting expert, or medical expert) must NOT be made based upon the likelihood that the individual will support the denial of benefits.”

“I also wanted to talk about venue selection and how it is being used improperly by some plan administrators….The DOL should consider a regulation that prevents plan administrators from selecting far-flung places as the only jurisdictions where they will be sued.”

“Finally the rule at 29 C.F.R. § 2560.503-1 needs to be amended to eliminate abusive conduct being perpetuated by insurers who refuse to finish an appellate review within the 90 day period described in the regulation.  The DOL should consider a rule which removes the possibility of deferential review if the decision to approve or deny benefits occurs after the 90 day period defined in the regulations. Such a rule will ensure that the administrative process does not drag on indefinitely.”

Questions about your long term disability insurance claim?

 Call (877)-428-9806 and we will be happy to answer your questions or concerns.


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