New ERISA Regulations for Disability Claims and Appeals
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Be in compliance with the new ERISA regulations.
Disability insurers and administrators of disability plans operate in a highly regulated environment, and the Department of Labor has issued new regulations controlling adjudication of disability claims by administrators that significantly deviate from past practices in the industry. The regulations impose new requirements for communicating with claimants, as well as additional substantive rules affecting the adjudication of such claims by administrators. This topic will help those charged with administering disability claims learn to comply with the new regulations. It will explain what new practices to follow, how to change past practices to become compliant with the new regulations, and the risks of non-compliance. This information is critical for administrators and employers who want to ensure they are compliant with the new regulations.
AuthorsAndrew W. McLaughlin
• Department of Labor Imposed New Regulations Governing the Handling of Disability Claims
• Overview of Additional Responsibilities Imposed on Administrators
• Why the Change?
The New Regulations
• What Are They and What Do They Require?
• Impact on the Claim Adjudication Process
• Effect on Claim Communications
• Conflict of Interest
• Effect on a Claim of Failing to Fully Comply With the Regulations
• Shifting of Grounds of Denial
• Disclosure of Internal Rules, Guidelines and Protocols
• Effect on Contractual Limitation Periods
To Some Extent, the New Regulations Codify Prior Judicial Rulings
• Lessons That Can Be Drawn From Those Prior Rulings
Practical Issues in Complying With the New Regulations