ERISA Regulations for Claims & Appeals
Disability Attorneys Serving Clients Nationwide
ERISA regulations apply to claims for long-term disability benefits with
disability insurance companies. The regulations are known as Claims Procedures,
and they apply to any disability benefits claims that are governed by
ERISA. Understanding these new regulations, with the help of a disability
lawyer, is key to the success of your claim.
In December 2016, the ERISA regulations were updated by the Department
of Labor. The new regulations will take effect on or after January 1,
2018. Any plan that provides for disability insurance benefits and falls
under ERISA will be affected by these new regulations. These new ERISA
regulations will be very beneficial to people applying for disability
benefits from disability insurance companies, adding protections to the
claims and appeals process.
What the New Regulations Look Like
To begin, the new ERISA regulations will require the disability insurance
company to decide all claims and appeals independently and unbiased. There
can be no motives (usually financial) for denying a claim. Medical experts
and vocational experts hired by the disability insurance company must
be nonbiased. Meaning, a medical expert or vocational expert cannot be
used because they usually find in favor of the disability insurance company.
Next, the ERISA regulations will now require more information to be provided
in the disability benefits denial letters. The disability insurance company
must explain why they did not agree with the medical or vocational expert’s’
opinion that supported your disability. Additionally, they must explain
why they did not agree with the Social Security Administration determination
of disability (if applicable). The letter must also include any of the
disability insurance company’s rules, policies, or regulations that
were relied upon in making their determination. Lastly, the disability
benefits denial letter must give you an explanation of your right to access
to your claim file and other documentation.
The new ERISA regulations must give you an opportunity to “review
and respond to new information.” For example, assume your appeal
denial is based on a reason different from the initial reason given for
the claim denial. You will now have a right to respond to the new reason.
You may do this by providing additional information or documentation supporting
The last major point in the new regulations deals with a violation of ERISA
law in the disability insurance plan or policy. If the plan or policy
does not follow the law in terms of claims procedures, then you could
sue under ERISA. Typically, you have to appeal, which is also known as
exhausting all administrative remedies, under the plan before you can
file a lawsuit. However, under the new regulations, if the plan does not
meet ERISA requirements for claims procedures, you will have been considered
to have met all requirements and can file a lawsuit right away.
Let Us Help You Today
The new ERISA regulations are a positive step for anyone filing a claim
under their ERISA disability policy. Although the regulations will not
take effect until January 2018, disability insurance companies are encouraged
to start changing their policies and plans to meet the new requirements.
Even with these new regulations, filing for disability benefits claims
or appealing a denial is a complicated process. Having an experienced
disability insurance attorney help you through it can make a huge difference
in the outcome. The experienced disability insurance attorneys at Dabdoub
Law Firm are familiar with all stages of the claims process. Taking into
consideration the new regulations, they can ensure you get the most out
of your disability insurance policy.
Call us today at (800) 969-0488 to get started with a member of our team.