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Department of Labor Issues New ERISA Disability Benefit Regulations

Posted by Gregory Paul | Mar 15, 2017 | 0 Comments

The Employee Retirement Income Security Act (ERISA) was first enacted in 1974. Since that time, the act has undergone a number of changes and amendments to help protect employees with private health and pension plans. This includes regulation of most private employer disability benefit regulations. Just before the new year, the Department of Labor issued new ERISA disability benefit regulations.

In 1977, the Department of Labor issued “Section 503,” which established the minimum requirements for claims procedures of employee benefit plans covered by ERISA. Section 503 was amended in 2000 to establish new timeframes for claims procedures and add additional requirements, which was intended to reduce the number of lawsuits filed over health and disability benefits disputes. However, disability benefit disputes continued to dominate ERISA litigation.

Most employees covered by ERISA have health benefits and/or pension benefits. Comparatively, a much smaller percentage of employees have private disability benefit plans. However, from 2006 to 2010, ERISA litigation involving long-term disability claims accounted for almost two-thirds of cases. The Department of Labor examined the ERISA regulations and found that practices were inconsistent with existing regulations regarding disability claims involving Section 503.

The Employee Benefits Security Administration under the Department of Labor published new claims procedures for plans providing disability benefits on December 12, 2016. The new rule goes into effect on January 18, 2017, applying to disability benefits claims filed on or after January 1, 2018.

Under the revised rules, claims and appeals are to be decided independently and impartially. Those who decide the claims should not have an incentive to deny claims, such as bonuses based on denials, or contracting with medical experts based on their reputation for denying disability.

Additionally, denial letters are to includes specific information, including why the plan did not agree with certain health care professionals or Social Security Administration disability determinations. Letters should also include a notice of the claimant's right to access their claim documents and files, and detail any guidelines relied on by the plan to deny the claim. If the plan makes a denial based on new evidence, the claimant is to be given notice and an opportunity to respond before the plan denies the appeal.

When a plan fails to follow their own claims procedures, a claimant may be able to file a lawsuit before exhausting the plan's claims procedures. Additionally, if the plan retroactively rescinds disability coverage, the claimant can proceed through the plan's appeals process.

According to the Department of Labor, the new rule “revises and strengthens the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the Affordable Care Act. “

Greg Paul has 16 years of experience fighting for his clients to make sure they get the disability benefits they deserve. We represent individuals and families who have been denied benefits by their insurance company or plan administrator. You have a limited time to appeal your disability denial, so do not delay. If you have been denied short-term or long-term disability benefits, contact our office for a free consultation.

About the Author

Gregory Paul

Gregory G. Paul is a trial lawyer who practices in the areas of disability, employment and toxic tort injury law. He is admitted to practice law in California, Maryland, Missouri, Ohio, Pennsylvania, Texas and West Virginia with additional admissions in federal courts nationwide. Greg is a graduate of the University of Pittsburgh and the University of the Pacific, McGeorge School of Law in Sacramento where he was on the Dean's List and Law Review.  He is a graduate of Gerry Spence's Trial Lawyers College.                        In addition to litigating cases on behalf of people denied benefits and rights, Greg has been a speaker at PBI: Employment Law West: Americans With Disabilities Act , Pittsburgh, PA (2012-2015); National Employment Lawyers Association: Breaking Down the Barriers in the Workplace, Oakland, CA (2010); NBI: Litigating ERISA Cases, Pittsburgh, PA (2008); ADA: Fighting for Fairness, Atlanta, GA (2006) and Chicago, IL (2008). He is a member of American Association for Justice, National Employment Law Association and the Million Dollar Advocates Forum. Greg is the Vice-Chair of the National Legal Advocacy Committee for the American Diabetes Association and recipient of the ADA 2008 National Service Award for Outstanding Advocacy.  LIST OF ADMISSIONS AND BAR ASSOCIATIONS Pennsylvania, 1999 West Virginia, 1999 Maryland, 2000 California, 2004 Ohio, 2005 Texas, 2006 U.S. District Court, Western District of Pennsylvania U.S. District Court, Eastern District of Pennsylvania U.S. District Court, Middle District of Pennsylvania U.S. District Court, Southern District of West Virginia U.S. District Court, Northern District of West Virginia U.S. District Court, District of Maryland U.S. District Court, District of Colorado U.S. District Court, Northern District of Ohio U.S. District Court, Southern District of Ohio U.S. District Court, Eastern District of Texas U.S. District Court, Northern District of Texas U.S. District Court, Southern District of Texas U.S. District Court, Northern District of California U.S. District Court, Eastern District of California U.S. District Court, Central District of California U.S. District Court, Eastern District of Michigan U.S. District Court, Eastern District of Arkansas U.S. District Court, Northern District of Illinois U.S. Court of Appeals, 3rd Circuit U.S. Court of Appeals, 4th Circuit U.S. Court of Appeals, 5th Circuit U.S. Court of Appeals, 6th Circuit U.S. Court of Appeals, 9th Circuit U.S. Court of Appeals, 11th Circuit Supreme Court of the United States Allegheny Bar Association Federal Bar Association American Bar Association The American Association for Justice Million Dollar Advocates Forum National Employment Lawyers Association Sonoma County Bar Association


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Greg Paul has over 20 years experience litigating in state and federal courts: 1) Fighting for long-term disability benefits against insurance companies such as Aetna, CIGNA, Guardian,Hartford, Liberty Mutual, Mutual of Omaha, Principal, Prudential, Reliance Standard, Standard, Sun Life, and Unum.

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