New regulations for ERISA disability benefits

While much of the country waits to see what will happen to their insurance under a new Republican White House and Congress that have pledged to end the Affordable Care Act, another system of health-related benefits is facing new, unrelated changes. Shortly before the change in administrations, the U.S. Department of Labor published new regulations for ERISA benefits.

The acronym ERISA refers specifically to the Employee Retirement Income Security Act of 1974, which provides minimum standards for pension plans. However, the term ERISA is often used to refer more generally to a set of federal laws that regulate benefit programs for employees in private industry. Among these benefits are disability benefits.

The new regulations apply to claims and appeals for disability benefits that fall under the umbrella of ERISA benefits. Among other effects, the new rules prohibit incentives for providers to deny claims. For instance, those who decide on insurance matters involving the program may not contract with a medical expert based on his or her reputation for certain outcomes. Likewise, insurers may not promise bonuses to insurance adjudicators based on their numbers of claim denials.

The new rules also require that employees who are denied disability benefits receive notice and an opportunity to respond. The rules also strengthen the appeals process.

Assuming the new rules are not rescinded by the new administration, they will go into effect in 2018.

For those who depend on ERISA disability benefits, it can be important to keep up with changes in the program, and it can be crucial to have the help of an attorney who is up to date on any changes. Attorneys can be helpful at many stages in the process, including the initial claims process and any appeals.

Source: The National Law Review, “The New ERISA Claims and Appeals Regulations for Disability Benefits,” Dec. 29, 2016