Changes to ERISA Disability Claims Effective April 2018


The Department of Labor (DOL) has announced changes in procedures for some ERISA Short-Term and Long-Term Disability (LTD) claims. Beginning April 1, 2018, some employer disability claims will have additional protections and safeguards for the individual claiming disability. These safeguards are also meant to help promote the initial goals of ERISA regulations, which were to instill fairness in the administrative process. The upcoming changes will require the benefit provider to give more information about their reasons for denying claims. The new regulations will require additional explanations about why a claimant's treating physician's opinions were insufficient, more references to specific DOL policies or internal rules will be required, and the claimant will be permitted to respond if a new reason for the denial is cited. It is important to be aware that these rules will not apply to all ERISA disability claims including privately paid plans, disability plans conditioned on an award on an unrelated disability claim from a third-party (i.e. disability that is dependent on another entity like Social Security finding you disabled), and short-term disability claims solely governed by state laws.

If you or someone you know has recently been denied Short-Term or Long-Term disability, have them call our office before filing an appeal on their own. ERISA disability claims are very complicated and meeting with an experienced attorney can help a claimant avoid the pitfalls that could result in another denial.

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