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The Wagner Law Group

The Wagner Law Group is a nationally recognized practice in the areas of ERISA and employee benefits, estate planning, employment, labor and human resources and investment management.

 

Established in 1996, The Wagner Law Group is dedicated to the highest standards of integrity, excellence and thought leadership and is considered to be amongst the nation's premier ERISA and employee benefits law firms. The firm has seven offices across the country, providing unparalleled legal advice to its clients, including large, small and nonprofit corporations as well as individuals and government entities worldwide. The Wagner Law Group's 31 attorneys, senior benefits consultant and four paralegals combine many years of experience in their fields of practice with a variety of backgrounds. Seven of the attorneys are AV-rated by Martindale-Hubbell and six are Fellows of the American College of Employee Benefits Counsel, an invitation-only organization of nationally recognized employee benefits lawyers.  Seven of the firm's attorneys have been named to the prestigious Super Lawyers list for 2017, which highlights outstanding lawyers based on a rigorous selection process.

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

 

Washington, D.C.

Tel: (202) 969-2800

 

Fax: (202) 969-2568

 800 Connecticut Avenue, N.W.

Suite 810

Washington, D.C. 20006

 

Chicago

Tel: (847) 990-9034

Fax: (847) 557-1312

190 South LaSalle Street

Suite 2100

Chicago, IL 60603

 

  

Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

  

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

300 Montgomery Street

Suite 600

San Francisco, CA 94104

  

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
25 W. Moody Avenue
St. Louis, MO  63119 

 

 

www.wagnerlawgroup.com

 

 

 

 

DOL Announces Applicability Date for Disability

Claims Regulations 

January 17, 2018

 

 

 

The DOL has announced April 1, 2018 as the effective date for its final disability claims procedure regulations.  The regulations were originally slated to apply to disability claims filed on or after January 1, 2018.  (See the Alert of 12-22-2016.)  However, in November 2017 the DOL delayed this effective date to allow for stakeholders to submit comments and leave open the possibility to amend (or rescind) the regulations.  (See the Alert of 10-26-2017.)


Final Regulations.  The final regulations impact initial disability claim determinations and appeals administration processes, as well as benefit denial notifications.  As a reminder, the final regulations add the following procedural requirements to the disability benefit claims process:

 

  • Rescissions of Coverage Procedures.  Plan administrators must treat certain rescissions of coverage as adverse benefit determinations.  (Note:  A rescission of coverage occurs when a plan administrator terminates a participant's coverage retroactively.)  As a result, participants may now appeal rescissions of coverage.  However, a rescission based on the participant's non-payment of premiums is not an adverse benefit determination.
  • Benefit Denial Notices.  Benefit denial notices must:

1.      Provide a more detailed description of the reason for the claim denial.  For example, in relevant cases, the notice must explain why the plan administrator disagrees with the opinions of the participant's health care professionals, or the Social Security Administration's determination of disability.
 

2.      Be written in in a linguistically and culturally appropriate manner, and explain that oral language services are available to the participant.  Similarly, the plan administrator must explain to participants that they are entitled to receive, upon request, any notice relevant to the determination in the applicable non-English language. 

  • Explanation of Claims Procedures. Plan administrators must explain the protocols that were used to determine the participant's benefit claim.
  • Access to Claims File.  Plan administrators must inform participants, in benefit denial notices, that they are entitled to access, free of charge, all documents relevant to the adverse claim determinations.
  • Access to New Evidence.  Plan administrators must provide participants with any new evidence being considered by the plan during the appeal process. 
  • Conflicts of Interest.  Plan administrators must make benefit determinations in a manner that ensures independence and impartiality of the decision-makers involved in the process.  To meet this requirement, plan administrators must ensure that the employer does not make employment decisions (i.e., hiring, firing, promotions, etc.) believing that such action will support the benefit denial.  Moreover, plans cannot provide bonuses on the basis of denials made by claims adjudicators. 

 

Employer Takeaway.  Employers sponsoring ERISA-covered plans that provide disability benefits must be sure that these plans are in compliance with the new regulations by April 1, 2018.  Before the effective date for the regulations (i.e., April 1, 2018), employers are advised to engage qualified legal counsel to review and confirm whether their ERISA-covered disability plans have been properly amended to implement the new requirements. 
 

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.