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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 29 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

 

 

 

 

 Disability Claims

Regulations Delayed

October 26, 2017

 

 

 

The DOL has proposed a 90-day delay in the effective date of the new ERISA disability claims regulations.  This would change the effective date of the regulations to April 1, 2018.  


Background.  In December 2016, the DOL released final regulations that amended the procedures for ERISA disability claims.  The final regulations were slated to apply to disability claims made on or after January 1, 2018, and would impact initial disability claim determinations, benefit denial notifications, and appeals processes. 

 
The final regulations will affect all ERISA-covered plans that condition benefits on the plans' finding of disability (as opposed to the determination of a third party, such as the Social Security Administration).  Some of the more substantial changes made by the final regulations include: 

  • Increased disclosure requirements.  Benefit denial notices must contain a more complete discussion on why the plan denied the claim and the standards used in making the  decision. 
  • Claim file and internal protocols.  Benefit denial notices must include a statement that the claimant is entitled to receive, upon request, the entire claim file and other relevant documents.  Benefit denial notices also must include the internal rules, guidelines, protocols, standards, or other similar criteria of the plan that were used in denying a claim, or a statement that none were used.
  • Review and Respond to New Information.  Plans may not deny benefits on appeal based on new or additional evidence or rationales that were not included when the benefit was denied at the claims stage, unless the claimant is given notice and a fair opportunity to respond.
  • Conflicts of Interest.  Plans must ensure that disability benefit claims and  appeals are adjudicated in a manner designed to ensure the independence and impartiality of the persons involved in making the decision.
  • Deemed Exhaustion. If a plan does not adhere to all claims processing rules, the claimant is deemed to have exhausted the internal appeal process and may immediately pursue
    his or her claim in court.
  • Coverage Rescissions. Rescissions of coverage, including retroactive terminations due to alleged misrepresentation of fact (e.g., errors in the application for coverage) must be
    treated as adverse benefit determinations, thereby triggering the plan's appeals procedures.
  • Communication Requirements in Non-English Languages.  Plans must provide benefit denial notices in a non-English language in certain situations, using essentially the same standard applicable to group health benefit notices under the ACA. 

Many stakeholders expressed concerns that these revisions will increase plan costs and litigation as well as impair workers' access to benefits.


DOL Delay.  In response to stakeholders' concerns about the impact of the final regulations, DOL has proposed a 90-day delay to the effective date for the regulations to enable it to seek additional comments and data about the impact of the final regulations and consider whether to rescind or modify the rule.  If the DOL's proposed delay becomes finalized, the final claims regulations would begin applying to disability claims made on or after April 1, 2018 (instead of January 1, 2018).     

 

The DOL's proposal is available for review at: https://www.gpo.gov/fdsys/pkg/FR-2017-10-12/pdf/2017-22082.pdf
 
 

 

 

 

 

 

This Newsletter is protected by copyright. Material appearing herein may be reproduced with appropriate credit.

 

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.