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.
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.
Wagner Law Group
Connecticut Avenue, N.W.
Fax: (561) 293-3591
7108 Fairway Drive
Palm Beach Gardens, FL 33418
East Kennedy Boulevard
Tampa, FL 33602
Francisco, CA 94104
25 W. Moody Avenue
St. Louis, MO 63119
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:
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.
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.
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.
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.
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.
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.
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,
The DOL's proposal is
available for review at: https://www.gpo.gov/fdsys/pkg/FR-2017-10-12/pdf/2017-22082.pdf