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The Department of Labor (DOL) issued regulations that revise the ERISA claims procedure regulations for employee benefit plans that provide disability benefits (the New Disability Claims Regulations). They are based on the Affordable Care Act’s (the ACA) enhanced claims and appeals regulations for group health plans (the ACA Enhanced Regulations). The scope of the New Regulations are broader than you may realize and apply to any plan, regardless of how it is characterized, that provides benefits or rights that are contingent on whether the plan determines an individual to be disabled. This can include ERISA-governed short-term disability plans, long-term disability plans, qualified retirement plans (e.g., a 401(k) plan), nonqualified retirement plans, workman’s compensation and health, wellness and welfare plans. Importantly, the New Disability Claims Regulations would not apply if a plan does not make the determination of disability, but instead relies on a third party’s determination of disability, such as a determination of disability made by the Social Security Administration.
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