(from SHRM) The DOL's new procedures for processing disability claims took effect April 1. Any employer-sponsored plan that deals with disability claims should be amended as needed. If plan documents have not yet been updated, employers should still prepare to handle claims under the new procedures, benefits attorneys advise. The rule is intended to give U.S. workers new procedural protections when dealing with plan fiduciaries and insurance providers that deny their claims for disability benefits. In brief, the rule:
- Requires that the reason for a denied claim be provided as soon as possible and sufficiently in advance of the date that the plan's decision on appeal is due, to give the claimant a reasonable opportunity to respond.
- Ensures that disability claimants receive a clear explanation for why their claim was denied, as well as information on their rights to appeal a denial and to review and respond during the course of an appeal to any new or additional evidence the plan relied on in connection with the claim.
- Requires that a claims adjudicator cannot be hired, promoted, terminated or compensated based on the likelihood of denying claims.
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