The Department of Labor (DOL) has issued its final rules on disability claims procedures as they pertain to employee benefit plans. The final rule affecting retirement and health & welfare plans subject to ERISA affects all claims filed after April 1, 2018.

The final rule created new responsibilities in how disability benefit claims and appeals are managed to better ensure plan participants get a full and fair review when the disability determination is to be made by the plan administrator.

Several changes were made in creating the final rule. The changes include:

  • specific requirements to guarantee the claim reviewer’s impartiality; and
  • required language and disclosures on the adverse benefit determination notice received by participants; and
  • new responsibilities that must be met by the reviewer before they may issue an adverse determination; and
  • updated language assistance requirements to accommodate those not English literate.

So What’s Next? Plan Administrators making disability determinations should review their internal processes and policies for the final rule and update if needed. In addition, review your plan documents and SPDs (or work with your third-party administrator) to determine if plan amendments are necessary. While Nyhart does not anticipate amendments will be needed for its plans because of how they are written, we still encourage our clients to review their internal processes and policies as mentioned. Please contact your Nyhart consultant for help.