DOL Delays Updated Disability Claims Rules Through April 1, 2018 | Practical Law

DOL Delays Updated Disability Claims Rules Through April 1, 2018 | Practical Law

The Department of Labor (DOL) finalized a 90-day delay of the applicability date for its final regulations that updated the claims procedure requirements for plans providing disability benefits under the Employee Retirement Income Security Act of 1974 (ERISA). The DOL's final rule delays the final regulations' applicability date from January 1, 2018, through April 1, 2018.

DOL Delays Updated Disability Claims Rules Through April 1, 2018

Practical Law Legal Update w-011-7170 (Approx. 5 pages)

DOL Delays Updated Disability Claims Rules Through April 1, 2018

by Practical Law Employee Benefits & Executive Compensation
Published on 24 Nov 2017USA (National/Federal)
The Department of Labor (DOL) finalized a 90-day delay of the applicability date for its final regulations that updated the claims procedure requirements for plans providing disability benefits under the Employee Retirement Income Security Act of 1974 (ERISA). The DOL's final rule delays the final regulations' applicability date from January 1, 2018, through April 1, 2018.
On November 24, 2017, the DOL issued a final rule that delays by 90 days the applicability date of final regulations governing the claims procedure requirements for ERISA plans that provide disability benefits (81 Fed. Reg. 92316 (Dec. 19, 2016); 29 C.F.R. § 2560.503-1). Issued in December 2016, the final regulations amended the existing DOL claims regulations for plans providing disability benefits (see Legal Update, Final DOL Disability Claims Regulations Require Notice of Contractual Limitations Periods and Practice Note, Claims Procedure Requirements for Disability Claims). The final rule adopts without change the DOL's proposed rule, issued October 10, 2017, to delay by 90 days the applicability date of the final disability claims procedure regulations (see Legal Update, DOL to Delay Updated Disability Claims Rules Through April 1, 2018; 82 Fed. Reg. 47409 (Oct. 12, 2017)).
Without the 90-day delay, the DOL's final disability regulations would have applied for disability benefits under ERISA plans filed on or after January 1, 2018. With the now-final 90-day delay, the changes to the disability-related claims regulations under the December 2016 regulations apply to claims for disability benefits filed after April 1, 2018.
In proposing its 90-delay to the final regulations' applicability date in October 2017, the DOL also sought comments and data on whether the December 2016 final disability regulations should be rescinded, modified, or retained. The comment period for responses regarding these issues closes on December 11, 2017.

Enhanced Procedural Requirements Under the DOL Final Regulations

The changes under the DOL's disability final regulations reflected similar claims procedure enhancements applicable to group health plans under the Affordable Care Act's (ACA's) internal claims and appeals rules (see Practice Notes, Internal Claims and Appeals Under the ACA and Affordable Care Act (ACA) Overview). Among other changes, the DOL's disability final regulations:
  • Limit conflicts of interest by requiring independence and impartiality of plan decisionmakers.
  • Expand the content requirements for denial notices involving disability claims.
  • Provide claimants notice and an opportunity to respond prior to appeal-level denials based on new or additional evidence or rationales.
  • Strengthen deemed exhaustion rules in the context of disability benefit claims.
  • Expand the definition of "adverse benefit determination" to include rescissions of disability benefit coverage.
  • Require that claims notices be provided in a culturally and linguistically appropriate manner.
For analysis of these changes in the context of plans that provide disability benefits, see Practice Note, Claims Procedure Requirements for Disability Claims.

Reasons for the Delay

Public Comments

After the disability regulations were finalized in December 2016, the administration changed and the Trump Administration issued an executive order instructing the federal agencies to reduce regulatory burdens (Executive Order 13777 (82 Fed. Reg. 12285 (Feb. 24, 2017))). In response, the DOL received comments from some segments of the regulated community asserting that the final disability regulations:
  • Would increase plan costs, resulting in employers reducing or eliminating disability coverage or employees choosing to drop coverage.
  • Would result in increased litigation.
  • Were unnecessary in light of existing protections for participants and beneficiaries.
Regarding specific provisions in the final regulations, commenters argued that:
  • The right to review and respond to new information and rationales unnecessarily complicates the benefits process.
  • Certain disclosure requirements require plans to look at disability standards and definitions that differ from those in the plans.
  • The deemed exhaustion provision "tilts the balance" against plans and insurers in litigated disability disputes.
As a result, according to the DOL, the main reason for the 90-day applicability date delay is to solicit data and information and reexamine the regulations' impact in light of the newly received information.

No Additional Extensions for Applicability Delay and Comment Period

In finalizing the 90-delay, the DOL expressly rejected commenters' requests for an even longer delay. In the DOL's view, it would be premature to consider a delay of longer than 90 days without reliable data and information supporting commenters' assertions that the final disability regulations will lead to unwarranted cost increases and a reduction in disability benefits. If the DOL receives data and information supporting these assertions, it may provide additional time for the regulated community to submit comments on the data and information. Only then would the DOL consider any further delay of some or all of the requirements of the final disability regulations beyond April 1, 2018.

Practical Impact

As noted, the period for providing comments, data, and other information about whether the DOL's December 2016 final disability claims regulations should be rescinded, modified, or retained remains open until December 11, 2017. The DOL was not persuaded by comments arguing that this deadline should be extended.
It's difficult to tell at this point whether the December 2016 final regulations will become applicable in 2018 – or if they will instead be delayed or rescinded altogether. The DOL suggests that its decision will largely depend on whether commenters submit persuasive comments and data by the December 11, 2017 deadline in support of their calls to revise or rescind the rule. For now, however, this remains a topic that we'll be keeping a close eye on in early 2018.