New Rules for ERISA Benefits Claim Evaluations

New rules are scheduled to take effect for short- and long-term disability claims and how they are investigated by plan fiduciaries. These changes will affect workers who have short- or long-term disability benefits through their jobs in Washington, D.C. and in the rest of the U.S.

Short- and long-term disability benefits fall under the mandates of the Employee Retirement Income Security Act, which is a federal law that governs employee benefits. The regulations are meant to add new protections to people who file claims for benefits when they become disabled and are unable to return to their jobs either temporarily or permanently. The regulations make a number of changes that should help to make the claims process more transparent and fair.

Plan fiduciaries who make adverse findings to those of vocational professionals, treating doctors or the Social Security Administration must disclose why they disagreed with those other determinations. Before an appeals decision can be made, the plan will have to provide any new information on which it relied to the claimant without charge. The claimant will then have a reasonable time period within which he or she can respond. In the event that a plan fails to strictly follow the rules, the claimant may file a lawsuit in court before the internal appeals process is completed. The court may then use a de novo standard instead of one that favors the plan.

People who receive denials of their ERISA benefits claims may want to talk to experienced lawyers who practice in the area of employee benefits law. Attorneys may help their clients to secure all of the documents that they need to strengthen their claims on appeal. The lawyers may review their clients’ internal files from the plan to analyze all of the information that the plan used to reach its decision and then work to add favorable evidence that supports the basis for their clients’ claims.

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