New regulations issued by the U.S. Department of Labor (DOL) with respect to all forms of ERISA-governed disability plans will go into effect on January 1, 2018.  The law is well-settled that Texas occupational injury benefit plans are ERISA plans, and such plans have a strong record of ERISA compliance over the past three decades.  Therefore, this new rule affects plan administrators and those who assist in the provision of disability benefits, and further require:

1. avoiding conflicts of interest, with an emphasis on independent and impartiality for final decision makers and those who support benefit decisions;
2. including a “discussion of decision” in benefit denial letters;
3. if any new evidence is considered at the appeal stage, the employee must be given notice and an opportunity to respond;
4. if a plan fails to strictly adhere to all requirements in the claim processing rules, the employee is deemed to have exhausted his or her administrative remedies and can proceed with filing a lawsuit for wrongful denial of benefits;
5. rescissions of benefit coverage that have a retroactive effect are considered to be adverse benefit determinations that trigger a plan’s appeal procedures;
6. plan administrators must provide notices to employees in a culturally and linguistically appropriate manner; and
7. any statute of limitations period must be referenced in a benefit denial letter.

Please contact your PartnerSource Team Leader or Director for more information.  All Texas injury benefit plans and claim procedures should comply with these new DOL regulations on or before January 1, 2018.