Our September 2017 Option Insights newsletter discussed new regulations issued by the U.S. Department of Labor (DOL) that will affect the way Texas injury benefit plans administer disability (aka “lost time”) claims.  Then, in October 2017, the DOL responded to employer concerns about potential program cost increases by delaying these new rules and providing more opportunity for interested parties to submit comments.  Following further review, the DOL has now decided to press forward with the rules applying to all disability benefit claims on or after April 2, 2018.

The Employee Retirement Income Security Act (ERISA) has long provided detailed direction on the claims process for Texas injury benefit plans, including timeframes, notice requirements, and qualifications for employers, third party claim administrators and insurance companies that make benefit claim decisions. These new DOL regulations make further procedural improvements to protect the rights of workers when their claims for disability benefits are denied.  For example, the new rules provide:

∙ Increased disclosure requirements for benefit denial notices;
∙ Employee rights to review and respond to new information before a final claim decision;
∙ Heightened impartiality standards for claim decision makers; 
∙ Clarification related to exhaustion of a plan's internal remedies;
∙ More protections related to ongoing disability benefits; and
∙ Additional foreign language requirements.

Updates are needed now to all injury benefit plan documents, claim procedures and employee communications to comply with this new law.  PartnerSource is currently providing a comprehensive set of legal communications and other claims administration documents to assist our PartnerShip Program clients with these important program updates. As always, we are focused on providing integrated solutions to our clients to ensure that benefit claims continue to be administered properly.  We also want to ensure that employers and Texas employees are adequately informed of their new rights and responsibilities.

If you have not already done so, we recommend that you contact your PartnerSource Team Leader or Director to help ensure that your Texas Injury Benefit Plan and claims administrator are prepared to comply with these new disability claim regulations on April 2, 2018.