Finally, after more than a year of writing, refining, and hearing comment for and against, the Department of Labor's Employee Benefit Security Administration has issued its regulations regarding the claim process for long-term disability claims. There has been a good bit of unfairness in the process, and the Department of Labor (DOL) has now addressed some of that unfairness.
The DOL has also interpreted the prior regulations to give further assistance and guidance to courts in interpreting the regulations. This also is a great help as Congress has directed that the Department of Labor interpret and provide such guidance for plan administrators and claims administrators to follow.
Some of the good changes:
- The claimant gets the last word if new information is generated on appeal. It is unfair to have your claim denied, and then, when you appeal the claims, the administrator changes the reasoning and do not give you a chance to respond. It is like trying to hit a moving target.
- Decisions denying your claim must account for all opinions, including those with which the plan does not agree. It is unfair to pick and choose what the claims administrator wants to use to deny a claim. A claims administrator is supposed to fairly weigh the evidence. No more “cherry picking!”
- A plan must provide a date by which an internal limitations period will expire. This is the plan's limitation of action rule. That is the date that you must file a lawsuit. If you go past that date your claim is barred. It has been unfair to have some subjective or hard-to-figure-out bar dates. Commentators express the view that it is unreasonable to have an internal limitations period which expires before the administrative process is up.
While these changes may not mean anything to those who are still able to work, they mean quite a bit to those who, through no fault of their own, find themselves unable to work their full-time jobs. When you pay premiums for long-term disability coverage or you work for that benefit, you do so believing that it will protect you when you find yourself unable to perform all the duties of your job. That is only fair. The protection should come through for you in your time of need. You don't pay premiums just to see an honest claim denied. More comments and information will be posted on this website.
Read the regs for yourself at the Federal Register. Or, if you're further curious about the new long-term disability claims procedure regulations, feel free to get in touch with a disability lawyer here at The Martin Law Group. We provide disability lawyer services for folks throughout Mississippi.