If disability decisions made on or after April 1, 2018, do not comply with the new disability claims procedures, and the claim is later litigated, a court will review the issues “de novo” and give no deference to an administrative determination, nor limit review to the facts and documents that were assembled as the administrative record.
The following is a brief overview of the changes. For more information, please reference this article in its entirety here.
- Independence and Impartiality; Avoiding Conflicts of Interest.
- Additional Disclosure Requirements.
- Right to Review and Respond to New Information Before Final Decision.
- Deemed Exhaustion of Claims and Appeals Processes.
- Coverage Rescissions; Adverse Benefit Determinations.
- Culturally & Linguistically Appropriate Notices.
If you have any specific questions on if and how the new disability claim and appeal rules affect your benefit plans, please contact Carl Lammers or any other attorney in Frost Brown Todd’s Employee Benefits Group.