On September 9, 1998, the Department of Labor issued a proposed regulation (63 FR 48390) that would establish new standards for the processing of group health, disability, pension and other employee benefit plan claims filed by participants and beneficiaries. The regulation, which would apply to all ERISA plans, substantially changes the responsibility of single and multiemployer plans in the processing of benefit claims.

The proposal would dramatically shorten the time limits for administrators and fiduciaries to make decisions on health and disability claims. The proposal would also require plans to provide participants with more timely information about the plan's claims procedures and more information about the denial of a claim. Appeals would be decided by a party who is neither the initial claim reviewer nor a subordinate of the initial claim reviewer, and for decisions based on medical judgments, the appeal reviewer must consult with a medical professional.

If you are interested in filing comments with DOL or monitoring the rulemaking process, please contact Steve Spencer at 215-963-5714

This article is published to inform clients and friends of Morgan Lewis and should not be construed as providing advice on any specific matter.