Comments on Unum’s Final ERISA Disability Claims Procedure Regulations Notice

April 2018

The U.S. Department of Labor (DOL) recently announced final regulations which revise the claims procedures for employee benefit plans providing disability benefits (See 29 C.F.R. §2560.503-1). These regulations will take effect for disability claims made on or after April 1, 2018. Plan documents and Summary Plan Descriptions (“SPDs”) must conform to these legal requirements. If a plan participant has been denied a benefit based on an adverse determination of disability and the new procedures are not strictly followed, then the claimant will be deemed to have exhausted administrative remedies and may seek action in court and other remedies.

Accordingly, EZ ERISAPlan has updated our Wrap document to include new default Claims Procedure language to include the updated disability terms in the revised regulations.

Recently, questions have emerged about Unum’s Final ERISA Disability Claims Procedure Regulations Notice and how it works in conjunction with EZ ERISAPlan’s Wrap Document.

When a Constituent Benefit Program is insured, the insurer is the Claims Administrator and the lead fiduciary for any benefit determinations under that Program. This new default language does not take effect with respect to a plan or Constituent Benefit Program, unless the underlying Program does not have legally sufficient language, and the Plan Administrator makes such a determination, in writing. This language is added to be sure that your ERISA-governed Wrap document and SPD meet these new legal requirements. 

Unum has updated their insurance policy to comply with the regulation update, and you have nothing to worry about.

Because Unum will be processing claims under this new regulation going forward, and Plan Sponsors must provide notice to the participants 210 days following the close of the plan year, we recommend existing ERISA Wrap Document or All-In-One Health and Welfare subscribers republish their document by the end of their 2018 Plan Year. Those without existing subscriptions should produce a Wrap Document before the close of their 2018 Plan Year.   

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