ERISA Based Long Term Disability Issues in the 'Post Pandemic' World

In 2015, the US Department of Labor published a proposed rule in the Federal Register revising claims procedure regulations for ERISA Disability plans which provided benefits to workers. Not surprisingly, the DOL was inundated with comments from plan participants, consumer groups, employer groups, insurance groups and others. After reviewing those comments, the DOL revised several key regulations in an effort to provide disability claimants a full and fair review of their ERISA disability claims under ERISA Section 503 and pursuant to strong procedural protections Congress enacted under the Affordable Care Act  under the Department's implementing regulation at 29 CFR 2590.715-2719 (http://www.ecfr.gov/current/title-29/section-2590.715-2719) while also trying to balance the cost to insurers and employers. The final rule applied to ERISA disability claims filed on or after April 2018. The DOL hoped that that final rule would promote fairness and accuracy in the claims review process and protect beneficiaries in ERISA disability plans.

Then on March 13, 2020, the COVID-19 National Emergency was declared back to March 1, 2020. The global pandemic caused claimants, employers, and insurers to adjust to a world where in-person medical treatment was essentially suspended for a lengthy period except for treatment of COVID-19, and while most workers (outside the health care field) worked remotely. On May 4, 2020, in response to this new world order, the US Department of Labor, the Treasury Department and the IRS issued joint notifications of Extensions to certain Timeframes for Employee Benefit Plans. Those extensions affected ERISA disability claims and appeals and external review deadlines under the 2018 regulations. Due dates and deadlines were adjusted under the above claims provisions accordingly until the end of the COVID-19 national emergency.

The COVID-19 Public Health Emergency (PHE) ended May 11, 2023. This seminar will address the underlying 2018 US DOL regulations impacting ERISA Disability Claims, how the COVID-19 PHE affected those claims, and how to move forward in presenting those claims.


Learning Objectives:

1. Examine the impact of COVID-19 PHE on medical proofs in ERISA LTD claims during the PHE period and beyond
2. Address issues related to Telehealth treatment of ERISA disability claimants during the COVID-PHE period and beyond
3. Review issues relating to objective testing administered via telehealth during the COVID-PHE and beyond and the arguments against it by insurers
4. Discuss the impact of the COVID-19 PHE on ERISA disability claims practices throughout the PHE and beyond