The Impact of a Social Security Disability Determination on ERISA Based Long Term Disability Benefits under a Welfare Benefit Plan

When an employer offers short and/or long term disability benefits as part of an ERISA (Employee Retirement Income Security Act) Welfare Benefit Plan the laws and rules issued by the U.S. Department of Labor (DOL) including requirements for the processing of benefit claims, time parameters for when a decision must be rendered following the filing of a claim and a claimant’s rights upon denial of a claim apply. On November 18, 2015 the DOL proposed rules revising the existing ERISA Claim regulations pertaining to disability benefits (29 C.F.R. § 2650). The comment period ended January 19, 2016. The proposed regulations were created to align with the goals and protections afforded under the Affordable Care Act to assure more fairness in claims processing. Among the proposed regulations are provisions that require that the adverse benefit decision provide a basis for disagreement with a contrary Social Security decision. 

This course, led by attorney Barbara Comerford, examines the basics of ERISA Long Term Disability Insurance in Welfare Benefit Plans, compares those claims to Social Security Disability claims, examines the existing DOL regulations, Code of Federal Regulations and laws that pertain to both, and assesses the impact the proposed DOL regulations may have on them.

Learning Objectives:

I.     Recognize the different administrative review standards in ERISA LTD claims and SSD claims 

II.    Understand the relevant DOL regulations, Code of Federal Regulation provisions, and case law pertaining to the review of both ERISA and SSD claims 

III.   Comprehend the distinctions and similarities of both types of claims, and the impact each has on the other 

IV.   Discuss the most recent data on the number of workers affected by each of these claims