News & Analysis as of

Patient Protection and Affordable Care Act (PPACA) › Claim Procedures

The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +
The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal subsidies to reduce the number of uninsured citizens. less -
Polsinelli

Department of Labor Sues UnitedHealth TPA Over Claim Denials

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The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis...more

Verrill

December 2018 Client Advisory

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This Client Advisory highlights important developments in the law governing employee benefit plans and executive compensation over the past year. It offers insight into what these developments mean for employers and plan...more

Verrill

New Disability Claims Procedures Affect Retirement Plans and Deferred Compensation Plans Too

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Much has been written about the Department of Labor’s final rule regarding disability benefit claims procedures (the “Final Rule”), which took effect on April 2, 2018. And by now, most employers – and all disability insurance...more

Katten Muchin Rosenman LLP

Are Your Qualified and Nonqualified Employee Benefit Plans in Compliance With the New ERISA Disability Claims Regulations?

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Effective for claims filed after April 1, 2018, employee benefit plans governed by the Employee Retirement Income Security Act (ERISA) must comply with the US Department of Labor's new disability claims regulations....more

Locke Lord LLP

No More Delays for Revised Disability Claims Regulations

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Effective April 1, 2018, the changes to the Department of Labor’s disability claims regulations will finally go into effect, providing participants with a more full and fair review of disability benefit claims that is more in...more

Bass, Berry & Sims PLC

Action Needed by Certain ERISA Plans – New Disability Claims Procedures Apply Beginning April 2018

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In January 2018, the U.S. Department of Labor (DOL) announced that final regulations affecting how some ERISA plans process claims and appeals will apply beginning April 1, 2018. As explained below, the final regulations...more

Patterson Belknap Webb & Tyler LLP

Prepare for New Claims Procedures for Disability Benefit Plans

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After several rounds of additional review and a three-month delay in the effective date, the final regulations originally issued by the U.S. Department of Labor (the “DOL”) in December 2016, which established new requirements...more

McCarter & English, LLP

No Further Delays for Enhanced Disability Claims Procedures: ERISA Plans Facing April 1, 2018 Compliance Date

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On December 19, 2016, the Department of Labor (“DOL”) issued final rules that significantly expand the existing claims procedures applicable to ERISA-covered benefit plans that provide disability or other benefits conditioned...more

Snell & Wilmer

New Disability Claims Regulations Take Effect for All Plans April 1, 2018

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As noted in our previous blog post, The New Disability Claims Regulations: They Don’t Only Apply to Disability Plans, the Department of Labor (“DOL”) issued regulations that revise the ERISA claims procedure regulations for...more

Mintz - Employment Viewpoints

No More Delays! New Disability Claims Rules to Take Effect April 2, Says DOL

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On April 2, 2018, significant changes to ERISA’s disability claims procedures will take effect. These new rules will require all ERISA-covered plans which provide disability benefits to make significant modifications to the...more

Seyfarth Shaw LLP

DOL’s New Disability Plan Claims Regulations To Become Effective

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The Department of Labor’s new regulations governing disability claims and appeals published on December 19, 2016 will go into effect on April 1, 2018, as announced by the DOL on January 5, 2018. ...more

Proskauer Rose LLP

ERISA Newsletter - Fourth Quarter 2017

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Editor's Overview - For over two decades, federal law has required covered health plans and insurers to ensure that certain mental health benefits are in parity with offered medical/surgical benefits. The meaning of...more

Snell & Wilmer

The New Disability Claims Regulations: They Don’t Only Apply to Disability Plans

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The Department of Labor (“DOL”) issued regulations that revise the ERISA claims procedure regulations for employee benefit plans that provide disability benefits (the “New Disability Claims Regulations” or “New Regulations”)....more

Proskauer - Employee Benefits & Executive...

Disability Claims Procedures Should be Updated for New Regulations

Proskauer - Employee Benefits & Executive... on

As open enrollment approaches for many benefit plans, employers and plans sponsors should check to make sure their claims procedures for disability claims are consistent with regulations that become effective for plan years...more

Proskauer - Employee Benefits & Executive...

Updated Health Care Reform Legislation Comparison Chart

Proskauer - Employee Benefits & Executive... on

The chart below compares key provisions of the Affordable Care Act (ACA), the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA). This chart is current as of July 13, 2017, and as of that date,...more

Ballard Spahr LLP

Health Care Reform in Transition While Congress Deliberates

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Changes are imminent for the Affordable Care Act and a range of other laws and regulations affecting the health care industry. Ballard Spahr attorneys established a Health Care Reform Initiative in 2008 to monitor and analyze...more

Balch & Bingham LLP

DOL Tightens Disability Claim Processing Rules

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“Isn’t this an ACA blog?” Yes, it is. “So, why are you writing about disability plan administration?” Because they said so. The preamble to the proposed rules explains – Inasmuch as disability and lost earnings can be sources...more

Proskauer - Employee Benefits & Executive...

Claims Administrator Not Liable Under ERISA For Alleged Failure to Follow ACA’s Enhanced Benefit Claim Procedures

Proskauer - Employee Benefits & Executive... on

A federal court in New York appears to have issued the first published decision addressing alleged violations of the enhanced benefit claim procedures arising out of the Affordable Care Act (ACA). The new procedures contain...more

Baker Donelson

Ordering/Referring Phase 2 Begins May 1st - Claims Will Be Denied

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In an April 24, 2009 transmittal, CMS announced a two-phase claims editing expansion designed to allow verification that the physician or non-physician practitioner (NPP) listed as the ordering/referring provider on a...more

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