The word disability does not by itself identify the claims covered by the Labor Department’s December 19, 2016 procedural rule. Within Title I ERISA plans, the key question is whether the claims adjudicator must determine disability to decide entitlement. That test can matter even when the wider arrangement is a pension plan rather than a plan labeled disability insurance. [2016-30070]

Conversely, a plan benefit conditioned on a disability finding made by an outside party is not treated as a disability claim for these special procedures. The rule does not rewrite Social Security’s eligibility criteria. Its adopted safeguards concern decisions and appeals, including disclosure of new evidence and a chance to respond before an adverse decision on review. [2016-30070]

The November 18, 2015 proposal supplies the procedural rationale. It sought to adapt specified protections used in group health claims, including impartial decision-making, access to the claim file and advance notice of new appeal reasoning. It did not propose importing every health-plan rule. Proposal and final text are successive documents in one Labor Department proceeding, not independent corroboration of outcomes. [2015-29295][2016-30070]

Timing is similarly specific. The published schedule sets January 18, 2017 effectiveness and January 1, 2018 applicability for newly filed disability claims, with specified transitional provisions for January 18 through December 31, 2017. This December 26 retrospective reports that original schedule, not later implementation. Neither a covered claim nor a procedural safeguard determines whether benefits must ultimately be paid. [2016-30070]

Source documents

  1. Claims Procedure for Plans Providing Disability Benefitshttps://www.govinfo.gov/content/pkg/FR-2016-12-19/html/2016-30070.htm
  2. Claims Procedure for Plans Providing Disability Benefitshttps://www.govinfo.gov/content/pkg/FR-2015-11-18/html/2015-29295.htm