FYI: AD&D and ERISA Claims Procedures

May 31, 2005

by Cindy Van Bogaert
 

Here is an FYI: Employee Benefits Update from Cindy Van Bogaert, Partner and Chair of the Employee Benefits Practice Group at Boardman Law Firm LLP.

A recent Department of Labor ("DOL") Advisory Opinion (2005-06A (Apr. 11, 2005) available at http://www.dol.gov/ebsa/pdf/ao2005-06a.pdf)  addresses the application of the Employee Retirement Income Security Act of 1974, as amended ("ERISA") claims procedure to one employer's accidental death and dismemberment ("AD&D") policy. Although an advisory opinion may be relied upon only by the parties identified in the request, this opinion provides insights as to the DOL's views. 

ERISA claims procedures contain different standards for responding to disability claims.  It is important to identify which standard applies in the event of a claim. The opinion provides a helpful discussion of when the ERISA claims requirements for disability benefits apply instead of the general claims procedure requirements.

Note that generally both the state insurance law and Federal ERISA claims procedures can apply to insured AD&D and other insurance benefit policies.  When reviewing these policies and other insured plan documentation, employers should make sure that documentation includes not only state-mandated language on claims, but also that the plan and summary plan description include the required Federal ERISA disclosures regarding the ERISA claims procedures. 

If you have any questions or need assistance, please contact Cindy Van Bogaert at (608) 281-7543 or cvanbog@boardmanlawfirm.com.

Would you like to have FYI: Employee Benefits Update sent directly to your e-mail inbox? If so, please send your request, with e-mail address, to Cindy Van Bogaert at cvanbog@boardmanlawfirm.com.