PWBA Answers Frequently Asked Questions on Claims Regulation

Archived News Release — Caution: Information may be out of date.

Washington, DC - The U. S. Department of Labor’s Pension and Welfare Benefits Administration today released guidance to help the employee benefit community comply with the benefit claims regulation published last year for pension, health and disability claims.

Assistant Secretary Ann L. Combs said, “Today’s guidance is an important step in helping plans comply with the claims regulation in a timely fashion. We hope this guidance will make compliance less burdensome on the benefit community as it implements systems to process benefit claims, while maintaining the regulation’s important protections for workers and their families. We also expect to provide additional guidance in the future designed to facilitate smoother implementation of the benefit claim requirements, and welcome additional questions from the regulated community.”

The claims regulation, published in the November 21, 2000 Federal Register, establishes new rules for processing group health and disability benefit claims for plans governed by the Employee Retirement Income Security Act (ERISA). The regulation sets new, shorter time frames, additional disclosure requirements, and new standards for making claims decisions.

The regulation applies to new pension and disability claims filed on or after January 1, 2002, and applies to new group health claims only for plan years beginning on or after July 1, 2002. The regulation will be fully effective by January 1, 2003.

The new guidance, published as frequently asked questions and answers, focuses primarily on compliance with the rules governing the processing of group health and disability claims.

The new guidance can be obtained on the Internet at www.dol.gov/pwba or by calling 1.800.998.7542 to obtain free printed copies.

U.S. Department of Labor news releases are accessible on the Internet. The information in this news release will be made available in alternate format upon request (large print, Braille, audio tape or disc) from the Central Office for Assistive Services and Technology. Please specify which news release when placing your request. Call 202.693.7773 or TTY 202.693.7775.

Archived News Release — Caution: Information may be out of date.