Labor Department Issues Additional Answers to “Frequently Asked Questions” on the Claims Procedure 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Archived News Release — Caution: Information may be out of date.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 additional guidance that clarifies the scope of the claims procedure regulation.

PWBA Assistant Secretary Ann L. Combs said, “Today’s guidance is part of our continuing commitment to facilitate compliance with the new claims procedure regulation.”

This guidance supplements the set of “Frequently Asked Questions” on the claims procedure regulation released by the department on December 15, 2001. The new guidance addresses issues involving the application of the regulation to prescription drug programs, arbitration of non-benefits claims, and “top hat” plans. The guidance also clarifies the application of the “exhaustion of administrative remedies” doctrine when a plan fails to establish or follow a claims procedure consistent with the regulation.

The claims procedure rules published in the November 21, 2001, Federal Register apply to pension and disability benefit claims filed on or after January 1, 2002. Group health plans become subject to the rules as of the first day of the plan year beginning on or after July 1, 2002, but not later than January 1, 2003. The new guidance can be obtained on the PWBA Web site or by calling PWBA's Toll-Free Employee & Employer Hotline number: 1.866.275.7922 to obtain free printed copies.

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Archived News Release — Caution: Information may be out of date.