WASHINGTON – Your company just denied your disability claim. What do you do now? How long do you have to file an appeal? And with whom?
The Obama administration is planning to upgrade consumer protections for tens of millions of workers and family members covered by health, disability and pension plans, ordering companies to clearly explain decisions on claims and how employees can dispute denials.
The basic idea is to require health and other plans to spell out what a worker needs to know to safeguard his rights.
“People need to have a clear road map to appeal claims,” Phyllis Borzi, assistant secretary for employee benefits at the Labor Department, said in an interview.
Department officials also want to make the appeals process more responsive. One of the changes under consideration would require health plans to decide appeals for urgent medical care in 24 hours, instead of up to 72 hours as currently allowed.
“On the health side, this is significant because a lot of people have experienced a situation where a claim is denied,” said Paul Fronstin, a policy expert for the nonpartisan Employee Benefit Research Institute. “Now there would be an expedited process to address that.”
Officials say they plan to issue the new rules by next spring.
The health, disability and retirement plans at issue fall under the umbrella of a 1970s federal law called the Employee Retirement Income Security Act, which gives employers flexibility to design benefit programs while setting basic standards.
About 130 million people are covered by health plans governed by the law, including most employees of major companies.
This year’s health care overhaul included a “patient’s bill of rights” that added new appeals protections for people in private insurance plans. But many employees at big companies did not benefit from those improvements. That’s because they are in plans considered “grandfathered” and outside the scope of the overhaul legislation.
However, those same health plans do fall within the jurisdiction of the 1970s law and the regulations the Labor Department is now reviewing.