27 Sep 2022

Help Me Help You: Fine-Tuning Your Benefit Claims Process

All ERISA plans are required to have reasonable procedures for filing benefit claims. A claim for benefits can consist simply of a participant’s request for a plan benefit. So plans should have procedures for handling benefit claims. This includes notifying the plan administrator or other claims fiduciary of the request, involving counsel where needed, and notifying an insurer, where it’s an insured benefit, or an actuary or the plan recordkeeper. This process map illustrates how to handle a claim under an ERISA pension plan. See if your plan process complies.

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Employee Benefits & Executive Compensation Key Legal Developments Tracker
Stay informed on new developments.
- ERISA. DOL issues guidance through EBSA addressing when a qualified public accountant that examines an employee benefit plan’s financial statements (as applicable) is independent for purposes of rendering an opinion on the financial statements. DOL Interpretive Bulletin 2022-01, 87 Fed. Reg. 54368 (Sept. 6, 2022).
- Legislative Developments. The U.S. Senate Finance Committee released the legislative text of the Enhancing American Retirement Now (EARN) Act, after the measure was favorably reported in a committee markup. Section-by-section summary of the bill.
- Health and Welfare Benefits. Plan sponsors offering prescription drug coverage must provide notices of creditable or non-creditable coverage to Medicare-enrolled individuals before each year’s Medicare Part D annual enrollment period—this year, by October 14. The notice obligation should be provided to retirees and their dependents, Medicare-enrolled active employees and their dependents, and Medicare-enrolled COBRA participants and their dependents.
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