The Department of Labor’s regulation governing ERISA claims and administrative appeals provides a comprehensive structure for the claim process required of all ERISA plans. While there is plenty of room within the context of the regulation for a particular plan to contain its own essentially bespoke claims process, the regulation imposes the broader outline with which all such processes must comply. Another way I like to put this is by comparison to a jazz quartet – the composition provides the general framework within which the individual player can improvise before coming back to the general harmony of the group as a whole. The Department’s claim regulation works the same way – every claim process must align with certain overall requirements, but within those requirements are plenty of opportunities for a plan administrator to go off on a solo and craft its own approach to claims while still complying with the regulatory requirements.

I will be discussing this theme on Thursday, June 6th, as part of the webinar I am presenting for Lorman on the handling of disability claims under the Department of Labor’s claim regulations. If you would like to attend, reach out before you sign up and I will forward discount information to you.