Department of Labor Regulations

Pursuant to a grant of authority by Congress, the U.S. Secretary of Labor has promulgated a set of regulations that specify how ERISA-controlled claims are required to be administered. The regulations cover several “nuts and bolts” topics, including: (i) the deadlines applicable to claim denials, appeal submissions and appeal decisions; and (ii) mandatory consultation with an appropriately trained health care professional. They also give rise to several rights that are critically important to claimants, including the right to be advised in writing of the “specific reason or reasons” for the denial, and the right to receive, free of charge, a complete copy of the disability insurer’s claim file.

The regulations have been amended several times over the years, and the current version features a timetable of applicability in its final subparagraph (i.e., subparagraph (p)). The complete text of the current regulations can be found at: Department of Labor Regulations.