Erisa's regulatory requirements

AuthorScott M. Riemer/Jennifer L. Hess
Chapter 3
e rights of claimants are set forth in the terms of the Policy.
However, over and above those rights are certain protections owed to
claimants under ERISA and the claims procedure regulations issued
by the United States Department of Labor, 29 C.F.R. §2560.503-1 (the
“Regulations”). e most important protections are: (1) ERISA’s du-
ciary standards and (2) the full and fair review requirements set forth in
503 of ERISA, and the Regulations.
When handling an ERISA disability claim, it is important to be
conversant in each of these two areas of protection. Whole books can be
written on these topics. What follows is intended to be an overview only.
We encourage all readers to take a deep dive into the Regulations and
the ever-growing case law interpreting them. ese protections should
guide how you handle claims, appeals, and litigation.
ERISA’s regulations were revised eective April 1, 2018. If your client
became disabled before April 1, 2018, older regulations may apply. Always
check to conrm which version of the regulations apply to yourcase.
e administrators of the plan must adhere to a set of strict duciary
duties in administering a plan. is means the administrator must dis-
charge its duties solely in the interests of participants and beneciaries, and
for the exclusive purpose of providing benets to participants and their
beneciaries. 29 U.S.C. §1104(a)(1)(A)(i-ii). Additionally, administrators
are required to discharge their duties with the same skill and diligence as

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