Nearly every month since the summer of 2020, we have had at least one client ask what will happen when the declared COVID-19 national emergency will come to an end. Recently, the White House has announced an end to the COVID-19 Public Health Emergency and National Emergency periods. Both will end on May 11, 2023.
What does the end of the COVID-19 national emergency mean for ERISA-covered employee benefit plans? What does the end of the national emergency mean for long term disability deadlines? After a period of transition, the deadlines will return to their pre-pandemic timelines.
The National Emergency Rules Issued by the Department of Labor
The end of the COVID-19 National Emergency will adjust certain long term disability claims deadlines, long term disability appeals deadlines, and other employee benefit deadlines. To understand how those deadlines will change, here is some background on the rules that went into effect in May 2020 and the further guidance that was issued in February 2021.
The May 2020 Rules
The initial rules issued by the Department of Labor, Department of Treasury, and the Internal Revenue Service established an “Outbreak Period.” The Outbreak Period extended certain employee benefit deadlines including:
Benefit Claim Deadline: The deadline under a long term disability plan or other employee benefit plan by which participants may file a benefit claim.
Appeal Deadline: The deadline under a long term disability plan or other employee benefit plan by which participants must file an appeal of an adverse benefit determination – a termination or denial of benefits.
COBRA Deadline: The 60-day deadline to elect COBRA coverage.
Special Enrollment Rights Deadlines: The 30-day period to exercise special enrollment rights in a group health plan following birth, adoption, or adoption placement of a child; marriage, loss of other health coverage; or eligibility for a state premium assistance subsidy.
Many other ERISA-covered deadlines were also extended.
The Outbreak Period began on March 1, 2020, and was to end 60 days after the announced end of the declared COVID-19 national emergency.
The May 2020 rules provided that the days that passed during the Outbreak Period did not count towards the affected deadlines. That is, the Outbreak Period “stopped the clock” on those deadlines, and those deadlines could not occur during the Outbreak Period.
The February 2021 Guidance
As the COVID-19 national emergency continued, the Employee Benefits Security Administration of Department of Labor, the Department of the Treasury, and the Internal Revenue Service issued additional guidance in February 2021 that provided that the disregarded period would be somewhat limited.
The February 2021 guidance, which is still in effect today, provides that the disregarded period of time will extend only to the earlier of (a) 1 year from the original deadline or (b) 60 days after the announced end of the National Emergency (the end of the Outbreak Period). The February 2021 guidance further made it clear that “in no case will a disregarded period exceed 1 year.”
How Deadlines Are Affected by the End of the National Emergency
We now know that the end of the Outbreak Period – the period of time disregarded for certain ERISA deadlines – is July 10, 2023.
Benefit Claim Deadline: Typically, a plan will provide for a period of time in which to file notice of claim and proof of claim. The extensions of these periods are coming to an end.
If the clock on these deadlines began before July 10, 2022, the new deadline is July 10, 2023. Otherwise, the clock on these deadlines begins on July 10, 2023 and ends after the number of days outlined in the plan document.
For example, for a 150 day time limit: For a claim that accrued on January 15, 2023, the deadline will be December 7, 2023. For a claim that accrued on July 1, 2022, the deadline will be July 1, 2023.
Claims accruing after July 10, 2023 will be subject to the deadlines outlined in the plan.
Appeal Deadline: The deadline to appeal a termination or denial of benefits must be no shorter than 180 days. The extension of this period is coming to an end.
If the clock on these deadlines began before July 10, 2022, the new deadline is July 10, 2023. Otherwise, the clock on these deadlines begins on July 10, 2023 and ends on January 6, 2024.
Denials or terminations received after July 10, 2023 will be subject to the deadlines outlined in the plan – typically 180 days.
COBRA Coverage Election: If the clock on these deadlines began before July 10, 2022, the new deadline is July 10, 2023. Otherwise, the clock on these deadlines begins on July 10, 2023 and ends on September 8, 2023.
Special Enrollment Rights Deadlines: If the clock on these deadlines began before July 10, 2022, the new deadline is July 10, 2023. Otherwise, the clock on these deadlines begins on July 10, 2023 and ends on August 9, 2023.
If you have any questions about how your ERISA deadlines may be affected by the end of the National Emergency, it is best to consult with an experienced lawyer who understands the complexities of ERISA and its effect on the long term disability claims and appeals processes.
How The Maddox Firm Can Help
Communicating with the insurance company: The Maddox Firm will take over all communications with your insurance company on your behalf. We will ensure that all forms and paperwork are completed accurately and in a timely manner, and make sure that your insurance company meets all of their required deadlines. Should your insurance company request an interview, your attorney will prepare you beforehand and attend the meeting to safeguard you from any overstepping or inappropriate questions.
Filing an appeal, litigation, or negotiating a settlement: If your short or long term disability claim is denied, The Maddox Firm can prepare and file an administrative appeal on your behalf. Typically, if a claim is denied or terminated, you must go through the internal appeal process with your insurance company. If your claim is denied on appeal, you can sue your insurance company for the wrongful denial. Your insurance company may also at some point offer a lump sum settlement to buy out your disability claim. The Maddox Firm routinely handles disability insurance appeals, litigation, and negotiations.
We always recommend speaking with a trusted attorney before filing or appealing a short or long term disability insurance claim. Whether you are looking for assistance in navigating the claims process, appealing a claim denial, or litigating a final adverse decision, The Maddox Firm can help. The team at The Maddox Firm will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.
Comentários