In a post-Chevron world, employers that sponsor self-insured health plans (and other benefit plans!) must continue to ensure that they are complying with ERISA’s claims procedures.
In a recent decision, the Eastern District of Virginia found that ERISA’s claims procedures, in particular regarding exhaustion and timing, continue to apply following the Supreme Court’s decision in Loper Bright, which provides that courts must exercise independent judgement in determining whether an administrative agency has acted within its statutory authority.
cogdell-v-reliance-standard-edva-09112024.pdf
In this case, the insurer argued that the 45-day requirement for decisions on appeal under ERISA’s claims procedures was invalid because it exceeded the Department of Labor’s (DOL) authority.
The court denied the insurer’s motion and found that the 45-day requirement was within the DOL’s authority, noting that the ERISA’s grant of authority to the DOL is “exceedingly broad.”
The court ordered the insurer to provide long-term disability benefits retroactively.
This is a good reminder for employers to review their benefit plan documents and operations for ongoing compliance…..especially considering that the Loper Bright decision may not change the degree of deference courts show in respect of ERISA and related DOL regulations.