PUBLIC SUBMISSION

Received: January 19, 2016

Status: Pending_Post

Tracking No. 1k0-8nh1-j8ft

Comments Due: January 19, 2016

Submission Type: Web

Docket: EBSA-2015-0017

Claims Procedure for Plans Providing Disability Benefits

Comment On: EBSA-2015-0017-0001

Claims Procedure for Plans Providing Disability Benefits

Document: EBSA-2015-0017-DRAFT-0043

Comment on FR Doc # 2015-29295

Submitter Information

Name: Yonatan Ben-Shalom

Address: 

1100 1st St. NE

12th Floor

Washington, DC, 20002

Email: yben-shalom@mathematica-mpr.com

Phone: 2022503553

General Comment

Our understanding is that this proposal primarily seeks to address two types of unjustified denials 

of claims for disability benefits under employer-sponsored plans:

1. Denials on the basis of a disability determination, when evidence otherwise indicates a 

disability

2. Denials on the basis of program eligibility (for example, due to rescission, when the rescission 

is erroneous)

We agree that the proposal will likely help to protect employees against inappropriate denials of 

disability benefits, and therefore increase public confidence in the fairness of the claims and 

appeals processes. However, evidence suggests that the additional beneficiaries awarded benefits 

as a result of the proposed changes will almost certainly be required to apply for Social Security 

Disability Insurance (SSDI) benefits by the insurance providers (Autor et al. 2014, Livermore et 
al. 2000). If that is the case, the proposed change is very likely to have the unintended 

consequence of increasing applications for SSDI and, albeit to a lesser extent, awards of SSDI. 

These unintended consequences will present additional costs to the federal government that are 

not included in the analysis of costs and benefits included in this proposal.

To be clear, we do not mean to imply that the proposed rule is bad, as more people will get 

disability benefits for which they are eligible, and many disability insurance plans do provide 

early intervention services to help workers return to work (Autor et al. 2014). However, we 

would advise the government to consider a more balanced approach, including regulations 

designed to ensure that claimants are provided with evidence-based medical, rehabilitation, and 

employment services as well as accommodations and assistive technologies they may need to 

continue to work rather than become reliant on private and public disability benefits. Increased 

insurer provision of effective stay-at-work/return-to-work services will directly benefit

employees and employers, reduce costs to the government, and increase tax revenues (BenShalom 2015).

Sincerely,

Yonatan Ben-Shalom, Ph.D.

Project Director, The SAW/RTW Policy Collaborative

Mathematica Policy Research

David C. Stapleton, Ph.D.

Director, Center for Studying Disability Policy

Mathematica Policy Research

References:

Autor, David, Mark Duggan, and Jonathan Gruber. "Moral Hazard and Claims Deterrence in 

Private Disability Insurance." American Economic Journal: Applied Economics 6, no. 4 (2014): 

110-41.

Ben-Shalom, Yonatan. Assessing the Costs and Benefits of Return-to-Work Programs (Issue 

Brief). Mathematica Policy Research, 2015.

Livermore, Gina A., David C. Stapleton, Mark W. Nowak, David C. Wittenburg, and Elizabeth 

D. Eiseman. "The Economics of Policies and Programs Affecting the Employment of People 

with Disabilities." (2000).