January 19, 2016

Submitted via http://www.regulations.gov

Office of Regulations and Interpretations

Employee Benefits Security Administration

Room N-5655

U.S. Department of Labor

200 Constitution Avenue NW

Washington, DC 20210

Attention: Claims Procedure Regulation Amendment for Plans Providing Disability Benefits 

(RIN 1210-AB39)

Dear Sir or Madam:

UnitedHealthcare appreciates the opportunity to provide the Employee Benefits Security 

Administration and the Department of Labor (collectively, the Agencies), with our comments in 

response to the Notice of Proposed Rulemaking on Claims Procedures for Plans Providing 

Disability Benefits.

UnitedHealthcare, a division of UnitedHealth Group, is dedicated to helping people live healthier 

lives. As a recognized leader in the health and well-being industry, we strive to improve the 

quality and effectiveness of health care for all Americans, enhance access to health benefits, 

create products and services that make health care more affordable, and use technology to make 

the health care system easier to navigate. UnitedHealthcare serves many of the country’s most 

respected employers, and we are also the nation’s largest Medicare health plan - serving nearly 

one in five seniors nationwide - and one of the largest Medicaid health plans, supporting 

underserved communities in 24 states and the District of Columbia. 

Below please find our specific recommendations.

Issue: Whether, and to what extent, modifications to the existing timing rules are needed to 

ensure that disability benefit claimants and plans will have ample time to engage in the backand-forth dialogue that is contemplated by the new review and response rights.

Recommendation: We support using existing timeframes under ERISA which should provide 

“ample” time for plans and claimants to engage in the necessary dialogue. If another standard is 

used, we encourage the Agencies to ensure that it is specific, unambiguous and consistent. 

Issue: The proposed rule provides that the effective date for the rules shall be 60 days after the 

date of publication of the Federal Register. If the final rule requires inclusion of the plan’s 

statute of limitations in adverse benefit determinations (ABDs), this date does not provide 

sufficient time to complete this significant undertaking and any necessary associated 

administrative functions. To accommodate the new requirement, plan administrators would need 

to undertake a thorough review of each plan’s documents to determine the appropriate statute of 
limitations and, where the plan is silent, attempt to determine the appropriate limitation for 

analogous cases under state law, or undertake numerous consultations with plan sponsors to 

ascertain plan intent. Furthermore, the proposed rule is unclear regarding whether the obligation 

to include a limitations period would be required where a plan is silent on the issue. Finally, 

significant undertaking would be required to appropriately and accurately connect the various, 

disparate adjudication systems to administer claims, appeals and member communications based 

on the varied timelines and triggering events. 

Recommendation: We urge the Agencies to consider the complex logistical and operational 

challenges involved in bringing claim systems, letter systems and business processes into 

compliance with the proposed requirements specifically to include notice of the plan’s statute of 

limitations in the ABDs, given that a significant volume of plans contain limitations periods of 

varying lengths triggered by different events. 

In the alternative, we propose inclusion of a general statement directing the claimant to the 

statutory period in the summary plan description or plan documents, or to the analogous period 

in state law, whichever is applicable. At a minimum, there should be a reasonable enforcement 

safe harbor period for health plans and issuers to make a good-faith effort to bring their systems 

and processes into compliance with the new requirements.

Thank you for taking time to review our comments. We appreciate your consideration and 

welcome the opportunity to discuss further.

Deputy General Counsel

January 19, 2016