Sent: Thursday, December 31, 2015 7:11 PM

To: EBSA, E-ORI - EBSA

Subject: Re: RIN 1210-AB39

Re: RIN 1210-AB39

Attention: Claims Procedure Regulation Amendment for Plans Providing Disability 

Benefits

Office of Regulations and Interpretations, Employee Benefits Security Administration

Room N-5655

U.S. Department of Labor

200 Constitution Avenue NW

Washington, DC 20210

To whom it may concern:

I am writing to comment on the Proposed Regulations issued by the Department of 

Labor, Employee Benefits Security Administration on November 18, 2015 

(“Proposed Regulations”).

I want to commend the Department of Labor (“Department”) for this very 

constructive proposal - thank you. I strongly approve of the comment made by the 

Department in the preamble that “disability claimants deserve protections equally 

as stringent as those that Congress and the President have put into place for health 

care claimants under the Affordable Care Act.”

I am presently a disability recipient under an employer-sponsored disability plan 

governed by the Employee Retirement Income Security Act of 1974 (“ERISA”) 

and its requirements regarding claims procedures. I can speak first hand to the 

potential abuses occurring under the current claims-procedure regulations and the 

urgent need to address these in the Proposed Regulations.

The proposed tightening of the conflict-of-interest rules is particularly welcome. 

Prohibition against a claims fiduciary (typically the insurance carrier insuring the 

disability claim under the employer plan) making any decisions regarding hiring, 

compensation, termination, promotion or similar matters with respect to any 

individual (such as a claims adjustor or medical expert), based on the likelihood 

that the individual will support the limitation or denial of disability benefits, 

should—going forward—help eliminate, or substantially reduce, the documented 

cases of such behavior by disability insurance carriers, most notably 
Unum/Provident (see John H. Lanbein, Susan J. Stabile, Bruce A. Wolk, Pension 

and Employee Benefit Laws at pp. 669-74). The insurance carrier would not be 

permitted to contract with a medical expert based on the expert’s pattern of 

denying claims, as is clearly the typical situation today, which I know from my 

own experience. This will, I hope, add a measure of integrity to independent 

medical exams (IMEs) used so frequently to contest, and ultimately deny, a 

disability claim notwithstanding the opinion of the claimant’s doctor.

The proposed amendments to the disclosure requirements should also prove

helpful to disability claimants faced with a claim denial based on ill-defined 

reasons. The requirement to produce a detailed description of the denied decision, 

including the basis for the plan’s disagreement with the claimant’s treating 

physician or the Social Security Administration as well as the internal rules, 

guidelines, protocols, standards or other criteria applied to deny the claim, should 

prove helpful in appealing denied claims in court.

The other proposed changes are meritorious as well and should be adopted as part 

of the final regulations. For example, the “de novo” standard of review in cases 

where the plan has not followed the correct procedures should provide an effective 

incentive for disability carriers to comply with the relevant rules—an incentive that 

is unfortunately so desperately needed.

The Proposed Regulations give disability claimants more procedural rights and 

safeguards to partially offset what is an unacceptably and unjustifiably uneven 

playing field at present. I can speak from personal experience that disabled 

claimants are faced with substantial procedural obstacles put in their way by 

disability carriers. This is particularly disturbing in light of the significantly 

diminished capacity of most claimants—due to the limitations imposed by their 

disability—to get through all the gratuitously cumbersome procedural hurdles and 

grueling, harassing and irrelevant requirements placed on them by the disability 

carriers. Given the lack of a jury trial, the prohibition against punitive damages and 

the potential deferential standard of review of denied claims, these proposed 

changes are critical to provide at least some fairness to disabled claimants in a 

process that is heavily structured against them.

For the above reasons, I strongly support adoption of the Proposed Regulations as 

soon as possible.

Sincerely,