The Employee Retirement Income Security Act of 1974 (“ERISA”) is a federal law that protects an individual’s rights to benefits under employee benefit plans. Passed in 1974, ERISA has been amended to expand the protections available to covered individuals. Notable amendments include, but are not limited to, the Consolidated Omnibus Budget Reconciliation Act (“COBRA”), the Health Insurance Portability and Accountability Act (“HIPAA”), and the Affordable Care Act.
However, as COVID-19, swept through the United States, impacting employers and employees alike, ERISA has not escaped unscathed. In addition to the foregoing amendments, President Donald Trump’s declaration of a national emergency and signing of the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) has resulted in the temporary amendment of various aspects of ERISA. In accordance with these actions, on May 4, 2020, the United States Department of Labor (“DOL”) issued a notification regarding relief and extension of timeframes under ERISA. Included in this notice were specific examples relating to each type of extension granted.
Example 5: Claims for Medical Treatment Under a Group Health Plan
Individual D is a participant in a group health plan. On March 1, 2020, Individual D received medical treatment for a condition covered under the plan. However, a claim relating to the medical treatment was not submitted until April 1, 2021. Under the plan, claims must be submitted within three hundred and sixty-five (365) days of the participant’s receipt of the subject medical treatment. However, Individual D’s claim was timely submitted because, for purposes of determining the three hundred and sixty-five (365) day period applicable to Individual D’s claim, the period beginning March 1, 2020, until sixty (60) days after the end of the national emergency, or after such other date announced by the DOL (“Outbreak Period”), is not included in the calculation. Therefore, Individual D’s last day to submit a claim is three hundred and sixty-five (365) days after June 29, 2020, which is June 29, 2021. As such, Individual D’s claim was timely.
Example 6: Internal Appeal – Disability Plan
On January 28, 2020, Individual E received notification of an adverse benefit determination from his disability plan. The notification advised Individual E that if he elected to file an appeal, he must do so within one hundred and eighty (180) days. When determining the one hundred and eighty (180) day period within which Individual E must file his appeal, the Outbreak Period is disregarded. Therefore, Individual E’s last day to submit an appeal is one hundred and forty-eight (148) days (180 – 32 days following January 28 to March 1) after June 29, 2020, which is November 24, 2020.
Example 7: Internal Appeal – Employee Pension Benefit Plan
On April 15, 2020, Individual F received a notice of adverse benefit determination from his 401(k) plan. The notification advised Individual F that he had sixty (60) days within which to file an appeal. When determining the sixty (60) day period, the Outbreak Period is not included in the calculation. Therefore, Individual F’s last day to submit an appeal is sixty (60) days after June 29, 2020, which is August 28, 2020
If you feel your rights under ERISA or the CARES Act have been violated, or if you have any other questions regarding your employment rights, please contact the experienced Birmingham employment law attorneys at Michel | King. You can contact us either online or by calling us at (205) 319-9724. We are here to serve you!