Agency Information Collection Activities; Submission for OMB Review; Comment Request; Employee Benefit Plan Claims Procedure Under the Employee Retirement Income Security Act
AI-generated summary for informational purposes only. Not legal advice. See the original source for the authoritative text.
The Department of Labor is seeking OMB approval to continue requiring employee benefit plans governed by ERISA to follow specific claims and appeals procedures. Plans must provide written or electronic notices explaining claim denials, citing relevant plan provisions, listing additional needed information, and describing appeal rights. Any appeal decision must also be issued in writing or electronically with specific reasons and plan references. This is an extension of an existing information collection (OMB Control Number 1210-0053) under the Paperwork Reduction Act. The regulation stems from ERISA sections 503 and 505. DOL estimates this affects over 4.3 million respondents and generates nearly 1.91 billion responses annually, with a total time burden of approximately 38.05 million hours and other costs of about $501.7 million per year. Public comments are due by May 4, 2026.
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Key Changes
- OMB review period ends May 4, 2026 for public comments
- Requires written or electronic denial notices with specific reasons and plan provision references
- Must describe additional information needed to perfect a claim and appeal steps
+ 3 more changes with Pro
Obligations
What this law requires
Provide written or electronic notice to every claimant whose claim is denied, containing the specific reasons for denial
Include reference to relevant plan provisions on which the claim denial is based in the denial notice
Describe any additional information necessary to perfect the claim in the denial notice
Describe the steps to be taken if a participant or beneficiary wishes to appeal the claim denial in the denial notice
Issue any adverse decision upon review in writing or electronic format with specific reasons for the decision