DOL Information Letter Confirms Participants’ Right to Authorized Representative
On Feb. 27, 2019, the DOL released an information letter provided to the Justus Group, L3C (Justus). Justus is a patient advocate and health care claim recovery expert for plan participants both at the initial application stage and at the appeals stages. As background, DOL information letters call attention to established principals under ERISA. This letter confirms participants’ right to have an authorized representative communicate with the plan on their behalf.
As background, ERISA’s claims procedure regulations allow claimants to designate an authorized representative that will act on behalf of the claimant. The authorized representative should receive any notifications concerning the initial claim determination or appeal. The letter makes it clear that any procedure established for determining whether an individual is authorized to act on behalf of a claim cannot prevent claimants from choosing their representative or from designating whether the representative will act on their behalf for the initial claim or the appeal of an adverse benefit determination, or both.
The letter also reminds plan sponsors to include the procedure for designating an authorized representative in the plan documents (including the SPD).
Plan sponsors should consider this guidance when operating their plan. Their plan documents should clearly state the process by which participants can designate an authorized representative and they should not preclude participants from doing so.