The Department of Labor has recently released a letter emphasizing the importance of allowing a participant to designate an authorized representative for an initial claim, the subsequent appeal if there is an adverse benefit determination, or both. The letter states that the claims and appeals procedure described in the plan document and SPD must also include the procedure for designating an authorized representative, if any. With the exception of an urgent care claim, where a health care professional with knowledge of the participant’s medical condition must be allowed to act as an authorized representative, there are generally no hard and fast rules regarding what procedure a plan may implement. The procedure must simply be reasonable, and most plans require the participant submit a form naming the representative.
In addition to ensuring their claims and appeals language includes information on designating an authorized representative, plans should also ensure that representatives are receiving the appropriate notices and disclosures. The DOL states that the representatives should receive all notifications and information that the participant is entitled to receive. Participants should be made aware of the broad swath of information the authorized representative will receive.