DOL Information Letter on Designating Authorized Representatives

The Department of Labor (DOL) recently issued an Information Letter reminding plan sponsors of ERISA benefit plans to document procedures for appointing authorized representatives in the benefit claim and appeal process.  The DOL notes that plans may establish reasonable procedures for appointing authorized representatives, which cannot prevent claimants from choosing who will act as their representative for the initial claim or for an appeal of an adverse benefit determination.  These reasonable procedures must be included in the plan’s SPD.

What are reasonable procedures?  The DOL has stated that a plan may require a claimant to complete a plan-approved form identifying an individual as an authorized representative (except in cases of a claim involving urgent care).  ASR requires that claimants and their chosen authorized representatives complete our Designation of Authorized Representative Form for all the ERISA benefit plans we administer.  This procedure is clearly stated in the plan documents/SPDs we draft for our clients.

Assignment of benefits by a claimant to a health-care provider does not constitute a designation of an authorized representative.  Such assignment of benefits generally allows a provider to receive a benefit payment under the plan but not to act as a claimant’s representative.

Note that an Information Letter is for informational purposes only and is not binding.  If you have questions about authorized representatives or the procedure for their designation, call ASR Health Benefits at (616) 957-1751 or (800) 968-2449.