Run-Out Period

[Gadgetfreak]

We use Accudraft for our document software. It mentions briefly a 90 day run-out period for submitting claims but doesn't detail it further. The EBIA manuals don't seem to discuss it either. Here is my question. Someone submits an incomplete claim on 3/31. Are we allowed to close the books at that time and forfeit his balance since he did not get a complete claim in by the deadline? Or, like with IRS filings, if they get it by the deadline but it is incomplete, there is time to correct? We can't leave our previous books open for so long. Clients want their totals. Without proper guidance I have been relying on the fact that, as long as I properly communicate this rule, we are OK. After all, the Doc says 90 days but I worry that it says to submit (not for it to be complete and accurate). Anyone have any thoughts on this issue (preferably with some guidance I can cite)? Thanks in advance.

[oriecat]

Aren't you in effect denying the claim, due to incomplete documentation, and wouldn't this then need to fall under the claims appeal process?

[Gadgetfreak]

Aren't you in effect denying the claim, due to incomplete documentation, and wouldn't this then need to fall under the claims appeal process?

Well, we are denying the claim for lack of documentation but also saying it is too late to resubmit because of the deadline. The question is, is the deadline for the initial submission. for the complete claim or is it up to the Administrator?

[Bill Presson]

Aren't you in effect denying the claim, due to incomplete documentation, and wouldn't this then need to fall under the claims appeal process?

Well, we are denying the claim for lack of documentation but also saying it is too late to resubmit because of the deadline. The question is, is the deadline for the initial submission. for the complete claim or is it up to the Administrator?

The Accudraft document that we use says the date is "to submit". So if you deny, then you are under the appeal process just like oriecat says.

If you don't want the runout to be that long, then amend the plan and make it 30 days.

[Gadgetfreak]

Aren't you in effect denying the claim, due to incomplete documentation, and wouldn't this then need to fall under the claims appeal process?

Well, we are denying the claim for lack of documentation but also saying it is too late to resubmit because of the deadline. The question is, is the deadline for the initial submission. for the complete claim or is it up to the Administrator?

The Accudraft document that we use says the date is "to submit". So if you deny, then you are under the appeal process just like oriecat says.

If you don't want the runout to be that long, then amend the plan and make it 30 days.

Thanks for the replies. Here are some follow-up questions:

1) The appeals process says the employer makes the final decision. Does it matter what the reason is? Can the employer deny for the same reason we did - it was not submitted completely on 3/31?

2) Can I close the books, reconcile the assets, create the report and forfeit the funds to the employer after 3/31 anyway? What will happen if we did make a mistake (and that is part of the answer to #1 above)?

Thanks again.

[oriecat]

Just curious, how much money are you talking about here?

[QDROphile]

If you look at the ERISA claims procedure regulations under section 503 of ERISA (ERISA regulation section 2560.503-1), you will find two pertinent provisions.

1. When a claim is denied, the denial must explain what would be necessary to perfect the claim.

2. A claimant may submit material for review of a denied claim even if the material was not submitted in the original claim.

When I put those two points together, I conclude that if the claimant submitted anything remotely resembling a valid claim by the deadline, you cannot preclude a claimant from supplementing the orginal documentation after the deadline and denial to cover the missing information and be successful in the claim. The conclusion presumes timely submission of materials under the claims procedures, including the review procedures.

[Guest jackswife]

I have a related question. If the processor denies the incomplete claim (submitted at the end of run-out), can they allow a "request for review" button on the website and accept additional info (receipt, signature, etc.) for 180 days after the denial? Must the claimant follow the formal appeals process included in the denial notification or does ERISA allow the submission of the info for 180 days? In effect, I am asking what the actual definition of "appeal" is.