[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9751 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 9751
To amend the Employment Retirement Income Security Act of 1974 to
establish additional requirements relating to claims and appeals.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 16, 2026
Ms. Lee of Pennsylvania introduced the following bill; which was
referred to the Committee on Education and Workforce
_______________________________________________________________________
A BILL
To amend the Employment Retirement Income Security Act of 1974 to
establish additional requirements relating to claims and appeals.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Consumer Appeal Rights Enforcement
Act''.
SEC. 2. ENFORCEMENT OF CLAIMS PROCEDURE AND EXTERNAL REVIEW
REQUIREMENTS.
(a) Equitable Relief and Penalties.--Section 502(a) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1132(a)) is amended--
(1) in paragraph (5), by inserting before the semicolon the
following: ``or the terms of the plan''; and
(2) in paragraph (6), to read as follows:
``(6) by the Secretary to collect any civil penalty under
this title;''.
(b) Penalty for Claims Procedure and External Review Requirement
Violations.--Section 502(c) of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1132(c)) is amended by adding at the end the
following:
``(14)(A) Global and individual violations.--
``(i) In general.--The Secretary
may assess a civil penalty under
subparagraph (B) against any person or
entity (other than a plan) that
materially causes (including through
failure to perform required actions) a
global violation described in clause
(ii) or individual violation described
in clause (iii).
``(ii) Global violation.--It shall be
deemed a global violation for a plan to fail to
have--
``(I) a claims procedure that
complies (in writing or in operation)
with--
``(aa) the terms of the
plan; or
``(bb) section 503
(including the requirements of
section 2560.503-1 of title 29,
Code of Federal Regulations, as
in effect on the date of
enactment of the Consumer
Appeal Rights Enforcement Act);
or
``(II) an external review process
that complies (in writing or in
operation) with--
``(aa) the terms of the
plan; or
``(bb) the requirements of
section 2590.715-2719 of title
29, Code of Federal
Regulations, as in effect on
the date of enactment of the
Consumer Appeal Rights
Enforcement Act.
``(iii) Individual violation.--It shall be
deemed an individual violation for a plan to
fail to--
``(I) provide a required
notification or disclosure to a
participant or beneficiary that
includes all required content;
``(II) respond to or decide a
participant's or beneficiary's claim,
appeal or request for external review
in a timely manner; or
``(III) respond to a participant's
or beneficiary's communication or
request for information with the
requested information to which the
participant or beneficiary is legally
entitled;
in a manner that violates the plan's written
claims procedure, section 503 (including the
requirements of section 2560.503-1 of title 29,
Code of Federal Regulations (as in effect on
the date of enactment of the Consumer Appeal
Rights Enforcement Act)), or the requirements
of section 2590.715-2719 of title 29, Code of
Federal Regulations (as in effect on the date
of enactment of the Consumer Appeal Rights
Enforcement Act).
``(iv) Separate violations.--Each
individual violation with respect to each
participant or beneficiary shall be treated as
a separate violation.
``(B) Penalty amounts.--
``(i) Global violation.--The amount of the penalty
imposed under this paragraph for a global violation
shall be no greater than the product of--
``(I) for each plan year in which such a
violation occurs, $1,000, multiplied by
``(II) the number of participants and
beneficiaries in the plan at the start of each
such plan year.
``(ii) Enhanced penalty for certain global
violations.--A penalty for a global violation may be
trebled if such violation is not corrected within 90
days after the Secretary gives written notice of the
Secretary's intent to assess such penalty to the plan
administrator and each person or entity that the
Secretary intends to hold liable for the penalty.
``(iii) Individual violation.--The amount of the
penalty imposed under this paragraph for an individual
violation shall be no greater than $1,000 for each day
beginning on the date on which--
``(I) a participant or beneficiary (or such
participant or beneficiary's authorized
representative) gives written notice of the
violation to the administrator and the
Secretary of Labor; or
``(II) if the Secretary discovers an
individual violation during the course of an
investigation pursuant to section 504, the
Secretary provides written notice to the
administrator of such violation.
and ending on the date on which the violation is
corrected.
``(iv) Enhanced penalty for certain individual
violations.--The civil penalty described in clause
(iii) may be trebled with respect to each separate and
distinct violation of subparagraph (A)(iii) that is not
corrected within the following periods beginning on the
date on which the plan administrator receives notice
described in subclauses (I) or (II) of clause (iii):
``(I) 90-day period with respect to a
violation pertaining to a plan that is not a
group health plan.
``(II) 30-day period with respect to a
violation pertaining to a group health plan.
``(III) 3-day period with respect to a
violation of a claim involving urgent care as
defined in section 2560.503-1(m)(1) of title
29, Code of Federal Regulations (as in effect
as of the date of enactment of the Consumer
Appeal Rights Enforcement Act).
``(v) Pattern or practice of individual
violations.--In addition to the penalties under clauses
(iii) and (iv), in the case that the Secretary
determines that a person or entity has engaged in a
pattern or practice of individual violations, the
Secretary--
``(I) shall provide notice to the plan of
the intent to assess a penalty with respect to
each individual violation that occurred within
the 3-year period ending on the date that such
notice was provided, unless each such
individual violation has been corrected;
``(II) with respect to each individual
violation, shall assess a penalty not less than
$100 and not greater than $1,000 for each day
each such violation during such period was not
corrected following receipt of the notice by
the Secretary; and
``(III) may waive some or all of the
penalties if the plan corrects the violations
within 120 days of receipt of the notice
required under subclause (I).
``(C) Joint and several liability.--Any person or entity
that materially causes (including through failure to perform
required actions) a violation described in subparagraph (A)
shall be jointly and severally liable for the payment of the
appropriate penalty described in subparagraph (B).''.
(c) Additional Penalty.--Section 502(g) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1132(g)) is amended by adding at
the end the following:
``(3)(A) In any action brought under subsection (a)(5) with
respect to a violation of section 503 (including a violation of
section 2560.503-1 of title 29, Code of Federal Regulations, as
in effect on the date of enactment of the Consumer Appeal
Rights Enforcement Act) or a violation of section 2590.715-2719
of title 29, Code of Federal Regulations (as in effect on the
date of enactment of the Consumer Appeal Rights Enforcement
Act), a court may impose against any defendant (other than a
plan), as additional relief, the penalties described under
subsection (c)(14).
``(B) A court may not impose such penalties if the
Secretary has previously assessed a penalty under subsection
(c)(14) against such defendant for the same violation.
``(C) The Secretary may not assess any penalty under
subsection (c)(14) against a person or entity if, in an action
brought under subsection (a)(5), a court has imposed a penalty
against such person or entity for the same violation.''.
(d) Effective Date.--The amendments made by this section shall
apply beginning on the date that is 90 days after the date of enactment
of this Act.
SEC. 3. DIRECT ENFORCEMENT AUTHORITY.
(a) In General.--Section 502(b)(3) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1132(b)(3)) is repealed.
(b) Effective Date.--The amendment made by this section shall apply
beginning on the date that is 90 days after the date of enactment of
this Act.
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