DOL gets teeth to punish health plans that stall your appeals
H.R. 9751 — Consumer Appeal Rights Enforcement Act · Filed by Summer Lee (D-PA) · 2 cosponsors · Introduced Jul 16, 2026 · Referred to committee
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What it does
This bill strengthens enforcement of health plan appeal and claims procedures by allowing the Department of Labor to assess civil penalties against plans and third parties (like insurers or administrators) that fail to follow required claims processes, deny timely appeals, or withhold required information from participants. Penalties range from $1,000 per day for individual violations to up to $3,000 per participant per year for systemic failures, with trebled penalties if violations aren't corrected within 30–90 days depending on plan type.
Why we flagged it
The bill's core mechanism is direct Department of Labor enforcement authority and civil penalties against plans and administrators for claims-procedure violations. It is a regulatory enforcement tool, not a benefit program or tax measure.
What the text implies
- Third-party administrators and insurers (not just plans themselves) face joint and several liability, potentially shifting compliance costs upstream to service providers and creating incentive for them to audit plan sponsors more aggressively.
- The 3-day cure period for urgent-care claim violations is extremely tight and may force plans to invest in real-time claims systems or face trebled penalties, raising operational costs.
The full analysis lists 4 implications of this text.
Who stands to gain
health plan participants and beneficiaries (through enforcement of appeal rights); Department of Labor (through penalty collection authority)