Tag Archives: Claim Procedures

Department of Labor Proposes to Delay Implementation of Disability Claim Regulations

On October 6, 2017, the Department of Labor signed a proposed Rule “to delay for ninety (90) days – through April 1, 2018 – the applicability of the Final Rule amending the claims procedure requirements applicable to ERISA-covered employee benefit plans that provide disability benefits.” Specifically, the DOL proposes: Section 2560.503-1 is amended by removing … Continue Reading

Internal quality assurance discussion about $100,000 error in plan interpretation not evidence of conflict

Running an employee benefit claims operation is a complex undertaking, which requires continual training and oversight. A robust quality assurance organization can play an important part in the overall management mix. Curran v. Aetna Life Ins. Co., 13-cv-289, 2016 WL 3843085 (S.D.N.Y. July 11, 2016), gives a concrete example of a quality assurance review catching … Continue Reading

Sixth Circuit criticizes administrator for not allowing treating doctors more time to return calls

Shaw v. AT&T Umbrella Ben. Plan No. 1, 795 F.3d 538 (6th Cir. 2015) concerned denial of plaintiff’s claim for disability due to chronic neck pain. The district court affirmed the denial, but the 6th Circuit reversed, finding the determination arbitrary and capricious. The court took issue with much of the claim administration, criticizing the … Continue Reading

Nice Second Circuit Decision Illustrating Appropriate Administrative Review

Ingravallo v. Hartford Life & Acc. Ins. Co., 2014 WL 1622798 (2d Cir. Apr. 24, 2014), doesn’t break any new legal ground, but it is nonetheless noteworthy for several reasons. It is rare that the Circuit reverses a District Court’s determination; here, it reversed and directed entry of judgment for Hartford. Second, it contains excellent … Continue Reading

Must disability claim administrators now obtain the SSDI file in the 11th Circuit?

A divided panel on the Eleventh Circuit has imposed on plan administrators “an obligation to consider the evidence presented to the SSA” by the claimant. While it is not particularly novel to hold that an SSDI award must be considered – most circuits require disability claim administrators to consider an SSDI award, or at least … Continue Reading

Effect of Requiring “Satisfactory” Proof Is A Popular Issue in the Circuits This Year

Every so often a bit of legal synchronicity seems to occur. Sometimes its personal, like when you have several cases with the same uncommon issue, or multiple cases in the same rarely visited court. In 2013, there appears to be a larger force at work that has caused three circuits to address the question whether … Continue Reading

Heimeshoff v. Hartford – Supreme Court Briefing

In petitioning for certiorari, Heimeshoff asked the Supreme Court to consider three questions: 1.         When should a statute of limitations accrue for judicial review of an ERISA disability adverse benefit determination? 2.         What notice regarding time limits for judicial review of an adverse benefit determination should an ERISA plan or its fiduciary give the claimant … Continue Reading

When Must a Claim Fiduciary Provide the Administrative Record? It May Be Later Than You Think

Any ERISA claim practitioner knows that a claimant is entitled to get a copy of the documents relevant to her claim on request and without charge. But when does the claimant’s right to this access become effective? More particularly, can the claim administrator defer production until after the claimant files an administrative appeal? A recent … Continue Reading
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