Employers who self fund their medical plans often have contracts with their third party administrators about claims processing. Some of those contracts provide that the claims processor has discretion to decide claims; others provide that the claims processor is simply acting in a ministerial fashion so that the employer ultimately retains discretion to decide contested
Understanding Employee Benefits and key developments in the employee benefits field and items of interest to our clients. MORE
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It is Always Good to Follow the Plan’s Claims Procedure in Denying a Claim – Part 2
By Stinson LLP on
Some months ago I blogged about an Eighth Circuit Court of Appeals decision involving high ranking executives participating in a company’s long term incentive plan where the executives won their suit under the plan, at least in part, because the employer had not properly followed the plan’s claims procedure. By not properly following those procedures,…