Claims procedure
| Currency | Current through May 31, 2023 |
| Citation | 29 C.F.R. §2560.503-1 |
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25 cases
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Rasenack ex rel. Tribolet v. Aig Life Ins. Co.
...to the claimant of the `specific reasons' for benefit denials." Nord, 538 U.S. at 825, 123 S.Ct. 1965 (citing 29 U.S.C. § 1133; 29 C.F.R. § 2560.503-1 (2002)). As we emphasized in Gilbertson, 328 F.3d at 635 (quoting Booton v. Lockheed Med. Benefit Plan, 110 F.3d 1461, 1463 (9th "In simple ......
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Freitas v. Geisinger Health Plan
...ERISA. Specifically, Plaintiffs argue that Defendants have violated 29 U.S.C. § 1133 by failing to follow the procedures outlined in 29 C.F.R. § 2560.503-1. Section 1133 provides that providers of employee benefit plans "shall provide adequate notice in writing to any participant or benefic......
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M.R. v. United Healthcare Ins. Co.
...plaintiff of the plan's time limit for filing an administrative appeal. The Second Circuit, after finding that this failure violated Section 2560.503-1, held that, a result, the plan's time limit was “not trigger[ed]” and refused to enforce it. Id. at 107 (“A notice that fails to substantia......
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Zavislak v. Netflix, Inc.
...§ 2560.503-1. In this circuit, “a failure to follow claims procedures imposed on benefits plans, as outlined in 29 U.S.C. § 1133 and 29 C.F.R. § 2560.503-1, cannot give rise to a penalty under 29 U.S.C. § 1132(c)(1).” Lee v. ING Groep, N.V., 829 F.3d 1158, 1161 (9th Cir. 2016). Penalties un......
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15 firm's commentaries
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After Heimeshoff: Applying An ERISA Plan’s Contractual Limitation of Actions Provision
...did not request any documents until after the three-year deadline. Id. at *7. The court also held that the ERISA claim regulation, 29 C.F.R. § 2560.503-1, “does not require a claims administrator to include in its [denial letter] to a plan participant the deadline for filing a cause of acti......
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The ERISA Litigation Newsletter - November 2011
...2008); Eden Surgical Ctr. v. Budco Group, Inc., No. 09-CV-3991, 2010 WL 2180360, *10, 2010 BL 127245, *10 (C.D. Cal. May 27, 2010). 29 C.F.R. § 2560.503-1. As always, be sure to review the section on Rulings, Filings, and Settlements of "Never Mind" – DOL Withdraws Proposed Regulation on th......
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The ERISA Litigation Newsletter - June 2012
...F.2d 427 (6th Cir. 2010). [21] Id. at 431. [22] Originally published by Bloomberg Finance L.P. Reprinted with permission. [23] See 29 C.F.R. § 2560.503-1. [24] See, e.g., Wert v. Liberty Life Ins. Co. of Boston, 447 F.3d 1060, 1062, 37 EBC 2261 (8th Cir. 2006) (97 PBD, 5/19/06; 33 BPR 1302,......
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Mental Health Parity Requirements and Medicaid Plans: CMS Seeks Comment on Proposed Rule
...therefore, would not impact a CHIP state plan’s compliance with parity requirements. Helaine Fingold Lynn Shapiro Snyder Lesley Yeung 29 C.F.R. § 2560.503-1 that discuss requirements related to notices for group health plans subject to the Employee Retirement Income Security Act (“ERISA”) d......
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