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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38 firm's commentaries
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Ninth Circuit Reverses Itself And Finds That At Least Some ERISA Claims Can Be Compelled To Arbitration
...as to benefit claims, ERISA not only encourages but requires claims procedures that include mechanism for review. 29 U.S.C. § 1133; 29 C.F.R. § 2560.503-1. So, given all that, can the employer or plan require arbitration of ERISA claims? Which ones? When? And might they really want Only sev......
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New York Court Rules Retirees Have Standing to Challenge Bristol-Myers Pension Risk Transfer
...at the conclusion of the appeal. “As long as the administrator substantially complies with the procedural requirements of 29 C.F.R. § 2560.503-1, engages in a ‘meaningful dialogue’ with the beneficiary, and provides a beneficiary with a ‘full and fair’ review, courts generally have not allo......
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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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3 books & journal articles
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'ERISA and NQDC'
...ERISA § 4065(a). 31 See ERISA § 3004. 32 ERISA § 103(a)(3)(A). 33 Id. § 103(a)(4)(A); § 103(d). 34 ERISA § 503, 29 U.S.C. § 1133. 35 29 CFR § 2560.503-1 36 Amato v. Bernard, 618 F.2d 559 (9th Cir. 1980); Graham v. Federal Express, 725 F. Supp. 429 (W.D. Ark. 1989); but see Berger v. Edgewat......
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Health care access
...Care Benefits for Adults, HEALTHCARE.GOV, 34. 42 U.S.C.A. § 300gg-19(a) (West, Westlaw through Pub. L. No. 119-1). 35. 29 C.F.R. § 2560.503-1 (March 14, 2025); see 42 U.S.C.A. § 300gg-19(b) (West, Westlaw through Pub. L. No. 37. 26 U.S.C.A. § 125(i) (West, Westlaw through Pub. L. No. 119-1)......
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Health care access: access after health care reform
...may shop for health insurance at competitive rates 34. 42 U.S.C.A. § 300gg-19(a) (West, Westlaw through Pub. L. No. 118-13). 35. 29 C.F.R. § 2560.503-1 (2023); see 42 U.S.C.A. § 300gg-19(b) (West, Westlaw through Sept. 36. 42 U.S.C. § 1395l (2022); Robert F. Rich, Eric Cheung, & Robert ......