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Plan?ÇÖs Limitations Period for Judicial Review of Benefit Denial Not Enforceable

A federal district court in the Tenth Circuit recently held in William G. v. United Healthcare that the six-month limitations period for filing a lawsuit challenging a benefits denial under a self-funded, employer-sponsored group health plan subject to ERISA, which was imposed by the terms of the plan, was unenforceable against the plaintiff who was a plan participant. The court determined that the benefit denial notices related to the participant?ÇÖs claim for benefits did not disclose the plan?ÇÖs limitations period as required by ERISA?ÇÖs claims regulations. Despite the fact that the plan?ÇÖs limitations period was specifically set out on three pages in the plan?ÇÖs summary plan description, the court followed precedent in other courts and interpreted ERISA?ÇÖs claims regulations to require disclosure of the plan?ÇÖs limitations period as part of the description of the plan?ÇÖs review procedures that must be included in benefit claim denial notices (including notices regarding claims… Continue Reading

July 2017
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