The U.S. Court of Appeals for the First Circuit has ruled, in Shields v. United of Omaha, that an insurer must make a coverage determination for a plan participant within a reasonable period of time...
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ERISA benefit claim
Delay in Final Claims Appeal Determination Excuses Claimant from ERISA’s Exhaustion of Administrative Remedies Requirement
The Second Circuit Court of Appeals, in McQuillin v. Hartford Life & Accident Ins. Co., has ruled that a claimant exhausted his plan’s administrative remedies and was, therefore, entitled to sue...
Court Says No Specific Wording Required in Plan Document to Give Plan Discretionary Claims Authority
The Second Circuit Court of Appeals, in Tyll vs. Black and Decker Life Insurance Program, has ruled that a plan document is not required to use any specific language in order to give the plan...
Court Confirms Participant Must Exhaust Administrative Remedies Before Filing a Suit
The U.S. District Court for the Southern District of New York, in Benson vs. Tiffany and Company SPD, has ruled that a participant in an ERISA-governed group health plan may not proceed with her...