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'Abuse of Discretion' Standard Applied Despite Claim Processing Error
Health Plan Law 
July 23, 2007
Excerpt: The case suggests that claims administrators may salvage the abuse of discretion standard in the face of missed deadlines, if: #1 they maintain 'contact' with the claimant; #2 they render a decision before suit is filed ... ; #3 the plan or policy does not provide for 'automatic denial of an appeal after a certain time period'; #4 the missed deadline resulted from delays over good faith evidentiary issues ... ; #5 The facts show that the claims administrator was nonetheless 'taking action on [the] appeal'; #6 They show 'substantial compliance' with the claims regulations.'
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