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Supreme Court Finding of Conflict of Interest Adds New Wrinkle to Benefit Claims Review
Thompson Hine
[Guidance Overview] July 7, 2008 3 pages. Excerpt: Taking a cue from Justice Breyer, employers may want to review how their benefits claims decision-making is currently structured and take active steps, such as using third-party administrators ('TPA') that are not the payor to decide claims and evaluating the TPA's performance based on reversals of denials by courts. Insurance companies may want to build firewalls between those who pay the claims and those who decide whether a benefit is valid under the terms of the insurance policy in order to minimize (perhaps to the vanishing point) the structural conflict of interest. MORE >> |
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