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Internal Appeals Processes Require Strict Compliance By Claimants
Health Plan Law
[Guidance Overview] Oct. 16, 2008
Excerpt: Two important judicial doctrines converge in this case, both to the detriment of the plaintiff. First, the court finds that the plan administrator 'substantially complied' with the claims regulations; second, the court applied the failure to exhaust administrative remedies defense, rebuffing the plaintiff's justification based upon futility. The caselaw continues to demonstrate that claimants must carefully attend to all requirements of internal appeals processes and resolve any close cases with further application to the appeals avenues offered under the plan.
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