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Independent Medical Review of ERISA Claim Is Not Entitled to Arbitration Standard of Review
Proskauer's ERISA Practice Center Mar. 19, 2013 "[An Oregon] federal district court held that the review of benefit denials by an independent review organization (IRO) is not akin to an arbitration proceeding, and thus did not preclude a plan participant from seeking judicial review under ERISA of an adverse benefit determination.... [This case is significant because] current [ACA] regulations and other guidance provide, without explanation, that IRO determinations are 'binding except to the extent that other remedies may be available under State or Federal law to either the group health plan or to the claimant.'... Exactly how the new ACA rules and the existing ERISA claims rules with judicial review under ERISA section 502 will interact remains to be seen and likely will be the subject of future litigation." [Yox v. Providence Health Plan, No. 12-cv-01348, 2013 WL 865968 (D. Ore., Mar. 8, 2013)] |
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