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DOL's New Audit Focus: Health Plan Claims and Appeals, and Hard-to-Value Retirement Plan Assets
Proskauer's ERISA Practice Center Link to more items from this source
Nov. 21, 2014

"DOL representatives have expressed concern that the complexity of health and welfare benefits adjudication creates an inherent risk of error (or, worse, fraud). The DOL is also concerned that benefits are being systematically denied at the initial claim level, because, more often than not, participants do not appeal the initial claims determinations. Further, the DOL is questioning whether plans are providing sufficient and understandable information regarding the reasons for denial of a claim, such that participants can adequately avail themselves of the appeals process."

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