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Tenth Circuit Finds District Court Applied Wrong Standard of Review in Evaluating Plan Administrator's Medical Necessity Determination
Hinshaw & Culbertson LLP Link to more items from this source
Oct. 6, 2020

"Although the Plan published its reservation of discretionary authority in a document called the 'Plan Instrument,' according to the court, it failed to give participants sufficient notice that the document existed. Plan participants received a Summary Plan Description which did not mention discretionary authority or disclose the existence of the Plan Instrument. The Summary Plan Description did state that participants may ask to examine Plan documents that were relevant to their claim. However, the Tenth Circuit found that this statement 'did not suggest the existence of another document affecting judicial review.' " [Lyn M. v. Premera Blue Cross, No. 18-4098 (10th Cir. Jul. 24, 2020)]

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