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First Circuit Holds That 'Full and Fair Review' of Claim Denial Requires Disclosure of Medical Reports Generated During Appeal
Kantor & KantorLink to more items from this source
Nov. 18, 2021

"ERISA ... requires that plan fiduciaries employ a 'full and fair' claims procedure for reviewing benefit claims. But courts have grappled with ... whether this requires that a plan participant or beneficiary making a claim for benefits be given an opportunity to review and respond to medical reports before they are relied upon by the claims administrator to deny the claim. The answer from the First Circuit is a resounding 'yes,' regardless of what version of the [DOL's] claims regulation applies." [Jette v. United of Omaha Life Ins. Co., No. 20-1713 (1st Cir. Nov. 10, 2021)]

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