February 2016

You know that procedural irregularities in an appeal denial of a claim for ERISA-governed benefits can change the standard of review from arbitrary and capricious to de novo review.

But not all the time. The claimant should also “provide meaningful new evidence or raise significant new issues on administrative appeal.”

Here’s the case of

You already know that claimants with a denied claim must submit an appeal and exhaust administrative remedies before filing suit.

But are phone calls sufficient to trigger the appeal process?

And, can a claimant trump the exhaustion requirement by alleging the denial was in “bad faith” and, therefore was a “special circumstance?”

Here’s the case