How are appeals affected by DOL regulations?
DOL requires, in general, the following: • Members must be provided with a “full and fair review” of all adverse benefit decisions • A member must be afforded at least 180 days from the initial adverse determination to file an appeal • A member must not be required to file more that two appeals before he or she may bring a civil action • A person who made the adverse benefit determination that is the subject of the appeal or his subordinate must not conduct the appeal
