If a plan determines that a claim does not provide sufficient information, must the plan take an extension of time and request additional information from the claimant?
No. The provisions governing extensions of time are permissive and not mandatory. As such, plans may provide for taking extensions of time or not, and plan administrators may be given the discretion to decide whether to take an extension of time in connection with any individual claim. Consequently, as a general matter, a plan may deny claims at any point in the administrative process on the basis that it does not have sufficient information; such a decision would allow the claimant to advance to the next stage of the claims process.
Related Questions
- If a plan determines that a claim does not provide sufficient information, must the plan take an extension of time and request additional information from the claimant?
- Are existing AWEP projects eligible to request a time extension and additional funds through an amendment, or do the sponsors need to submit a completely new proposal?
- What happens if the admitting diagnosis code at the time of admission certification has a different extension than the code on the claim submitted to HFS?
