Under what circumstances may a plan afford claimants the ability to appeal their benefit claim beyond the review level required by the regulation?
While the regulation limits a plans claims procedure to a maximum of two mandatory appeal levels, the regulation does permit plans to offer voluntary additional levels of appeal, including arbitration or any other form of alternative dispute resolution, provided that certain conditions are met. The conditions of the regulation focus on ensuring that the claimant elects the additional appeal voluntarily.
While the regulation limits a plan s claims procedure to a maximum of two mandatory appeal levels, the regulation does permit plans to offer voluntary additional levels of appeal, including arbitration or any other form of alternative dispute resolution, provided that certain conditions are met. The conditions of the regulation focus on ensuring that the claimant elects the additional appeal voluntarily. Specifically, the regulation provides that, in the case of such voluntary levels of appeal, the plan s claims procedure must provide: (i) the plan will not assert a failure to exhaust administrative remedies where a claimant elects to pursue a claim in court rather than through the voluntary level of appeal; (ii) the plan agrees that any statute of limitations applicable to pursuing the claimant s claim in court will be tolled during the period of the voluntary appeal process; (iii) the voluntary level of appeal is available only after the claimant has pursued the appeal(s) required by
Related Questions
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