Plan Disclosures

: : Plaintiff May Proceed On ERISA Claims Challenging Repricing of Provider Claims

Through this matter, Plaintiffs are attempting to stop Defendants allegedly improper practice of underbilling for chiropractic services that Plaintiffs provided to their patients. Presently before the Court are motions to dismiss the First Amended Complaint filed by the . . . Defendants. Plaintiffs allege that the Cigna and Aetna Defendants hired the Vendor Defendants to …

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Stricter Review of Benefits Denial Where Plan Terms Inadequately Disclosed

[P]lan administrators must create written plan documents and offer members an opportunity to examine those documents to “determine exactly what [their] rights and obligations are under the plan.” Id. (quoting H.R. Rep. No. 93-1280, at 297 (1974), reprinted in U.S.C.C.A.N. 4639, 5077, 5078). Given the members’ right to examine the documents, the plan administrator must …

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:: Insurer’s Failure to Provide Requested Information Excuses Failure to Exhaust Administration Remedies

When stripped of its “futility” label, Brown’s argument is a winner. Prudential’s failure to comply with its duty under § 1133(2) to provide Brown with “a reasonable opportunity . . . for a full and fair review” of Prudential’s decision to discontinue her LTD benefits excuses Brown’s failure to exhaust before bringing suit under § …

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