Common use of DEEMED EXHAUSTION OF INTERNAL CLAIMS AND APPEAL PROCESS Clause in Contracts

DEEMED EXHAUSTION OF INTERNAL CLAIMS AND APPEAL PROCESS. SAMPLE In the case of a plan that fails to adhere to the minimum requirements for employee benefit plan procedures relating to Claims for Benefits, the Member is deemed to have exhausted the internal claims and appeals processes of paragraph C and D herein. Accordingly the Member may initiate an external review under paragraph F of this section, as applicable. The Member is also entitled to pursue any available remedies under section 502(a) of ERISA or under State law, as applicable, on the basis that the plan has failed to provide a reasonable internal claims and appeals process that would yield a decision on the merits of the Claim for Benefits. If a Member chooses to pursue remedies under section 502(a) of ERISA under such circumstances, the Claim for Benefits, Grievance, or Appeal is deemed denied on review without the exercise of discretion by an appropriate fiduciary.

DEEMED EXHAUSTION OF INTERNAL CLAIMS AND APPEAL PROCESS. SAMPLE In the case of a plan that fails to adhere to the minimum requirements for employee benefit plan procedures relating to Claims for Benefits, the Member is deemed to have exhausted the internal claims and appeals processes of paragraph C and D herein. Accordingly the Member may initiate an external review under paragraph F of this section, as applicable. The Member is also entitled to pursue any available remedies under section 502(a) of ERISA or under State law, as applicable, on the basis that the plan has failed to provide a reasonable internal claims and appeals process that would yield a decision on the merits of the Claim for Benefits. If a Member chooses to pursue remedies under section 502(a) of ERISA under such circumstances, the Claim for Benefits, Grievance, Grievance or Appeal is deemed denied on review without the exercise of discretion by an appropriate fiduciary.

DEEMED EXHAUSTION OF INTERNAL CLAIMS AND APPEAL PROCESS. SAMPLE In the case of a plan that fails to adhere to the minimum requirements for employee benefit plan procedures relating to Claims for Benefits, the Member is deemed to have exhausted the internal claims and appeals processes of paragraph C and D herein. Accordingly the Member may initiate an external review under paragraph F of this section, as applicable. The Member is also entitled to pursue any available remedies under section 502(a) of ERISA or under State law, as applicable, on the basis that the plan has failed to provide a reasonable internal claims and appeals process that would yield a decision on the merits of the Claim for Benefits. If a Member chooses to pursue remedies under section 502(a) of ERISA under such circumstances, the Claim for Benefits, Grievance, Benefits or Appeal is deemed denied on review without the exercise of discretion by an appropriate fiduciary.

DEEMED EXHAUSTION OF INTERNAL CLAIMS AND APPEAL PROCESS. SAMPLE In the case of a plan that fails to adhere to the minimum requirements for employee benefit plan procedures relating to Claims for Benefits, the Member is deemed to have exhausted the internal claims and appeals processes of paragraph C and D herein. Accordingly the Member may initiate an external review under paragraph F of this section, as applicable. The Member is also entitled to pursue any available remedies under section 502(a) of ERISA or under State law, as applicable, on the basis that the plan has failed to provide a reasonable internal claims and appeals process that would yield a decision on the merits of the Claim for Benefits. If a Member chooses to pursue remedies under section 502(a) of ERISA under such circumstances, the Claim for Benefits, Grievance, or Appeal is deemed denied on review without the exercise of discretion by an appropriate fiduciary.

DEEMED EXHAUSTION OF INTERNAL CLAIMS AND APPEAL PROCESS. SAMPLE In the case of a plan that fails to adhere to the minimum requirements for employee benefit plan procedures relating to Claims for Benefits, the Member is deemed to have exhausted the internal claims and appeals processes of paragraph C and D herein. Accordingly the Member may initiate an external review under paragraph F of this section, as applicable. The Member is also entitled to pursue any available remedies under section 502(a) of ERISA or under State law, as applicable, on the basis that the plan has failed to provide a reasonable internal claims and appeals process that would yield a decision on the merits of the Claim for Benefits. If a Member chooses to pursue remedies under section 502(a) of ERISA under such circumstances, the Claim for Benefits, Grievance, or Appeal is deemed denied on review without the exercise of discretion by an appropriate fiduciary.. Sample