Deemed exhaustion of internal claims and appeals processes Sample Clauses

Deemed exhaustion of internal claims and appeals processes. (1) In the case of a plan or issuer that fails to strictly adhere to all the requirements of this paragraph (b)(2) with respect to a claim, the claimant is deemed to have exhausted the internal claims and appeals process of this paragraph (b), except as provided in paragraph (b)(2)(ii)(F)(2) of this section. Accord- ingly the claimant may initiate an ex- ternal review under paragraph (c) or (d) of this section, as applicable. The claimant is also entitled to pursue any available remedies under section 502(a) of ERISA or under State law, as appli- cable, on the basis that the plan or issuer has failed to provide a reason- able internal claims and appeals proc- ess that would yield a decision on the merits of the claim. If a claimant chooses to pursue remedies under sec- tion 502(a) of ERISA under such cir- cumstances, the claim or appeal is deemed denied on review without the exercise of discretion by an appropriate fiduciary.
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Related to Deemed exhaustion of internal claims and appeals processes

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