Full and fair review. The Plan or the Plan’s Designee shall allow a Member, the Member’s Representative or Health Care Provider acting on behalf of the Member to review the claim file and to present evidence and written testimony as part of the internal claims and Appeals and Grievances process. Specifically, in addition to the requirements of paragraphs G.2.a through c herein, the following apply:
Full and fair review. A claimant must be allowed to review the file and present evidence and testimony as part of the internal appeals process. Claimants must be provided, at no charge, with any new or additional evidence considered relied upon or generated by the Plan in connection with the claim sufficiently in advance of the final adverse benefit determination to give the claimant a reasonable opportunity to respond prior to that date. The Plan must also meet the conflict of interest requirements of DOL Reg. § 2590.715-2712(b)(2)(D).
Full and fair review. A plan and issuer must allow a claimant to review the claim file and to present evidence and testimony as part of the internal claims and appeals process. Specifi- cally, in addition to complying with the requirements of 29 CFR 2560.503– 1(h)(2)—
Full and fair review. The Executive must be allowed to review the file and present evidence and testimony as part of the appeals process. Executives must be provided, free of charge, with any new or additional evidence considered, relied upon or generated by the Plan in connection with the claim sufficiently in advance of the final adverse benefit determination to give the Executive a reasonable opportunity to respond prior to that date in accordance with DOL Reg. 2560.503-1(h)(4).
