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What are my rights during the administrative process?

What are my rights during the administrative process?

Any NY disability lawyer should tell you that under ERISA you are entitled to a full and fair review of your claim. When benefits are denied, you must be told in writing:

(i) the specific reason for the denial; (ii) the plan provision(s) on which the denial is based; (iii) any additional material and information that is needed before the insurer will pay the claim and an explanation of why this is needed; (iv) the plan’s review procedures and the time limits applicable for such procedures; and (v) any specific rule, guideline, protocol, or similar criteria relied upon in making the determination (a copy should be provided to you free of charge upon request).

If your denial letter fails to tell you about any of these items, your rights are being violated.

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