Health and welfare plans are seeing an increase in third parties bringing appeals following an adverse determination of a claim, and it is not always clear if the party bringing the claim has been appointed by the participant. Given these increased appeals from third parties, we recommend employers review the plan documents and SPDs and clarify, as appropriate, the procedures that must be followed for a participant to appoint an authorized representative. Retirement plans should also do the same. Keep in mind that third party administrators may also have their own procedures for appointing a representative. Therefore, the procedures set forth in the SPD must be drafted to take into account the possibility that one or more of the plan's TPAs have their own procedures.
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