ERISAclaim.com Offers Comments on Aetna Overpayment ERISA Class Action: Feds (DOL) Told Court Aetna Must Comply with ERISA First

Hanover Park, IL (PRWEB) December 07, 2012

On November 30, 2012, federal government, DOL (Department of Labor), filed an Amicus Brief in the Court of Appeals for the Third Circuit in support of plaintiff providers in an overpayment ERISA class-action: Aetna must comply with federal law ERISA for all post-payment overpayment demand due to ERISA plan coverage dispute; a healthcare provider with a valid assignment has federal rights to ERISA appeals and lawsuit in federal court; a post-payment, retroactive, overpayment demand is an ERISA adverse benefit determination, triggering full and fair reviews guaranteed under ERISA; and Aetna’s hypothetical state law claims of fraud may not short-circuit federal ERISA procedural protections for both in-network and out of network providers and patients. ERISAclaim.com now offers webinars, advanced trainings and litigation support to assess this DOL action for all healthcare providers.

According to the Court document, DOL advised the Court in part: The crux of the question at issue here is not whether the plaintiff or the defendant is correct in their views of the plan terms, but whether Aetna must comply with the procedures mandated by ERISA section 503 and its accompanying regulations in rendering a determination based on a plan interpretation that is adverse to the plan participants and beneficiaries. Under the statute and regulations, the beneficiary or participant is entitled to a claims procedure that “afford[s] a reasonable opportunity . . . for a full and fair review by the appropriate named fiduciary of [a] decision denying [a] claim,” 29 U.S.C.

ERISAclaim.com Offers Comments on Aetna Overpayment ERISA Class Action: Feds (DOL) Told Court Aetna Must Comply with ERISA First