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Delayed and Denied: Toward an Effective ERISA Remedy for Improper Processing of Healthcare Claims

34 Pages Posted: 30 Mar 2013  

Katherine Traverse Vukadin

Texas Southern University - Thurgood Marshall School of Law

Multiple version iconThere are 2 versions of this paper

Date Written: June 1, 2010

Abstract

This article advocates a shift in thinking in the enforcement of claims processing regulations. Under the current approach, most non-compliance is excused under the “substantial compliance” doctrine, and even substantial departures from the claims regulations generally result in no substantive remedy. This approach excuses practically all instances of regulatory non-compliance and places the enforcement burden on those least able to shoulder it — the individuals seeking and paying for medical care. Instead, ERISA’s goal of ensuring contracted benefits would be better served if enforcement moved to a presumed-harm approach, akin to the approach used in numerous consumer finance laws. This article argues that the same concerns driving consumer financial protections have even greater force where healthcare is concerned.

Keywords: ERISA, Healthcare, Claims, Denial, Remedy

Suggested Citation

Vukadin, Katherine Traverse, Delayed and Denied: Toward an Effective ERISA Remedy for Improper Processing of Healthcare Claims (June 1, 2010). Available at SSRN: https://ssrn.com/abstract=2241146 or http://dx.doi.org/10.2139/ssrn.2241146

Katherine Vukadin (Contact Author)

Texas Southern University - Thurgood Marshall School of Law ( email )

3100 Cleburne Street
Houston, TX 77004
United States

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