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Administrative Exhaustion Archives

How long may claim appeals be tolled?

A recent ruling from a federal court in Ohio discusses the interplay between the "deemed exhausted" provision of the ERISA claim regulations - 29 C.F.R. Sec. 2560.503-1(l) - and claim administrators' requests to "toll" the clock on when claim appeals have to be decided.  In Gay v. National Rural Electric Cooperative Association Group Benefits Program, 2014 WL 5475284 (S.D.Ohio October 29, 2014), the court determined that if additional information is requested, the request must be made within the initial period permitted under the ERISA claim regulations.  The court further ruled that tolling ends when the claimant responds, regardless of whether the claim administrator considers the response inadequate. Finally, the court ruled that tolling will never extend the deadline for deciding claims beyond the extension permitted in the regulations.

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