United States Second Circuit

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Halo v. Yale Health Plan, 14-4055

In a civil action, brought by insured plaintiff claiming that defendant violated the Department of Labor's claims-procedure regulation, 29 C.F.R. section 2560.503-1, in handling her health insurance claim, the district court's grant of summary judgment to defendant is vacated and the case remanded where: 1) a plan's failure to comply with the regulation will result in a claim being reviewed de novo in federal court, unless the plan has otherwise established procedures in full conformity and con show that its failure to comply was inadvertent and harmless; and 2) civil penalties are not available to a participant or beneficiary for a plan's failure to comply with the claims-procedure regulation.

Appellate Information

  • Decided
  • Published 2016/04/12

Judges

  • KATZMANN

Court

  • United States Second Circuit

Counsel

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