19 Del. Admin. Code § 2007-18.0

Current through Reigster Vol. 28, No. 6, December 1, 2024

Section 2007-18.0 - Appeals - LTD Claim Determinations

18.1 The claimant or the claimant's representative may appeal to the DIP insurance carrier or third-party administrator for a full and fair review of the LTD benefit determination. The claimant may:

18.1.1 Request a review by submitting a written application to the DIP insurance carrier or third-party administrator within 180 days of the claim denial;

18.1.2 Request copies of documents, records, and other information relevant to the claim; and

18.1.3 Submit written comments, documents, records and other information relating to the claim.

18.2 The DIP insurance carrier or third-party administrator will make a decision no more than 45 days after receiving the claimant's appeal unless the DIP insurance carrier or third-party administrator determines special circumstances that require an extension of time to process the appeal. If the appeal requires an extension, the DIP insurance carrier or third-party administrator will make a decision no more than 90 days after receiving the claimant's appeal. The written decision will include specific references to policy provisions on which the decision is based.

19 Del. Admin. Code § 2007-18.0

19 DE Reg. 78 (7/1/2015)
28 DE Reg. 57 (7/1/2024) (Final)