Independent Services for Final Claim Appeals
Our Mission — CAFS was founded specifically as a speciality, independant third party claim appeal administrator for individual claim appeals for ERISA-governed and other employee benefit plans. CAFS acts as an independent fiduciary and independant evaluator to adjudicate claim appeals for any type of employee benefit plan. CAFS provides individual claim appeal services for, short and long-term disability plans, pension plans, including defined benefit plans, defined contribution plans such as profit sharing and 401(k) plans, and medical plans and other plans
By assuming the important role as the an independant claim appeal administrator or fiduciary, CAFS eliminates conflict of interest, provides a highly analytic assessment, reduces liability and exposure and work load of internal company staff, and overall, improves the quality and integrity of ERISA plan governance and decision-making. CAFS has established its approach to fiduciary decision-making to be a better choice for sponsors, regardless of how final appeals are currently being handled.
When your company retains CAFS to be the independent processor for final claim appeals, your company has chosen an independent fiduciary that is truly independent and provides the highest quality processing and skilled claim analysis, all fully compliant with the requirements. CAFS establishes credibility for your plan process, eliminates conflict of interest and any perception of conflict of interest, improves employee confidence, increases the integrity of claim processing and provides material advantages to all concerned.
“An ERISA fiduciary must act with prudence, loyalty and disinterestedness, requirements carefully delineated in the statute.” Langbecker v. Electronic Data Systems Corp., Case Number 04-41760, (5th Cir.)(2007).
Many companies and their various attorneys and consultants realize that using CAFS as an independent appeal processor or fiduciary is a perfect fit, and a better alternative to the current handling of final claim appeals. Regardless of whether final claim appeals are handled by internal staff or a committee, or by your regular third party administrator, or an insurance company, the advantages that CAFS delivers make it the preferred alternative.
Personal and corporate liability results when internal committees or human resource staff take on the decision-making role. In most cases, this exposure is not desirable. Internal staff rarely have sufficient time for training and education in the areas of ERISA fiduciary law and claim adjudication to keep exposure in check. This has become more of a concern recently, when significant class action lawsuits have been filed regarding a variety of ERISA matters. Indeed, it is a matter of best practice to maintain a third party independent source of decision-making, to ensure that the processes and plan terms are followed.
Moreover, unavoidable conflict of interest arises when companies and internal staff make decisions under the company’s plans. Internal staff are often seen as protecting the company's economic interests, rather than the plan’s integrity. Ultimately, time pressures and ever-increasing work loads, means that internal staff do not have sufficient time to fully assess claims, or prepare detailed and complete responses that cite to plan terms, facts, and provide analysis, as required by the plan and related requirements. Invariably, CAFS is a better alternative. top
Many sponsors wish to retain substantial control over the process. While this desire can be admirable, it can be seen as emphasizing the conflict of interest concerns. CAFS specifically addresses this concern through its process. CAFS is always focused on the right administrative decision for the ERISA plan, and is able to achieve this, through its detailed and complete process. top
CAFS is a better alternative for the processing of final appeals for all types of ERISA-governed plans. The independence that CAFS delivers reduces liability and exposure, making CAFS a more efficient and effective alternative.
Please note that CAFS does not provide any legal brokerage, asset management or accounting services and does not hold or control any plan assets. top
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