Short and Long-Term Disability Plans

CAFS was founded specifically to provide independent final claim appeal processing for ERISA plans, and in particular, the final claim appeal for disability plans.  CAFS acts as an independent fiduciary, under ERISA, to adjudicate short and long-term disability benefit final claim appeals, in accordance with the rigors of ERISA.  By assuming the important role as the ERISA claim appeal fiduciary, CAFS eliminates conflict of interest, and improves the quality and integrity of decision-making.  We have designed our approach to fiduciary decision-making to be a better choice for sponsors of disability plans, regardless of how final appeals are currently being handled.   

When your company outsources final disability claim appeals to CAFS, you have chosen an independent fiduciary that provides the highest quality processing and skilled claim analysis, all fully compliant with the ERISA.  CAFS establishes credibility, eliminates conflict of interest and any perception of conflict of interest, improves employee confidence, increases the integrity of disability claim processing and provides material advantages to all concerned.

"Heightened scrutiny is required when an insurance company [or self-insured plan] is both plan administrator and funder…Potential self-dealing warrants that fiduciary…decisions be closely inspected." Pinto v. Reliance Std. Life Ins. Co., 214 F.3d 377 (3rd Cir. 2000).

A Prudent Final Claim Appeal Alternative

Many companies and their consultants realize that using CAFS as the independent fiduciary for short and long term disability plan final appeals 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 a third party administrator, or an insurance company, the advantages that CAFS delivers make it the preferred alternative to fiduciary processing of final appeals.

Personal and corporate liability results when internal committees or human resource staff, take on the ERISA fiduciary decision-making. In most cases, this exposure is not desirable, yet internal staff rarely have sufficient time for training and education in the areas of fiduciary law, disability claims and claim adjudication to keep exposure in check. Moreover, conflicts of interest, when companies and internal staff are seen as protecting the company's economic interests, lead to increased costs and a potential loss of integrity in claims processing. 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 ERISA claim regulations (29 C.F.R. §2560.503-1). CAFS is a better alternative.

For those companies that use outside claims administrators, or insurance companies, as the final appeal fiduciary, there are drawbacks as well. These type of administrators are reluctant or refuse to accept a fiduciary role, and when they do, it can be expensive. Unfortunately, in this vital role, these providers do not always provide consistent quality, and do not always employ qualified degreed professionals to ensure the integrity of the appeal process, or ensure that the sponsor and the covered employees are protected.

While third party claims administrators and insurance companies do have an important role as claims administrators, they are looked upon with suspicion when handling final claim appeals, and often do not and cannot provide the fresh, neutral, complete decision-making required by ERISA. This is especially true, because insurance companies and claims administrators are often looked upon with suspicion when they deny claims, and are seen as protecting their own process, when they “rubber stamp” prior decisions.

CAFS is a better alternative. The independence that CAFS delivers reduces liability and exposure, making CAFS a more efficient and effective alternative