CAFS was founded specifically as a specialty, independent third party claim appeal administrator for individual claim appeals for ERISA-governed and other employee benefit plans. CAFS acts as an independent fiduciary and independent evaluator to adjudicate claim appeals for any type of employee benefit plan. CAFS provides individual claim appeal services for, medical plans, short and long-term disability plans, severance plans, pension plans, including defined benefit plans, defined contribution plans such as profit sharing and 401(k) plans, and other plans.
By assuming the important role as the an independent 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.
Best Practice and Better Alternative
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.
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. Giving up control, however, does not mean losing your company’s culture. We work closely with our clients to ensure that their corporate culture is reflected in the appeal process.
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.