Medical Appeals

CAFS provides independent final claim appeal processing for medical and other types of plans, such as severance plans, stay pay plans, certain executive compensation plans. CAFS adjudicates any claims raised by individual claimants with respect to their benefits under such plans. CAFS reduces 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 these types of welfare benefit, regardless of how such final appeals are currently being handled.

When plan sponsors undertake this important role internally, there are concerns of conflict of interest, self-dealing and whether the process was prudent. There is also concern about liability for internal staff and executives – even personal liability. Thus, the best practice is to retain an independent third party for this function. Due to the complexities of these arrangements, there are very limited sources of providers that have the capability, expertise and the willingness to take on this important role.

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