From: Paul Sullivan [mailto:sullivanpaul01@gmail.com] 

Sent: Tuesday, October 24, 2017 11:10 AM

To: EBSA, E-ORI - EBSA

Subject: RIN 1210 AB 39

It has been my privilege to represent claimants in regard to their claims for benefits from ERISAgoverned employee welfare benefit plans for the last 30 years -- commencing with the arrival of 

Pilot Life.

It has been my experience that as a regular matter most plans and their insurers and third-party 

administrators are NOT forthcoming when it comes to disclosing anything at all with regard to 

their internal rules and protocols governing claims. (Coincidentally, I am in litigation right now 

against a prominent disability insurance company which outright and repeatedly denied me 

access to such information during the administrative processes prior to suit.) This has become in 

my experience the accepted modus operandi throughout the industry.

The only resolution, if it may be termed one, is to file suit in federal district court and force the 

insurer or TPA to admit its violation of the claims regulation after, so to speak, the horse has 

already left the barn.

It baffles me how anyone can claim a costs increase to plans or insurers by requiring them to 

adhere to the well known requirements of the claims regulation.

Moreover, the laxity of many federal courts in calling them on it is couched in terms of 

"substantial compliance." This so-called doctrine hides a multitude of sins. The simple clarity of 

the claims regulation's language apparently cannot be left un-muddied by insurers and TPAs. 

Many pages of court cases and vast amounts of time and expense are devoted AFTER suit is 

filed in the vast majority of cases to whether the non-compliance by the individual insurer or 

TPA was "substantial."

This is a disgrace. The simple requirements of the regulation can virtually be automated and 

produced virtually at the stroke of a key, if the insurers and TPAs genuinely wanted to save 

expense. Their conduct belies their motivation.

Wanted or not, they make it a trek through the desert of administrative review which only the 

hardiest souls can hope to survive. If the claimant attempts to "perfect" the claim, it is in the 

nebulous world of guesswork about what the internal protocols, that is, the safeguards and 

verification protocols hypothetically applicable to the particular type of claim, might be.

Lengthy denial letters often recite plan provisions but give little or no hint as to how or why the 

denial came about. They often invite the claimant to send to the insurer or TPA additional 

materials which seem indistinct from what was already submitted -- again with little explanation 

at all as to what relevance, if any, the additional material might have to the claim or the denial of 

the claim.

It seems that "ready access" to the federal courts has become over time the modern-day version 

of P.T. Barnum's famous invitation: "25 cents to the Egress!"
Sincerely yours,

Paul Sullivan

--

Paul M. Sullivan, Jr.,

Attorney At Law, P.A.

4440 PGA Blvd., Suite 600

Palm Beach Gardens, FL 33410

(561) 689-7222

(561) 689-5001- Fax

NOTICE: This electronic transmission, including any attachment, contains

information which may be confidential or privileged. This information is

intended to be for the sole use of the individual or entity named above. If

you are not the intended recipient, you must not review, retransmit, convert

to hard copy, copy, disseminate, or otherwise use the contents of this

information. If you have received this electronic transmission in error,

please immediately notify the sender by telephone at 561-689-7222 or by

electronic mail at sullivanpaul01@gmail.com and delete this message. Please note that

if this electronic transmission contains a forwarded message or is a reply

to a prior message, some or all of the contents of this electronic

transmission may not have been produced by Paul M. Sullivan, Jr., Attorney at Law, P.A.