Common use of APPEAL OF DENIAL CLAIM Clause in Contracts

APPEAL OF DENIAL CLAIM. If a claim for benefits is denied or if the Director has received no response to such claim within 90 days of its submission (in which case the claim for benefits shall be deemed to have been denied), the Director, at the Director's sole expense, may appeal the denial to the Board within 60 days of the receipt of written notice of the denial or the date such claim is deemed to be denied. In pursuing such appeal the Director (i) may request in writing that the Board review the denial, (ii) may review pertinent documents and (iii) may submit issues and comments in writing. The decision on review shall be made within 60 days of receipt of the request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time is required, written notice of the extension shall be furnished to the Director before the end of the original 60-day period. The decision on review shall be made in writing, shall be written in a manner calculated to be understood by the Director and shall include specific references to the provisions of this Agreement on which the denial is based. If the decision on review is not furnished within the time specified above, the claim shall be deemed denied on review.