Appeals of Denied Claims. In the event that WSP denies payment of claim(s) submitted by the Fire Agency under this Agreement, the Fire Agency may appeal the denial according to the Mobilization Plan. The process contained in the Mobilization Plan is the sole administrative recourse available to the Fire Agency for the appeal of denied claims.
Appeals of Denied Claims. If a claim is denied, totally or partially, the Administrator will provide the Claimant with a written denial stating (i) the specific reasons for the denial, (ii) references to the pertinent Plan provisions upon which the denial is based, (iii) a description of any additional information the Claimant might be required to provide with an explanation of why it is needed, and (iv) an explanation of the Plan’s appeal procedure. The written denial will be sent to the Claimant within 60 days after receipt of the claim by the Administrator. The 60 days may be extended for up to another 30 days if special circumstances warrant an extension of time. If an extension is needed by the Administrator to process the claim, the Claimant will be notified in writing before the beginning of the extension period. The notice will include an explanation of the circumstances requiring the extension of time and the date by which the Administrator expects to render a decision on the claim. A Claimant may appeal the denial of a claim for Benefits by submitting a written request for a full and fair review to the Administrator. The Claimant may examine pertinent documents and submit pertinent issues and comments in writing; provided that neither the Employer nor the Administrator will be required by virtue of this provision to waive any privilege as to materials in their records or the records of their agents, including but not limited to the attorney-client privilege. The Claimant may have a representative throughout the appeals process who, if the Claimant chooses, may be a representative from the bargaining unit of which the Claimant is a member. The Claimant’s written request for a review must be submitted within 60 days of the written notice of denial of the claim. The full and fair review will be completed and a decision rendered by the Administrator within 60 days after receipt of the written request for review; provided that the time for rendering a decision may be extended upon written notice to the Claimant, if warranted by special circumstances, for up to 30 days from the date of the receipt of the written request for review. The Administrator’s decision will be in writing and will include specific reasons for the decision, with specific references to the Plan provisions on which the decision is based. The decision of the Administrator will be final and binding; provided, however, that this procedure is not intended to limit other remedies that may be available to the Cla...
Appeals of Denied Claims. Each Claimant shall have the opportunity to appeal the claims official’s denial of a claim in writing to an appeals official appointed by the Plan Administrator (which may be a person, committee, or other entity). A Claimant must appeal a denied claim within sixty (60) days after receipt of written notice of denial of the claim, or within sixty (60) days after it was due if the Claimant did not receive it by its due date. The Claimant shall have the opportunity to submit written comments, documents, records and other information relating to the Claimant’s claim. The Claimant (or the Claimant’s duly authorized representative) shall be provided upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim. The appeals official shall take into account during its review all comments, documents, records and other information submitted by the Claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefits review. Any claims that the Claimant does not pursue in good faith through the appeals stage, such as by failing to file a timely appeal request, shall be treated as having been irrevocably waived.
Appeals of Denied Claims. The Executive shall have the opportunity to appeal the claims official’s denial of a claim in writing to an appeals official appointed by the Plan Administrator (which may be a person, committee, or other entity). The Executive must appeal a denied claim within sixty (60) days after receipt of written notice of denial of the claim, or within sixty (60) days after it was due if the Executive did not receive it by its due date. The Executive shall have the opportunity to submit written comments, documents, records and other information relating to the Executive’s claim. The Executive (or the Executive’s duly authorized representative) shall be provided upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the Executive’s claim. The appeals official shall take into account during its review all comments, documents, records and other information submitted by the Executive relating to the claim, without regard to whether such information was submitted or considered in the initial benefits review. Any claims that the Executive does not pursue in good faith through the appeals stage, such as by failing to file a timely appeal request, shall be treated as having been irrevocably waived. Appendix A-1
