Common use of Application for Review Clause in Contracts

Application for Review. (a) If a claimant wishes a review of the decision denying his claim to benefits under the Agreement, other than a claim described in clause (b) of this Section 6.1.4, he must submit the written application to the Plan Administrator within sixty (60) days after receiving written notice of the denial. (b) If the claimant wishes a review of the decision denying his claim to benefits under the Agreement due to the Executive’s Disability, he must submit the written application to the Appeals Fiduciary within one hundred eighty (180) days after receiving written notice of the denial. With respect to any such claim, in deciding an appeal of any denial based in whole or in part on a medical judgment (including determinations with regard to whether a particular treatment, drug, or other item is experimental, investigational, or not medically necessary or appropriate), the Appeals Fiduciary shall: (i) consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment; and (ii) identify the medical and vocational experts whose advice was obtained on behalf of the Agreement in connection with the denial without regard to whether the advice was relied upon in making the determination to deny the claim. Notwithstanding the foregoing, the health care professional consulted pursuant to this clause (b) shall be an individual who was not consulted with respect to the initial denial of the claim that is the subject of the appeal or a subordinate of such individual.

Application for Review. (ai) If a claimant wishes a review of the decision denying his claim to benefits under the this Agreement, other than a claim described in clause paragraph (bii) of this Section 6.1.4section 4(e), he Executive must submit the written application to the Plan Claims Administrator within sixty (60) days after receiving written notice of the denial. (bii) If the claimant wishes a review of the decision denying his claim to benefits under the this Agreement due to the Executive’s DisabilityExecutive becoming Substantially Disabled, he Executive must submit the written application to the Appeals Fiduciary within one hundred eighty (180) days after receiving written notice of the denial. With respect to any such claim, in deciding an appeal of any denial based in whole or in part on a medical judgment (including determinations with regard to whether a particular treatment, drug, or other item is experimental, investigational, or not medically necessary or appropriate), the Appeals Fiduciary shall: (i1) consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment; and (ii2) identify the medical and vocational experts whose advice was obtained on behalf of the this Agreement in connection with the denial without regard to whether the advice was relied upon in making the determination to deny the claim. Notwithstanding the foregoing, the health care professional consulted pursuant to this clause (bsection 4(e) shall be an individual who was not consulted with respect to the initial denial of the claim that is the subject of the appeal or a subordinate of such individual.

Application for Review. (a) If a claimant wishes a review of the decision denying his claim to benefits under the Agreement, other than a claim described in clause (b) of this Section 6.1.4, he must submit the written application to the Plan Administrator within sixty (60) days after receiving written notice of the denial. (b) If the claimant wishes a review of the decision denying his claim to benefits under the Agreement due to to, the Executive’s 's Disability, he must submit the written application to the Appeals Fiduciary within one hundred eighty (180) days after receiving written notice of the denial. With respect to any such claim, in deciding an appeal of any denial based in whole or in part on a medical judgment (including determinations with regard to whether a particular treatment, drug, or other item is experimental, investigational, or not medically necessary or appropriate), the Appeals Fiduciary shall: (i) consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment; and (ii) identify the medical and vocational experts whose advice was obtained on behalf of the Agreement in connection with the denial without regard to whether the advice was relied upon in making the determination to deny the claim. Notwithstanding the foregoing, the health care professional consulted pursuant to this clause (b) shall be an individual who was not consulted with respect to the initial denial of the claim that is the subject of the appeal or a subordinate of such individual.

Application for Review. (ai) If a claimant wishes a review of the decision denying his claim to benefits under the this Agreement, other than a claim described in clause paragraph (bii) of this Section 6.1.4section 4(e), he Executive must submit the written application to the Plan Claims Administrator within sixty (60) days after receiving written notice of the denial. (bii) If the claimant wishes a review of the decision denying his claim to benefits under the this Agreement due to the Executive’s DisabilityExecutive becoming Substantially Disabled, he Executive must submit the written application to the Appeals Fiduciary within one hundred eighty (180) days after receiving written notice of the denial. With respect to any such claim, in deciding an appeal of any denial based in whole or in part on a medical judgment (including determinations with regard to whether a particular treatment, drug, or other item is experimental, investigational, or not medically necessary or appropriate), the Appeals Fiduciary shall: (i1) consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment; and (ii2) identify the medical and vocational experts whose advice was obtained on behalf of the this Agreement in connection with the denial without regard to whether the advice was relied upon in making the determination to deny the claim. Notwithstanding the foregoing, the health care professional consulted pursuant to this clause (bsection 4(e) shall be an individual who was not consulted with respect to the initial denial of the claim that is the subject of the appeal or a subordinate of such individual.

Application for Review. (a1) If a claimant wishes a review of the decision denying his claim to benefits under the this Agreement, other than a claim described in clause paragraph (b2) of this Section 6.1.44(b)(iv), he must submit the written application to the Plan Claims Administrator within sixty (60) days after receiving written notice of the denial. (b2) If the claimant wishes a review of the decision denying his claim to benefits under the this Agreement due to the Executive’s DisabilityExecutive being Permanently Disabled, he must submit the written application to the Appeals Fiduciary within one hundred eighty (180) days after receiving written notice of the denial. With respect to any such claim, in deciding an appeal of any denial based in whole or in part on a medical judgment (including determinations with regard to whether a particular treatment, drug, or other item is experimental, investigational, or not medically necessary or appropriate), the Appeals Fiduciary shall: (iA) consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment; and (iiB) identify the medical and vocational experts whose advice was obtained on behalf of the this Agreement in connection with the denial without regard to whether the advice was relied upon in making the determination to deny the claim. Notwithstanding the foregoing, the health care professional consulted pursuant to this clause (bSection 4(b)(iv) shall be an individual who was not consulted with respect to the initial denial of the claim that is the subject of the appeal or a subordinate of such individual.