Common use of Benefit Claims Procedure Clause in Contracts

Benefit Claims Procedure. (a) Any claim for benefits under the Plan shall be made in writing to the Plan Administrator. If such claim for benefits is wholly or partially denied, the Plan Administrator shall, within thirty (30) days after receipt of the claim, notify the Participant or Beneficiary of the denial of the claim. Such notice of denial shall: (1) Be in writing; (2) Be written in a manner calculated to be understood by the Participant or Beneficiary, and (3) Contain: (A) The specific reason or reasons for denial of the claim, (B) A specific reference to the pertinent Plan provisions upon which the denial is based, (C) A description of any additional material or information necessary to perfect the claim, along with an explanation of why such material or information is necessary, and (D) An explanation of the claim review procedure in accordance with the provisions of this Article. (b) Within sixty (60) days after the receipt by the Participant or Beneficiary of a written notice of denial of the claim, or such later time as shall be deemed reasonable taking into account the nature of the benefit subject to the claim and any other attendant circumstances, the Participant or Beneficiary may file a written request with the Plan Administrator that it conduct a full and fair review of the denial of the claim for benefits. (c) The Plan Administrator shall deliver to the Participant or Beneficiary a written decision on the claim within thirty (30) days after the receipt of the aforementioned request for review, except that if there are special circumstances (such as the need to hold a hearing, if necessary) which require an extension of time for processing, the aforementioned thirty (30) day period shall be extended to sixty (60) days. Such decisions shall: (1) Be written in a manner calculated to be understood by the Participant or Beneficiary, (2) Include the specific reason or reasons for the decision, and (3) Contain a specific reference to the pertinent Plan provisions upon which the decision is based. (d) The decision of the Plan Administrator shall be final and binding on all parties, unless determined by a court of competent jurisdiction to be arbitrary and capricious.

Benefit Claims Procedure. (ai) Any claim for the payment of benefits under the Plan this Agreement shall be made in writing to the Plan Administrator. If such claim for benefits is wholly or partially denied, the Plan Administrator shall, within thirty ninety (3090) days after receipt of the claim, notify the Participant or Beneficiary claimant of the denial of the claim. Such notice of denial shall: denial: (1A) Be shall be in writing; ; (2B) Be shall be written in a manner calculated to be understood by the Participant or Beneficiary, and claimant; and (3C) Contain: shall contain (AI) The the specific reason or reasons for denial of the claim, , (BII) A a specific reference to the pertinent Plan provisions of the Agreement upon which the denial is based, , (CIII) A a description of any additional material or information necessary to perfect the claim, along with an explanation of why such material or information is necessary, and and (DIV) An an explanation of the claim review procedure in accordance with the provisions of this Articleprocedure. (bii) Within sixty (60) days after the receipt by the Participant or Beneficiary claimant of a written notice of denial of the claim, or such later time as shall be deemed reasonable taking into account the nature of the benefit subject to the claim and any other attendant circumstances, the Participant or Beneficiary claimant may file a written request with the Plan Administrator that it conduct a full and fair review of the denial of the claim for benefits. (ciii) The Plan Administrator shall deliver to the Participant or Beneficiary claimant a written decision on the claim within thirty sixty (3060) days after the receipt of the aforementioned aforesaid request for review, except that if there are special circumstances (such as the need to hold a hearing, if necessary) which require an extension of time for processing, the aforementioned thirty aforesaid sixty (3060) day period shall be extended to sixty one hundred twenty (60120) days. Such decisions decision shall: : (1A) Be be written in a manner calculated to be understood by the Participant or Beneficiary, claimant; (2B) Include include the specific reason or reasons for the decision, and ; and (3C) Contain contain a specific reference to the pertinent Plan provisions of the Agreement upon which the decision is based. (d) The decision of the Plan Administrator shall be final and binding on all parties, unless determined by a court of competent jurisdiction to be arbitrary and capricious.

Benefit Claims Procedure. (a) 9.1 Any claim for benefits under the Plan shall be made in writing to the Plan AdministratorCommittee. If such claim for benefits is wholly or partially denied, the Plan Administrator Committee shall, within thirty ninety (3090) days after receipt of the claim, notify the Participant or Beneficiary Eligible Spouse of the denial of the claim. Such notice of denial shall: (1a) Be shall be in writing; , (2b) Be shall be written in a manner calculated to be understood by the Participant or BeneficiaryEligible Spouse, and and (3c) Contain: shall contain (A1) The the specific reason or reasons for denial of the claim, , (B2) A a specific reference to the pertinent Plan provisions upon which the denial is based, , (C3) A a description of any additional material or information necessary to perfect the claim, along with an explanation of why such material or information is necessary, and and (D4) An an explanation of the claim review procedure procedure. The ninety day period may, under special circumstances, be extended up to an additional ninety days upon written notice of such extension to the claimant which notice shall specify the extraordinary circumstances and the extended date of the decision. Notice of extension must be given prior to expiration of the initial ninety day period. If no notice of decision is given within the periods specified above, the claim shall, on the last day of the notice period, be deemed to have been denied and the Participant may file a request for review as provided in accordance with the provisions of this Articlenext paragraph. (b) 9.2 Within sixty (60) days after the receipt of the decision denying a claim (or the occurrence of the date that a claim is deemed denied) by the Participant or Beneficiary of a written notice of denial of the claim, or such later time as shall be deemed reasonable taking into account the nature of the benefit subject to the claim and any other attendant circumstances, Eligible Spouse the Participant or Beneficiary Eligible Spouse may file a written request with the Plan Administrator Committee that it conduct a full and fair review of the denial of the claim for benefits. The claimant or his duly authorized representative may review pertinent documents and submit issues and comments in writing to the Committee in connection with the review. (c) 9.3 The Plan Administrator Committee shall deliver to the Participant or Beneficiary Eligible Spouse a written decision on the claim review of the denial within thirty sixty (3060) days after the receipt of the aforementioned aforesaid request for review, except that if there are special circumstances (such as the need to hold a hearing, if necessary) which require an extension of time for processing, the aforementioned thirty aforesaid sixty (3060) day period shall shall, upon written notice to the Participant or Eligible Spouse be extended to an additional sixty (60) days. Such decisions shall: decision shall (1a) Be be written in a manner calculated to be understood by the Participant or Beneficiary, Eligible Spouse, (2b) Include include the specific reason or reasons for the decision, and and (3c) Contain contain a specific reference to the pertinent Plan provisions upon which the decision is based. If the decision on review is not delivered to the Participant or Eligible Spouse within the periods specified, the claim shall be considered denied on the last day of the review period. (d) The decision 9.4 Upon a Participant or Eligible Spouse filing a claim the Committee shall notify the party filing of the Plan Administrator shall be final claim and binding on all parties, unless determined by a court of competent jurisdiction to be arbitrary and capriciousreview procedure including the time periods involved.

Benefit Claims Procedure. (a) Any claim for benefits under the Plan shall be made in writing to the Plan Administrator. If such claim for benefits is wholly or partially denied, the Plan Administrator shall, within thirty (30) days after receipt of the claim, notify the Participant or Beneficiary of the denial of the claim. Such notice of denial shall: (1) Be be in writing; (2) Be be written in a manner calculated to be understood by the Participant or Beneficiary, and (3) Containcontain: (A) The the specific reason or reasons for denial of the claim, (B) A a specific reference to the pertinent Plan provisions upon which the denial is based, (C) A a description of any additional material or information necessary to perfect the claim, along with an explanation of why such material or information is necessary, and (D) An an explanation of the claim review procedure in accordance with the provisions of this Article. (b) Within sixty (60) days after the receipt by the Participant or Beneficiary of a written notice of denial of the claim, or such later time as shall be deemed reasonable taking into account the nature of the benefit subject to the claim and any other attendant circumstances, the Participant or Beneficiary may file a written request with the Plan Administrator that it conduct a full and fair review of the denial of the claim for benefits. (c) The Plan Administrator shall deliver to the Participant or Beneficiary a written decision on the claim within thirty (30) days after the receipt of the aforementioned request for review, except that if there are special circumstances (such as the need to hold a hearing, if necessary) which require an extension of time for processing, the aforementioned thirty (30) day period shall be extended to sixty (60) days. Such decisions shall: (1) Be be written in a manner calculated to be understood by the Participant or Beneficiary, (2) Include include the specific reason or reasons for the decision, and (3) Contain contain a specific reference to the pertinent Plan provisions upon which the decision is based. (d) The decision of the Plan Administrator shall be final and binding on all parties, unless determined by a court of competent jurisdiction to be arbitrary and capricious. (1) If after a Participant's Account becomes distributable under Article VII no claim for benefit is made by the Participant within 6 months after notice by certified mail addressed to such Participant is sent to the last known address of such Participant, then the Participant's Account shall be deemed to have been forfeited, and the forfeiture shall be allocated pursuant to section 6.04 of the Plan. (2) If a Participant whose Participant's Account has been forfeited pursuant to this provision at any time thereafter makes a claim for the benefit, the dollar amount of the Participant's Account which was forfeited, unadjusted for earnings or losses subsequent to the date of forfeiture, shall be restored during the Plan Year in which the claim is made. The restoration shall be made as follows: first, from any Forfeitures which would have otherwise been allocated for the Plan Year; second, from any earnings of the Trust Fund for the Plan Year; and finally, from Employer contributions allocated for the Plan Year.

Benefit Claims Procedure. (a) Any claim for benefits under the Plan shall be made in writing to the Plan Administrator. If such claim for benefits is wholly or partially denied, the Plan Administrator shall, within thirty (30) days after receipt of the claim, shall notify the Participant or Beneficiary of the denial of the claim within 90 days after receipt of the claim (or within 180 days, if special circumstances require an extension of time for processing the claim, and if written notice of such extension and circumstances is given to the claimant within the initial 90-day period). Notwithstanding the foregoing, if a claim is for distribution of benefits under the Plan as a result of a Disability, written notice of the disposition of the claim shall be furnished to the claimant within 45 days after the application is filed. If the claim is unable to be processed within the initial 45-day period for reasons beyond the control of the Plan Administrator, the time for reviewing the claim may be extended an additional 30 days provided that written notice of the extension is provided to the claimant before the initial 45-day review period expires. If at the end of the 30-day extension period, the claim is still unable to be processed due to reasons beyond the control of the Plan Administrator, the time for reviewing the claim may be extended for an additional 30 days provided that written notice of the extension is provided to the claimant before the 30-day extension period expires. Such notice of denial shall: (1) Be be in writing; (2) Be be written in a manner calculated to be understood by the Participant or Beneficiary, ; and (3) Containcontain: (Ai) The the specific reason or reasons for denial of the claim,; (Bii) A specific a reference to the pertinent specific Plan provisions upon which the denial is based,; (Ciii) A a description of any additional material or information necessary to perfect the claim, along with an explanation of why such material or information is necessary, ; and (Div) An an explanation of the claim claims review procedure and the applica- ble time limits in accordance with the provisions of this ArticleSection, as well as a statement of the claimant’s right to bring an action under ERISA section 502(a) following an adverse determination upon review. (b) Within sixty (60) 60 days after the receipt by the Participant or Beneficiary of a written notice of denial of the claim, or such later time as shall be deemed reasonable taking into account the nature of the benefit subject to the claim and any other attendant circumstances, the Participant or Beneficiary (or his duly authorized representative) may file a written request with the Plan Administrator that it conduct a full and fair review of the denial of the claim for benefits. However, if the claim that was denied was for distribution of benefits under the Plan as a result of a Disability, a claimant shall have 180 days from the date that the claim was denied to file such a request. As part of such a request, the Participant or Beneficiary (or his duly authorized representative) may submit written comments, documents, records, and other information relating to the claim for benefits (regardless of whether such information was submitted or considered in the initial benefit determination). A claimant 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 for benefits. (c) The Plan Administrator shall deliver to the Participant or Beneficiary a written decision on the claim within thirty (30) 60 days after the receipt of the aforementioned request for review, except that if there are special circumstances cir- cumstances (such as the need to hold a hearing, if necessary) which require an extension of time for processing, the aforementioned thirty (30) 60-day period shall be extended to sixty 120 days (if written notice of such extension and circumstances is given to the claimant within the initial 60) days-day period). Notwithstanding the foregoing, if the claim is for distribution of benefits under the Plan as a result of a Disability, a final decision shall be made by the Plan Administrator within 45 days of receipt of the appeal. The Plan may extend the review period for an additional 45 days pro- vided that written notice of the extension is provided to the claimant before the initial 45-day review period expires. Such decisions shall: (1) Be be written in a manner calculated to be understood by the Participant or Beneficiary,; (2) Include include the specific reason or reasons for the decision, and; (3) Contain contain a specific reference to the pertinent specific Plan provisions upon which the decision is based; (4) include a statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claimant’s claim for benefits; and (5) include a statement of the claimant’s right to bring an action under ERISA section 502(a). (d) The decision of the Plan Administrator shall be final and binding on all parties, unless determined by a court of competent jurisdiction to be arbitrary and capricious.