Common use of Claim Decision Clause in Contracts

Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (i) The specific reasons for the denial; (ii) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iii) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (iv) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (v) A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 27 contracts

Samples: Supplemental Executive Retirement Plan Agreement (Columbia Banking System Inc), Executive Supplemental Compensation Agreement (BayCom Corp), Supplemental Executive Retirement Plan Agreement (Columbia Banking System Inc)

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Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (i) The specific reasons for the denial; (ii) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iii) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (iv) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (v) A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 11 contracts

Samples: Executive Supplemental Compensation Agreement (Five Star Bancorp), Director Retirement Agreement (Santa Lucia Bancorp), Director Retirement Agreement (Santa Lucia Bancorp)

Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant Claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant Claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant Claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimantClaimant. The notification shall set forth: (i) The specific reasons for the denial; (ii) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iii) A description of any additional information or material necessary for the claimant Claimant to perfect the claim and an explanation of why such material or information is necessary; (iv) Appropriate information as to the steps to be taken if the claimant Claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (v) A statement of the claimantClaimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 4 contracts

Samples: Executive Supplemental Compensation Agreement (California BanCorp), Split Dollar Agreement (California BanCorp), Executive Supplemental Compensation Agreement (California BanCorp)

Claim Decision. Upon receipt of such a claim, the Plan Administrator shall respond to such claimant advise the Claimant that a reply will be forthcoming within ninety (90) 90 days after receiving the receipt of the benefits claim by the Plan Administrator and that the Plan Administrator shall, in fact, deliver such reply within such period. The Plan Administrator may, however, extend the reply period for an additional 90 days, unless the Plan Administrator determines that special circumstances require an extension of time for making a determination with respect to the benefits claim. If the Plan Administrator determines that special circumstances require additional an extension of time for processing making a determination with respect to the claimbenefits claim is required, the Plan Administrator can extend shall provide the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, Claimant with written notice of such extension prior to the end of the initial ninety (90) 90 day period, that an additional period is required. The extension notice of extension must set forth shall indicate the special circumstances requiring the extension of time and the date by which the Plan Administrator expects to render its decisionthe benefit determination. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in adopt a manner written opinion, using language calculated to be understood by the claimant. The notification shall set Claimant, setting forth: (i) The specific reasons for the such denial; (ii) The specific Specific reference to pertinent provisions of the Agreement this Plan on which the such denial is based; (iii) A description of any additional material or information or material necessary for the claimant Claimant to perfect the his or her claim and an explanation of why such material or such information is necessary;; and (iv) Appropriate information as to A description of the steps to be taken if the claimant wishes to submit the claim for review Plan’s appeal procedures and the time limits applicable to such procedures; and (v) A , including a statement of the claimantClaimant’s right to bring a civil action under ERISA Section 502(a) of ERISA following an adverse benefit determination on reviewa denial of the appeal of the denial of the benefits claim.

Appears in 4 contracts

Samples: Supplemental Executive Retirement Plan (Somerset Hills Bancorp), Supplemental Executive Retirement Plan (Somerset Hills Bancorp), Supplemental Executive Retirement Plan (Somerset Hills Bancorp)

Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (ia) The specific reasons for the denial; (iib) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iiic) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (ivd) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (ve) A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 3 contracts

Samples: Split Dollar Agreement (Columbia Banking System, Inc.), Split Dollar Agreement (Columbia Banking System, Inc.), Split Dollar Agreement (Columbia Banking System Inc)

Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (ia) The specific reasons for the denial; (iib) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iiic) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (ivd) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (ve) A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 3 contracts

Samples: Joint Beneficiary Agreement (BayCom Corp), Joint Beneficiary Agreement (BayCom Corp), Joint Beneficiary Agreement (BayCom Corp)

Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (i) The specific reasons for the denial; (ii) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iii) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (iv) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (v) A statement of the claimant’s 's right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 2 contracts

Samples: Executive Supplemental Compensation Agreement (Columbia Banking System, Inc.), Executive Supplemental Compensation Agreement (Columbia Banking System, Inc.)

Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator Administration· shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (i) The specific reasons for the denial; (ii) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iii) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (iv) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (v) A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 2 contracts

Samples: Executive Supplemental Compensation Agreement (BayCom Corp), Executive Supplemental Compensation Agreement (BayCom Corp)

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Claim Decision. Upon receipt of such claim, the Plan Administrator shall 13 Unit Plan2019/3/1 respond to such claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (i) The specific reasons for the denial; (ii) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iii) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (iv) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (v) A statement of the claimant’s 's right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 1 contract

Samples: Executive Supplemental Compensation Agreement (Columbia Banking System, Inc.)

Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (i) The specific reasons for the denial; (ii) The specific reference to pertinent provisions of the Columbia SERP Agreement on which the denial is based; (iii) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (iv) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (v) A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 1 contract

Samples: Supplemental Executive Retirement Plan Agreement (Columbia Banking System Inc)

Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause 18 by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (i) The specific reasons for the denial; (ii) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iii) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (iv) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (v) A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 1 contract

Samples: Supplemental Executive Retirement Plan Agreement (Columbia Banking System Inc)

Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (ia) The specific reasons for the denial; (iib) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iiic) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (ivd) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (ve) A statement of the claimant’s 's right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 1 contract

Samples: Split Dollar Agreement (Columbia Banking System, Inc.)

Claim Decision. Upon receipt of such claim, the Plan Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If , the Plan Administrator determines that special circumstances require additional time for processing the claim, the Plan Administrator can extend the response period by an additional ninety (90) days for reasonable cause by notifying the claimant in writing, prior to the end of the initial ninety (90) day period, that an additional period is required. The notice of extension must set forth the special circumstances and the date by which the Plan Administrator expects to render its decision. If the claim is denied in whole or in part, the Plan Administrator shall notify the claimant in writing of such denial. The Plan Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (i) The specific reasons for the denial; (ii) The specific reference to pertinent provisions of the Agreement on which the denial is based; (iii) A description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (iv) Appropriate information as to the steps to be taken if the claimant wishes to submit the claim for review and the time limits applicable to such procedures; and (v) A statement of the claimant’s 's right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Appears in 1 contract

Samples: Executive Supplemental Compensation Agreement (Columbia Banking System, Inc.)

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