Common use of Claim Decision Clause in Contracts

Claim Decision. The Claimant shall be notified within ninety (90) days after the claim is filed (forty-five (45) days for a Disability Claim), whether the claim is allowed or denied, unless the claimant receives written notice from the Plan Sponsor or appointee of the Plan Sponsor prior to the end of the ninety (90) day period (forty-five (45) days for a Disability Claim) stating that special circumstances require an extension of the time for decision. For a claim other than for Disability, such extension is not to extend beyond the day which is one-hundred eighty (180) days after the day the claim is filed as long as the Plan Sponsor notifies the claimant of the circumstances requiring the extension, and the date as of which a decision is expected to be rendered. For a Disability Claim, a thirty (30) day extension is permitted, with an additional thirty (30) days permitted, provided that the Plan Sponsor notifies the claimant prior to expiration of the first 30 day extension, of the circumstances requiring the extension, and the date as of which a decision is expected to be rendered. If the Plan Sponsor denies the claim, it must provide to the Claimant, in writing or by electronic communication: (i) The specific reasons for such denial; (ii) Specific reference to pertinent provisions of this Plan on which such denial is based; (iii) A description of any additional material or information necessary for the Claimant to perfect his or her claim, by providing such material to the Plan Sponsor within forty-five (45) days, and an explanation why such material or such information is necessary; and (iv) A description of the Plan’s appeal procedures and the time limits applicable to such procedures, including a statement of the Claimant’s right to bring a civil action under Section 502(a) of ERISA following a denial of the appeal of the denial of the benefits claim.

Claim Decision. The Claimant shall be notified within ninety (90) days after the claim is filed whether the claim is allowed or denied (forty-five (45) days for in the case of a claim involving Disability ClaimRetirement Benefits), whether the claim is allowed or deniedunless, unless for claims not involving Disability Retirement Benefits, the claimant receives written notice from the Plan Sponsor Administrator or appointee of the Plan Sponsor Administrator prior to the end of the ninety (90) day period (forty-five (45) days for a Disability Claim) stating that special circumstances require an extension of the time for decision. For a claim other than for Disability, such Such extension is not to extend beyond the day which is one-one hundred eighty (180) days after the day the claim is filed as long as filed. In the case of a claim involving Disability Retirement Benefits, Plan Sponsor notifies Administrator will notify the claimant of Claimant within the circumstances requiring the extension, and the date as of which a decision is expected to be rendered. For a Disability Claim, a thirty initial forty-five (3045) day extension is permitted, with period that Plan Administrator needs up to an additional thirty (30) days permitted, provided that to review the Plan Sponsor notifies the claimant prior to expiration of the first 30 day extension, of the circumstances requiring the extension, and the date as of which a decision is expected to be renderedClaimant’s claim. If the Plan Sponsor Administrator determines that the additional thirty (30) day period is not sufficient and that additional time is necessary to review the Claimant’s claim for Disability Retirement Benefits, the Plan Administrator may notify the Claimant of an additional thirty (30) day extension. If Plan Administrator denies the claim, it must provide to the Claimant, in writing or by electronic communication: (i) The specific reasons for such denial; (ii) Specific reference to pertinent provisions of this Plan Agreement on which such denial is based; (iii) A description of any additional material or information necessary for the Claimant to perfect his or her claim, by providing such material to the Plan Sponsor within forty-five (45) days, claim and an explanation why such material or such information is necessary; (iv) In the case of any claim involving Disability Retirement Benefits, a copy of any internal rule, guideline, protocol, or other similar criterion relied upon in making the initial determination or a statement that such a rule, guideline, protocol, or other criterion was relied upon in making the determination and that a copy of such rule will be provided to the Claimant free of charge at the Claimant’s request; and (ivv) A description of the PlanAgreement’s appeal procedures and the time limits applicable to such procedures, including a statement of the Claimant’s right to bring a civil action under Section 502(a) of ERISA following a denial of the appeal of the denial of the benefits claim.

Claim Decision. The Claimant shall be notified within ninety (90) days after the claim is filed whether the claim is allowed or denied (forty-five (45) days for in the case of a claim involving Disability ClaimRetirement Benefits), whether the claim is allowed or deniedunless, unless for claims not involving Disability Retirement Benefits, the claimant receives written notice from the Plan Sponsor Administrator or appointee of the Plan Sponsor Administrator prior to the end of the ninety (90) day period (forty-five (45) days for a Disability Claim) stating that special circumstances require an extension of the time for decision. For a claim other than for Disability, such Such extension is not to extend beyond the day which is one-one hundred eighty (180) days after the day the claim is filed as long as filed. In the case of a claim involving Disability Retirement Benefits, Plan Sponsor notifies Administrator will notify the claimant of Claimant within the circumstances requiring the extension, and the date as of which a decision is expected to be rendered. For a Disability Claim, a thirty initial forty-five (3045) day extension is permitted, with period that Plan Administrator needs up to an additional thirty (30) days permitted, provided that to review the Plan Sponsor notifies the claimant prior to expiration of the first 30 day extension, of the circumstances requiring the extension, and the date as of which a decision is expected to be renderedClaimant’s claim. If the Plan Sponsor Administrator determines that the additional thirty (30) day period is not sufficient and that additional time is necessary to review the Claimant’s claim for Disability Retirement Benefits, the Plan Administrator may notify the Claimant of an additional thirty (30) day extension. If Plan Administrator denies the claim, it must provide to the Claimant, in writing or by electronic communication: (i) 1. The specific reasons for such denial; (ii) 2. Specific reference to pertinent provisions of this Plan Agreement on which such denial is based; (iii) 3. A description of any additional material or information necessary for the Claimant to perfect his or her claim, by providing such material to the Plan Sponsor within forty-five (45) days, claim and an explanation why such material or such information is necessary; 4. In the case of any claim involving Disability Retirement Benefits, a copy of any internal rule, guideline, protocol, or other similar criterion relied upon in making the initial determination or a statement that such a rule, guideline, protocol, or other criterion was relied upon in making the determination and that a copy of such rule will be provided to the Claimant free of charge at the Claimant’s request; and (iv) 5. A description of the PlanAgreement’s appeal procedures and the time limits applicable to such procedures, including a statement of the Claimant’s right to bring a civil action under Section 502(a) of ERISA following a denial of the appeal of the denial of the benefits claim.

Claim Decision. The Claimant shall be notified within ninety (90) days after the claim is filed whether the claim is allowed or denied (forty-five (45) days for in the case of a claim involving Disability ClaimRetirement Benefits), whether the claim is allowed or deniedunless, unless for claims not involving Disability Retirement Benefits, the claimant receives written notice from the Plan Sponsor Administrator or appointee of the Plan Sponsor Administrator prior to the end of the ninety (90) day period (forty-five (45) days for a Disability Claim) stating that special circumstances require an extension of the time for decision. For a claim other than for Disability, such Such extension is not to extend beyond the day which is one-one hundred eighty (180) days after the day the claim is filed as long as filed. In the case of a claim involving Disability Retirement Benefits, Plan Sponsor notifies Administrator will notify the claimant of Claimant within the circumstances requiring the extension, and the date as of which a decision is expected to be rendered. For a Disability Claim, a thirty initial forty-five (3045) day extension is permitted, with period that Plan Administrator needs up to an additional thirty (30) days permitted, provided that to review the Plan Sponsor notifies the claimant prior to expiration of the first 30 day extension, of the circumstances requiring the extension, and the date as of which a decision is expected to be renderedClaimant's claim. If the Plan Sponsor Administrator determines that the additional thirty (30) day period is not sufficient and that additional time is necessary to review the Claimant's claim for Disability Retirement Benefits, the Plan Administrator may notify the Claimant of an additional thirty (30) day extension. If Plan Administrator denies the claim, it must provide to the Claimant, in writing or by electronic communication: (i) The specific reasons for such denial; (ii) Specific reference to pertinent provisions of this Plan Agreement on which such denial is based; (iii) A description of any additional material or information necessary for the Claimant to perfect his or her claim, by providing such material to the Plan Sponsor within forty-five (45) days, claim and an explanation why such material or such information is necessary; (iv) In the case of any claim involving Disability Retirement Benefits, a copy of any internal rule, guideline, protocol, or other similar criterion relied upon in making the initial determination or a statement that such a rule, guideline, protocol, or other criterion was relied upon in making the determination and that a copy of such rule will be provided to the Claimant free of charge at the Claimant's request; and (ivv) A description of the Plan’s Agreement's appeal procedures and the time limits applicable to such procedures, including a statement of the Claimant’s 's right to bring a civil action under Section 502(a) of ERISA following a denial of the appeal of the denial of the benefits claim.