Common use of Claim Decision Clause in Contracts

Claim Decision. Upon receipt of such claim, the Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Administrator determines that special circumstances require additional time for processing the claim, the 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 Administrator shall notify the claimant in writing of such denial. The Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (a) The specific reasons for the denial; (b) The specific reference to pertinent provisions of the Agreement on which the denial is based; (c) 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; (d) 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 (e) A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Claim Decision. Upon receipt of such claim, the Administrator shall respond to such claimant Claimant within ninety (90) days after receiving the claim. If the Administrator determines that special circumstances require additional time for processing the claim, the 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 Administrator shall notify the claimant Claimant in writing of such denial. The Administrator shall write the notification in a manner calculated to be understood by the claimantClaimant. The notification shall set forth: (a) The specific reasons for the denial; (b) The specific reference to pertinent provisions of the Agreement on which the denial is based; (c) 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; (d) 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 (e) A statement of the claimantClaimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Claim Decision. Upon receipt of such claim, the Administrator shall respond to such claimant Claimant within ninety (90) days after receiving the claim. If the Administrator determines that special circumstances require additional time for processing the claim, the 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 Administrator shall notify the claimant Claimant in writing of such denial. The Administrator shall write the notification in a manner calculated to be understood by the claimantClaimant. The notification shall set forth: (a) The specific reasons for the denial; (b) The specific reference to pertinent provisions of the Agreement on which the denial is based; (c) 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; (d) 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 (e) A statement of the claimantClaimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Claim Decision. Upon receipt of such claim, the Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Administrator determines that special circumstances require additional time for processing the claim, the 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 Administrator shall notify the claimant in writing of such denial. The Administrator shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (ai) The specific reasons for the denial; (bii) The specific reference to pertinent provisions of the Agreement on which the denial is based; (ciii) 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; (div) 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 (ev) A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Claim Decision. Upon receipt of such claim, the Administrator shall respond to such claimant within ninety (90) days after receiving the claim. If the Administrator determines that special circumstances require additional time for processing the claim, the 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 Administrator shall notify the claimant Claimant in writing of such denial. The Administrator shall write the notification in a manner calculated to be understood by the claimantClaimant. The notification shall set forth: (a) The specific reasons for the denial; (b) The specific reference to pertinent provisions of the Agreement on which the denial is based; (c) 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; (d) 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 (e) A statement of the claimantClaimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.

Claim Decision. Upon receipt of such claim, the Administrator Committee shall respond to such claimant within ninety (90) days after receiving the claim. If the Administrator Committee determines that special circumstances require additional time for processing the claim, the Administrator Committee 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 Committee expects to render its decision. If the claim is denied in whole or in part, the Administrator Committee shall notify the claimant in writing of such denial. The Administrator Committee shall write the notification in a manner calculated to be understood by the claimant. The notification shall set forth: (ai) The specific reasons for the denial; (bii) The specific reference to pertinent provisions of the Agreement on which the denial is based; (ciii) 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; (div) 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 (ev) A statement of the claimant’s right to bring a civil action under ERISA Section 502(a) following an adverse benefit determination on review.