Common use of Claim Decision Clause in Contracts

Claim Decision. Upon the receipt of a claim, the Administrator shall advise the Claimant that a reply will be forthcoming within ninety (90) days and shall, in fact, deliver such reply within such period. However, the Administrator may extend the reply period for an additional ninety (90) days for reasonable cause. Any claim not granted or denied within such time period shall be deemed to have been denied. If the claim is denied in whole or in part, then the Administrator shall provide written notice to the Claimant, setting forth: 1. The reason or reasons for such denial; 2. The reference to pertinent provisions of this Agreement on which such denial is based; 3. A description of any additional material or information necessary for the Claimant to perfect his or her claim and an explanation of why such material or such information is necessary; 4. Steps to be taken if the Claimant wishes to submit the claim for review; and 5. The time limits for requesting a review under subsequent provisions of this Section 6.7.