Common use of Claim Decision Clause in Contracts

Claim Decision. Upon receipt of a claim, the Corporation shall advise the Claimant that a reply will be forthcoming within 90 days and shall, in fact, deliver such reply within such 90-day period. Upon written notice prior to the expiration of the 90-day reply period, the Corporation may, however, extend the reply period for an additional 90 days for reasonable cause. If the claim is denied in whole or in part, the Corporation shall adopt a written opinion, using language calculated to be understood by the Claimant, setting forth: (A) the specific reason or reasons for such denial; (B) the specific reference to pertinent provisions of this Agreement on which such denial is based; (C) a description of any additional material or information necessary for the Claimant to perfect his or her claim and an explanation why such material or such information is necessary; (D) appropriate information as to the steps to be taken if the Claimant wishes to submit the claim for review; and (E) the time limits for requesting a review under subsection (3) and for review under subsection (4) of this section 10(b). If a notice of denial is not received within the reply period, the claim shall be deemed denied and the Claimant shall be permitted to request review, as set forth below.

Claim Decision. Upon receipt of a claim, the Corporation shall advise the Claimant that a reply will be forthcoming within 90 days and shall, in fact, deliver such reply within such 90-day period. Upon written notice prior to the expiration of the 90-day reply period, the Corporation may, however, extend the reply period for an additional 90 days for reasonable cause. If the claim is denied in whole or in part, the Corporation shall adopt a written opinion, using language calculated to be understood by the Claimant, setting forth: (A) the specific reason or reasons for such denial; (B) the specific reference to pertinent provisions of this Agreement on which such denial is based; (C) a description of any additional material or information necessary for the Claimant to perfect his or her claim and an explanation why such material or such information is necessary; (D) appropriate information as to the steps to be taken if the Claimant wishes to submit the claim for review; and (E) the time limits for requesting a review under subsection (3) and for review under subsection (4) of this section 10(b). If a notice of denial is not received within the reply period, the claim shall be deemed denied and the Claimant shall be permitted to request review, as set forth belowSection 10.

Claim Decision. Upon receipt of a claim, the Corporation shall advise the Claimant that a reply will be forthcoming within 90 days and shall, in fact, deliver such reply within such 90-day period. Upon written notice prior to the expiration of the 90-day reply period, the Corporation may, howeverhowev- er, extend the reply period for an additional addi- tional 90 days for reasonable cause. If the claim is denied in whole or in part, the Corporation shall adopt a written opinion, using language calculated to be understood by the Claimant, setting forth: (A) the specific reason or reasons for such denial; (B) the specific reference to pertinent provisions of this Agreement on which such denial is based; (C) a description descrip- tion of any additional material or information infor- mation necessary for the Claimant to perfect per- fect his or her claim and an explanation why such material or such information is necessary; (D) appropriate information as to the steps to be taken if the Claimant wishes to submit the claim for review; and (E) the time limits for requesting a review re- view under subsection (3) and for review under subsection (4) of this section 10(b). If a notice of denial is not received re- ceived within the reply period, the claim shall be deemed denied and the Claimant shall be permitted to request review, as set forth below.