Common use of CLAIMS APPEALS Clause in Contracts

CLAIMS APPEALS. Administrative Agent shall refer to Employer or its Plan Administrator or other designee, for final determination, any Claim for benefits or coverage that is appealed after initial rejection by Administrative Agent or any class of Claims that Employer may specify, including: (a) any question of eligibility or entitlement of the Participant for coverage under the Plan; (b) any question with respect to the amount due; (c) any claim requiring a discretionary determination with respect to coverage or (d) any other appeal.