Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 2 contracts
Samples: Restricted Stock Unit Award Agreement, Restricted Stock Unit Award Agreement (Interdigital Communications Corp)
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred 8.2.1 Benefits shall be paid in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws provisions of descent and distribution) (the “Claimant”) must file this Agreement. A Claimant shall send a written request with for such benefit, setting forth the Companyclaim, to the Company at its principal place of business. The claim will be forwarded to the Plan Administrator.
8.2.2 Upon proper delivery and receipt of such a claim, the Company will Plan Administrator shall advise the Claimant that a reply will be forthcoming within ninety (90) 90 days of receipt of and shall deliver such reply within such period. The Plan Administrator may, however, extend the claim whether the claim is denied. If special circumstances require more than ninety (90) reply period for an additional 90 days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madereasonable cause. If the claim is denied in whole or in part, the Claimant will be provided a Plan Administrator shall provide written opinion, in language calculated to be understood by the Claimantnotice, setting forth forth: (i) the specific reason(s) reason or reasons for the denial of the claim, or any part of it, such denial; (ii) the specific reference(s) reference to pertinent provisions of the Plan or this award upon Agreement on which such denial was is based, ; (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, claim and an explanation of why such material or such information is necessary, ; (iv) an explanation of appropriate information as to the steps to be taken if the Claimant wishes to submit the claim appeal procedure set forth in Section 13(c), belowfor review; and (v) the time limits for requesting a statement review under Section 8.2.3 and for review under Section 8.2.4.
8.2.3 If the claim is denied and a review is desired, the Claimant must, within 60 days after receipt by the Claimant of the Claimant’s right to bring a civil action under section 502(a) written denial of ERISA following an adverse claim, as described above, request in writing that the Plan Administrator reconsider the determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial Company. Such request must be addressed to the Plan Administrator at the Company’s principal place of the claimbusiness. The Claimant or his or her duly authorized representative may, but need not, may review the pertinent documents and submit issues and comments in writing for consideration by of the CompanyPlan Administrator. If the Claimant does not request a review reconsideration of the initial Plan Administrator’s determination within such sixty (60) days 60 day period, then the Claimant will shall be barred and estopped stopped from challenging the Plan Administrator’s determination. .
8.2.4 Within sixty (60) 60 days after the CompanyPlan Administrator’s receipt of a timely and properly delivered request for review, it will the Plan Administrator shall review the initial Company’s determination. After , and after considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will shall render a written opinion. The manner option, setting forth the specific reasons for the decision and content of the final decision will include the same information described above in Section 13(b) with respect containing specific references to the initial determinationpertinent provisions of this Agreement on which the decision is based. If special circumstances require that the sixty (60) -day time period be extended, the Company Plan Administrator will so notify the Claimant and the Plan Administrator will render the decision as soon as possible, but no not later than one hundred twenty (120) 120 days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 2 contracts
Samples: Executive Nonqualified Deferred Compensation Agreement (Lithia Motors Inc), Outside Director Nonqualified Deferred Compensation Agreement (Lithia Motors Inc)
Claims Procedure. To initiate (a) All claims shall be filed in writing by the Participant, his or her beneficiary or authorized representative of the claimant, by completing such procedures as the Administrative Committee shall require. Such procedures shall be reasonable and may include the completion of forms and the submission of documents and additional information.
(b) If a claim with respect is denied, notice of denial shall be furnished by the Administrative Committee to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant claimant within ninety (90) days of after receipt of the claim whether by the claim is denied. If Administrative Committee, unless special circumstances require more than an extension of time for processing the claim, in which event notification of the extension shall be provided to the Participant or Beneficiary and the extension shall not exceed ninety (90) days for processing, the Claimant will be notified in writing within ninety days.
(90c) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinionAdministrative Committee shall provide adequate notice, in language calculated writing, to be understood by the Claimantany claimant whose claim has been denied, setting forth (i) the specific reason(s) reasons for the denial of the claimsuch denial, or any part of it, (ii) specific reference(s) reference to pertinent provisions of the Plan or this award upon which such denial was basedprovisions, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, his or her claim and an any explanation of why such material or information is necessary, (iv) an explanation all written in a manner calculated to be understood by the claimant. Such notice shall include appropriate information as to the steps to be taken if the claimant wishes to submit his or her claim for review. The claimant or the claimant’s authorized representative must request such review within the reasonable period of time prescribed by the claim appeal procedure set forth in Section 13(c), below; and (v) a statement Administrative Committee. In no event shall such period of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within time be less than sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a days. A decision on review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does shall be made not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within later than sixty (60) days after the CompanyBank’s receipt of a the request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day further extension of time period for processing, a decision shall be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no rendered not later than one hundred twenty (120) days after following the Bank’s receipt of the request for review. The notice will explain what special circumstances make If such an extension necessary of time for review is required, written notice of the extension shall be furnished to the claimant prior to the commencement of the extension. The decision on review shall be furnished to the claimant. Such decision shall be in writing and indicate shall include specific reasons for the date decision, written in a final manner calculated to be understood by the claimant, as well as specific references to the pertinent Plan provisions on which the decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 2 contracts
Samples: Nonqualified Deferred Compensation Plan (Federal Home Loan Bank of Dallas), Nonqualified Deferred Compensation Plan (Federal Home Loan Bank of Dallas)
Claims Procedure. To initiate If any Participant or Beneficiary shall claim benefits for which the Committee has determined he is ineligible, or shall dispute the amount or timing of benefits determined by the Committee to be payable hereunder, he shall be entitled to make a claim with respect for benefits pursuant to this Paragraph (H). All claims for benefits under this Agreement, whether made by a Participant or Beneficiary, shall be in writing addressed and delivered to the settlement of Restricted Stock Units deferred in accordance with Section 5(b)Committee, Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with any member thereof, at the Company. Upon receipt of such claim's main office, shall contain the Company will advise the Claimant within ninety (90) days of receipt of claimant's name, mailing address, and telephone number, if any, and shall identify the claim whether in a manner reasonably calculated to make the claim is denied. If special circumstances require more than ninety (90) days for processing, understandable to the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madeCommittee. If the claim is defective in any foregoing respect, the Committee may at any time within ten days after said delivery give the claimant not less than ten days' written notice specifying the defect or defects and the deadline for correction. A claim shall be deemed to be effectively made when and if it is timely corrected in writing (addressed and delivered as aforesaid), or when it is timely and correctly prepared and delivered in the first place, or when it (or a revision thereof) is timely delivered as aforesaid if the Committee does not give written notice of any defect therein within ten days after said delivery. It is further agreed:
(1) If a claim is (or is deemed to be) effectively made, the Committee, shall within 60 days thereafter notify the claimant in writing whether the claim has been granted or has been denied in whole or in part, the Claimant will . Such notice shall be provided written in a written opinion, in language manner calculated to be understood by the Claimantclaimant, setting forth shall make specific reference to the Plan, and, if adverse in whole or in part, shall set forth:
(ia) the The specific reason(s) reason or reasons for the denial of the claim, or any part of it, denial;
(iib) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a A description of any additional material or information necessary for the Claimant claimant to perfect the claim, and together with an explanation of why such material or information is necessary, ; and
(ivc) an An explanation of the claim appeal review procedure set forth in Section 13(c), below; (3) and (v4) a statement below.
(2) If within said 60 days the claim has not been granted, it shall be deemed to have been denied for purposes of the Claimant’s right to bring a civil action claim review procedure set forth in (3) below, even if notice of denial has not been given under section 502(a(1) above.
(3) Upon denial of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (the claimant or the Claimant’s his duly authorized representative) may representative shall have 60 days within which to file with the Company Committee or any member thereof a written request for a review of the denial such denial, whereupon -
(a) The Committee shall as promptly as is practicable, but not later than 60 days after receipt of the such request, schedule a hearing to review said claim. .
(b) The Claimant claimant or his duly authorized representative mayshall, but need notpending and/or at said hearing, be permitted at all reasonable hours to review the pertinent documents and also be entitled to submit issues and comments in writing for consideration by writing.
(4) The hearing mentioned in (3) above shall be held at the Company's main office during normal business hours, unless a different time and/or place are mutually agreed upon. If the Claimant does not request It shall be attended by at least a review majority of the initial determination within such sixty (60) days periodCommittee. A decision on the claim shall be rendered thereat or as soon as possible thereafter, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) but in no event later than 120 days after the Company’s Committee's receipt of a the written request for review, it will review the initial determination. After considering all materials presented ; shall be in writing and include specific reasons; shall be written in a manner calculated to be understood by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner claimant; and content of the final decision will include the same information described above in Section 13(b) with respect shall contain specific reference to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render pertinent Plan provisions on which the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 2 contracts
Samples: Employee Stock Ownership and 401(k) Savings Plan and Trust Agreement (Source One Mortgage Services Corp), 401(k) Savings Plan and Trust Agreement (Source One Mortgage Services Corp)
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (a) A Participant or the person to whom ownership rights may have passed by will or the laws of descent and distribution) Beneficiary (the “Claimant”"claimant") must file shall have the right to request any benefit under the Plan by filing a written request claim for any such benefit with the CompanyAdministrator on a form provided by the Administrator for such purpose. Upon The Administrator shall give such claim due consideration and shall either approve or deny it in whole or in part. Within ninety (90) days following receipt of such claimclaim by the Administrator, notice of any approval or denial thereof, in whole or in part, shall be delivered to the Company will advise claimant or his duly authorized representative or such notice of denial shall be sent by mail to the Claimant claimant or his duly authorized representative at the address shown on the claim form or such individual's last known address. The aforesaid ninety (90) day response period may be extended to one hundred eighty (180) days after receipt of the claimant's claim if special circumstances exist and if written notice of the extension to one hundred eighty (180) days indicating the special circumstances involved and the date by which a decision is expected to be made is furnished to the claimant within ninety (90) days of after receipt of the claim whether the claim is deniedclaimant's claim. If special circumstances require more than ninety (90) days for processing, the Claimant will Any notice of denial shall be notified written in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language manner calculated to be understood by the Claimant, setting forth claimant and shall:
(i) the Set forth a specific reason(s) reason or reasons for the denial of the claim, or any part of it, denial,
(ii) Make specific reference(s) reference to the pertinent provisions of the Plan or this award upon on which such any denial was of benefits is based, ,
(iii) a description of Describe any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of explain why such material or information is necessary, and
(iv) an explanation Explain the claim review procedure of subparagraph 8.9(b). If a notice of approval or denial is not provided to the claimant within the applicable ninety (90) day or one hundred eighty (180) day period, the claimant's claim shall be considered denied for purposes of the claim appeal review procedure set forth in Section 13(cof subparagraph 8.9(b), below; and .
(vb) a statement of the Claimant’s right A Participant or Beneficiary whose claim filed pursuant to bring a civil action under section 502(asubparagraph 8.9
(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant may, within sixty (60) days following receipt of notice of such denial, or following the Claimant’s duly authorized representativeexpiration of the applicable period provided for in subparagraph 8.9
(a) may file with for notifying the Company a claimant of the decision on the claim if no notice of denial is provided, make written request application to the Administrator for a review of such claim, which application shall be filed with the denial Administrator. For purposes of such review, the claim. The Claimant claimant or his duly authorized representative may, but need not, may review Plan documents pertinent to such claim and may submit to the pertinent documents and submit Administrator written issues and comments in writing for consideration by the Companyrespecting such claim. If the Claimant does not request The Administrator may schedule and hold a hearing. The Administrator shall make a full and fair review of the initial determination within such sixty (60) days periodany denial of a claim for benefits and issue its decision thereon promptly, the Claimant will be barred and estopped from challenging the determination. Within but no later than sixty (60) days after receipt by the Company’s receipt Administrator of a the claimant's request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after such receipt if a hearing is to be held or if other special circumstances exist and if written notice of the extension to one hundred twenty (120) days is furnished to the claimant within sixty (60) days after the receipt of the claimant's request for a review. The notice will explain what special circumstances make an extension necessary Such decision shall be in writing, shall be delivered or mailed by the Administrator to the claimant or his duly authorized representative in the manner prescribed in subparagraph 8.9
(a) for notices of approval or denial of claims, and indicate shall:
(i) Include specific reasons for the date decision,
(ii) Be written in a final manner calculated to be understood by the claimant, and
(iii) Contain specific references to the pertinent Plan provisions on which the decision is expected to be madebased. Any The Administrator's decision on appeal will made in good faith shall be final, conclusive and binding upon all parties.
Appears in 2 contracts
Samples: Salaried Retirement Plan (Eskimo Pie Corp), Salaried Retirement Plan (Eskimo Pie Corp)
Claims Procedure. To initiate In the event that benefits under this Agreement are not paid to the Executive (or his beneficiary in the case of the Executive’s death), and such person feels entitled to receive them, a claim with respect shall be made in writing to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant Plan Administrator within ninety (90) days of receipt of from the date payments are not made. Such claim whether shall be reviewed by the Plan Administrator and the Bank. If the claim is denied. If special circumstances require more than , in full or in part, the Plan Administrator shall provide a written notice within ninety (90) days setting forth the specific reasons for processingdenial, specific reference to the provisions of this Agreement upon which the denial is based, and any additional material or information necessary to perfect the claim, if any. Also, such written notice shall indicate the steps to be taken if a review of the denial is desired. If a claim is denied and a review is desired, the Claimant will be notified Executive (or his beneficiary in the case of the Executive’s death), shall notify the Plan Administrator in writing within ninety (90) days of filing [and a claim shall be deemed denied if the claims than Plan Administrator does not take any action within the Company requires up to an additional aforesaid ninety (90) days day period]. In requesting a review, the Executive or his beneficiary may review this Agreement or any documents relating to replyit and submit any written issues and comments he or she may feel appropriate. The notice will explain what special circumstances make an extension necessary and indicate In its sole discretion the date a final decision is expected to be made. If Plan Administrator shall then review the claim is denied in whole or in part, the Claimant will be provided and provide a written opinion, in language calculated to be understood by the Claimant, setting forth decision within ninety (i90) days. This decision likewise shall state the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan Agreement on which the decision is based. If claimants continue to dispute the benefit denial based upon completed performance of this Agreement or this award upon which such denial was basedthe meaning and effect of the terms and conditions thereof, (iii) then claimants may submit the dispute to a description Board of any additional material or information necessary Arbitration for final arbitration. Said Board shall consist of one member selected by the Claimant to perfect claimant, one member selected by the claimBank, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of third member selected by the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claimfirst two members. The Claimant or his duly authorized representative mayBoard shall operate under any generally recognized set of arbitration rules. The parties hereto agree that they and their heirs, but need notpersonal representatives, review the pertinent documents successors and submit issues and comments in writing for consideration assigns shall be bound by the Company. If the Claimant does not request a review decision of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) Board with respect to the initial any controversy properly submitted to it for determination. If special circumstances require that Where a dispute arises as to the sixty (60) day time period Bank’s discharge of the Executive “for cause,” such dispute shall likewise be extended, submitted to arbitration as above described and the Company will so notify the Claimant and will render parties hereto agree to be bound by the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthereunder.
Appears in 2 contracts
Samples: Executive Salary Continuation Agreement (Lyons Bancorp Inc), Executive Salary Continuation Agreement (Lyons Bancorp Inc)
Claims Procedure. To initiate (i) Benefits will be provided to each Designated Employee as specified in this Plan. If a claim Designated Employee believes that he has not been provided with respect benefits due under the Plan, then the Designated Employee (who is hereafter referred to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (as the “Claimant”) must file has the right to make a written request with claim for benefits under the CompanyPlan. Upon receipt Written claims for severance pay benefits shall be governed by the following procedures; any written claims for health or welfare benefits shall be governed by the claims procedures of the applicable health or welfare plan. If such a written claim is made, and the Administrator wholly or partially denies the claim, the Company will advise Administrator shall provide the Claimant within ninety (90) days with written notice of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processingsuch denial, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinionsetting forth, in language a manner calculated to be understood by the Claimant, setting forth :
(iA) the specific reason(sreason or reasons for such denial;
(B) for specific reference to pertinent Plan provisions on which the denial of the claim, or any part of it, is based;
(ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iiiC) a description of any additional material or information necessary for the Claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and
(ivD) an explanation of the Plan’s claims review procedure and time limits applicable to those procedures, including a statement of the Claimant’s right to bring a civil action under ERISA Section 502(a) if the claim appeal procedure set forth is denied on appeal.
(ii) The written notice of any claim denial pursuant to Section 6(a)(i) shall be given not later than thirty (30) days after receipt of the claim by the Administrator, unless the Administrator determines that special circumstances require an extension of time for processing the claim, in Section 13(c), belowwhich event:
(A) written notice of the extension shall be given by the Administrator to the Claimant prior to thirty (30) days after receipt of the claim;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day period for giving notice of a claim denial; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Administrator expects to render the benefit determination.
(iii) The decision of the Administrator shall be final unless the Claimant, within sixty (60) days after receipt of notice of the claims denial from the Administrator, submits a written request to the Board of Directors of Perspecta, or its delegate, for an appeal of the denial. During that sixty (60) day period, the Claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claim for benefits. The Claimant shall be provided the opportunity to submit written comments, documents, records, and other information relating to the claim for benefits as part of the Claimant’s appeal. The Claimant may act in these matters individually, or through his or her authorized representative.
(iv) After receiving the written appeal, if the Board of Directors of Perspecta, or its delegate, shall issue a written decision notifying the Claimant of its decision on review, not later than thirty (30) days after receipt of the written appeal, unless the Board of Directors of Perspecta or its delegate determines that special circumstances require an extension of time for reviewing the appeal, in which event:
(A) written notice of the extension shall be given by the Board of Directors of Perspecta or its delegate prior to thirty (30) days after receipt of the written appeal;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day review period; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Board of Directors of Perspecta or its delegate expects to render the appeal decision. The period of time within which a benefit determination on review is required to be made shall begin at the time an appeal is received by the Board of Directors of Perspecta or its delegate, without regard to whether all the information necessary to make a benefit determination on review accompanies the filing of the appeal. If the period of time for reviewing the appeal is extended as permitted above, due to a claimant’s failure to submit information necessary to decide the claim on appeal, then the period for making the benefit determination on review shall be tolled from the date on which the notification of the extension is sent to the claimant until the date on which the claimant responds to the request for additional information.
(v) In conducting the review on appeal, the Board of Directors of Perspecta or its delegate shall take into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. If the Board of Directors of Perspecta or its delegate upholds the denial, the written notice of decision from the Board of Directors of Perspecta or its delegate shall set forth, in a manner calculated to be understood by the Claimant:
(A) the specific reason or reasons for the denial;
(B) specific reference to pertinent Plan provisions on which the denial is based;
(C) a statement that the Claimant is entitled to be receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claim for benefits; and
(D) a statement of the Claimant’s right to bring a civil action under section XXXXX 502(a).
(vi) If the Plan or any of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review its representatives fail to follow any of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days periodabove claims procedures, the Claimant will shall be barred deemed to have duly exhausted the administrative remedies available under the plan and estopped from challenging shall be entitled to pursue any available remedies under ERISA Section 502(a), including but not limited to the determination. Within sixty filing of an action for immediate declaratory relief regarding benefits due under the Plan.
(60vii) days after If the Company’s receipt Board of Directors of Perspecta or its delegate upholds the denial on review of a request for reviewseverance pay claim, it will or if a health or welfare benefit claim is denied on review under the initial determination. After considering all materials presented by applicable health or welfare plan and/or the Claimantadministrative remedies thereunder have been exhausted, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify then the Claimant and will render shall have the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date right to bring a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiescivil action under ERISA Section 502(a).
Appears in 2 contracts
Claims Procedure. To initiate In the event that benefits under this Agreement are not paid to the Executive (or his beneficiary in the case of the Executive’s death), and such person feels entitled to receive them under the terms of this Agreement, a claim with respect shall be made in writing to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee Bank within sixty (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (9060) days of receipt of after written notice from the claim whether Bank to the claim is denied. If special circumstances require more than ninety Executive or his beneficiary or personal representative that payments are not being made or are not to be made under this Agreement, or, within sixty (9060) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate after the date a final decision is expected such benefit should have been paid under this Agreement according to such claimant. Such claim shall be madereviewed by the Bank. If the claim is denied approved or denied, in whole full or in part, the Claimant will be provided Bank shall provide a written opinion, in language calculated to be understood by the Claimant, notice of approval or denial within sixty (60) days setting forth (i) the specific reason(s) reason for denial, specific reference to the provisions of this Agreement upon which the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was is based, (iii) a description of and any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why if any. Also, such material or information is necessary, (iv) an explanation written notice shall indicate the steps to be taken if a review of the denial is desired. If a claim appeal procedure set forth is denied (a claim shall be deemed denied if the Bank does not take action within the aforesaid sixty (60) day period) and a review is desired, the Executive (or beneficiary or personal representative in Section 13(c), below; and (v) a statement the case of the ClaimantExecutive’s right death) shall notify the Bank in writing within twenty (20) business days from the earlier of the date of the denial or the end of such sixty (60) day period. In requesting a review, the Executive or his beneficiary or personal representative may review this Agreement or any document relating to bring it and submit any written issues and comments he or she may feel appropriate. In its sole discretion the Bank shall then review the claim and provide a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within written decision within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of denial. This decision likewise shall state the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing specific reasons for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt and shall include reference to specific provisions of this Agreement on which the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madebased. Any decision of the Bank shall not be binding on appeal will be finalthe Executive, conclusive and binding upon all partieshis personal representative, or any beneficiary without consent, nor shall it preclude further action by the Executive, his personal representative or beneficiary.
Appears in 2 contracts
Samples: Supplemental Compensation Agreement (Campello Bancorp, Inc.), Supplemental Compensation Agreement (Campello Bancorp, Inc.)
Claims Procedure. To initiate a claim (i) Except with respect to the settlement of Restricted Stock Units deferred Third Party Claims covered by Section 15(e), any Buyer Indemnified Party or Seller Indemnified Party who wishes to make a claim for indemnification for a Loss pursuant to this Section 15 (an “Indemnified Party”) shall give written notice, as promptly as practicable, to each Person from whom indemnification is being claimed (an “Indemnifying Party”) in accordance with Section 5(b22. Any failure in providing such notice in accordance with this Section 15(d), Grantee (or however, shall not release the person Indemnifying Party from any of its obligations under this Section 15 except to whom ownership rights may have passed the extent that the Indemnifying Party is materially prejudiced by will or such failure; provided, however, that failure to assert a claim prior to the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt expiration of the claim whether survival period for an applicable representation or warranty shall serve to bar the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth as specified in Section 13(c15(a)(iv), below; and (v) a statement . Promptly after written notice of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been deniedprovided as set forth above, the Indemnified Party shall supply the Indemnifying Party with all material information and documents the Indemnified Party has in whole or its possession regarding such claim, together with all material information in part, a Claimant (or its possession regarding the Claimant’s duly authorized representative) may file with the Company a written request for a review amount of the denial Loss that the Indemnified Party asserts it has sustained or incurred, and shall provide reasonable access to the Indemnifying Party to inspect such other records and books in the possession of the claimIndemnified Party and relating to the claim and asserted Loss as the Indemnifying Party shall reasonably request. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request Indemnifying Party shall have a review period of the initial determination within such sixty fifteen (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (12015) days after receipt by the Indemnifying Party of such notice and such evidence to either (i) agree to the payment of the request Loss to the Indemnified Party or (ii) contest the payment of the Loss. If the Indemnifying Party does not agree to or contests the payment of the Loss within such fifteen (15) day period, then the Indemnifying Party shall be deemed not to have accepted the Loss and the Parties shall negotiate in good faith to seek a resolution of such dispute for reviewa thirty (30) day period and, if not resolved through negotiations during such period, then the parties shall be free to seek judicial remedies. The notice will explain what special circumstances make an extension necessary and indicate If the date a final decision is expected Indemnifying Party agrees to the payment of the Loss within such fifteen (15) day period (or during such thirty (30) day dispute resolution period), then the Indemnifying Party shall, within five (5) Business Days after such agreement, pay, or cause to be made. Any decision on appeal paid, to the Indemnified Party the amount of the Loss that is payable pursuant to, and subject to the limitations set forth in, this Section 15.
(ii) If a Buyer Indemnified Party is entitled to indemnification from a Seller Party for any Loss as provided above, satisfaction of such indemnification obligations of the Seller Parties will be finaleffected (A) first, conclusive by reducing the principal amount of the Note, and binding upon all parties(B) second if the principal balance of the Note (as and if previously adjusted) has been paid or if the principal balance of the Note is reduced to zero, by wire transfer in immediately available funds to an account specified by Buyer in writing for such purpose.
(iii) If a Seller Indemnified Party is entitled to indemnification from Buyer for any Loss as provided above, satisfaction of such indemnification obligations of such Buyer will be effected by wire transfer of immediately available funds to an account or accounts designated in writing by the Seller Indemnified Party in writing for such purpose.
Appears in 2 contracts
Samples: Unit Purchase Agreement, Unit Purchase Agreement (Lionbridge Technologies Inc /De/)
Claims Procedure. To initiate A person or Beneficiary (a “claimant”) who has not received benefits under the Agreement that he or she believes should be paid shall make a claim with respect to the settlement of Restricted Stock Units deferred for such benefits as follows, and strictly in accordance with Section 5(bsection 409A of the Code:
(a) Initiation—Written Claim. In the event that benefits under this Agreement are not paid to the Executive (or his or her Beneficiary in the case of the Executive’s death), Grantee and such person feels entitled to receive them, a claim shall be made in writing to the Plan Administrator within sixty (60) days from the date payments are not made. Such claim shall be reviewed by the Plan Administrator. If the claim is denied, in full or in part, the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file Plan Administrator shall provide a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant notice within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) reasons for the denial of specific reference to the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of and any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why if any. Also, such material or information is necessary, (iv) an explanation written notice shall indicate the steps to be taken if a review of the denial is desired. If a claim appeal procedure set forth is denied and a review is desired, the Executive (or his or her Beneficiary in Section 13(cthe case of the Executive’s death), below; and (v) a statement of shall notify the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within Plan Administrator in writing within sixty (60) days after receiving a notice from the Company that and a claim has been deniedshall be deemed denied if the Plan Administrator does not take any action within the aforesaid ninety (90)-day period. In requesting a review, in whole the Executive or in part, a Claimant (his or her beneficiary may review this Agreement or any documents relating to it and submit any written issue and comments he or she may feel appropriate. In its sole discretion the Claimant’s duly authorized representative) may file with Plan Administrator shall then review the Company claim and provide a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination decision within such sixty (60) days perioddays. This decision likewise shall state the specific provisions of the Agreement on which the decision is based.
(b) For purposes of implementing this claims procedure, the Claimant will Plan Administrator shall be barred responsible for the management, control, and estopped from challenging administration of the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionAgreement as established herein. The manner Employer may delegate to certain aspects of management and content operation responsibilities of the final decision will include Agreement including the same information described above employment of advisors and the delegation of ministerial duties to qualified individuals. All claim determinations under this Section 6.1 shall be made in Section 13(b) accordance with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt section 409A of the request for review. The notice will explain what special circumstances make an extension necessary Code and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesRegulations thereunder.
Appears in 2 contracts
Samples: Supplemental Executive Retirement Plan Agreement, Supplemental Executive Retirement Plan Agreement
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred (a) Benefits shall be payable in accordance with Section 5(b)the plan provisions. Should the designated beneficiary fail to receive benefits to which such beneficiary believes he or she is entitled, Grantee a claim may be filed. Any claim for a plan benefit hereunder shall be filed by the beneficiary (claimant) of this plan by written communication which is made by the claimant or the person claimant’s authorized representative which is reasonably calculated to whom ownership rights may have passed by will bring the claim to the attention of the Named Fiduciary.
(b) If a claim for a plan benefit is wholly or the laws of descent and distribution) (the “Claimant”) must file partially denied, a written request with notice of the Company. Upon receipt decision shall be furnished to the claimant by the Named Fiduciary or his designee within a reasonable period of such claim, the Company will advise the Claimant within ninety (90) days of time after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimantplan, setting forth which notice shall include the following information:
(i) the The specific reason(s) reason or reasons for the denial of the claim, or any part of it, denial;
(ii) specific reference(s) Specific reference to the pertinent plan provisions of the Plan or this award upon which such the denial was is based, ;
(iii) a A description of any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and
(iv) an An explanation of the plan’s claim appeal procedure set forth in Section 13(c), below; and review procedures.
(vc) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company In order that a claim has been denied, in whole or in partclaimant may appeal a denial of a claim, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant claimant or his duly authorized representative may, but need not, representative:
(i) May request a review by written application to the Named Fiduciary or his designee not later than 60 days after receipt by the claimant of written notification of denial of a claim;
(ii) May review pertinent documents and documents; and
(iii) May submit issues and comments in writing for consideration by the Company. If the Claimant does not request a writing.
(d) A decision on review of the initial determination within such sixty (60) days period, the Claimant will a denied claim shall be barred and estopped from challenging the determination. Within sixty (60) made not later than 60 days after the CompanyNamed Fiduciary’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If unless special circumstances require that the sixty (60) day an extension of time for processing, in which case a decision shall be rendered within a reasonable period be extended, the Company will so notify the Claimant and will render the decision as soon as possibleof time, but no not later than one hundred twenty (120) 120 days after receipt of the a request for review, The decision on review shall be in writing and shall include the specific reason(s) for the decision and the specific reference(s) to the pertinent plan provisions on which the decision is based.
(e) Notwithstanding anything contained in this paragraph to the contrary, any claim for a death benefit under an insurance policy under this plan shall be filed with the Insurer by the claimant or his authorized representative on the form or forms prescribed for such purpose by the Insurer. The notice will explain what special circumstances make an extension necessary and indicate Insurer shall have sole authority for determining whether a death claim shall or shall not be paid, either in whole or in part, in accordance with the date a final decision is expected to be made. Any decision terms of such annuity or insurance contract which may have been purchased on appeal will be final, conclusive and binding upon all partiesthe life of the Employee.
Appears in 2 contracts
Samples: Split Dollar Life Insurance Agreement (First Horizon National Corp), Split Dollar Life Insurance Agreement (First Horizon National Corp)
Claims Procedure. To initiate a Any controversy or claim arising out of or relating to this Agreement shall be filed with respect the Fiduciary which shall make all determinations concerning such claim. Any decision by the Fiduciary denying such claim shall be in writing and shall be delivered to the settlement of Restricted Stock Units deferred all parties in interest in accordance with Section 5(b)the notice provisions of Article 5.3 hereof. Such decision shall set forth the reasons for denial in plain language. Pertinent provisions of the Agreement shall be cited and, Grantee (or where appropriate, an explanation as to how the person to whom ownership rights may have passed by Employee can perfect the claim will or the laws be provided. This notice of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt denial of such claim, the Company benefits will advise the Claimant be provided within ninety (90) days of the Fiduciary’s receipt of the Employee’s claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madebenefits. If the claim is denied in whole or in partFiduciary fails to notify the Employee of his decision regarding his claim, the Claimant will claim shall be considered denied, and the Employee shall then be permitted to proceed with his appeal as provided in this Article. An Employee who has been completely or partially denied a benefit shall be entitled to appeal this denial of his claim by filing a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of his position with the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within Fiduciary no later than sixty (60) days after receiving a notice from receipt of the Company that a written notification of such claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request denial. The Fiduciary shall schedule an opportunity for a full and fair review of the denial issue within thirty (30) days of receipt of the claimappeal. The Claimant or his duly authorized representative maydecision on review shall set forth specific reasons for the decision, but need not, review and shall cite specific references to the pertinent documents and submit issues and comments in writing for consideration Agreement provisions on which the decision is based. Following his review of any additional information submitted by the Company. If Employee, either through the Claimant does not request hearing process or otherwise, the Fiduciary shall render a decision on his review of the initial determination denied claim in the following manner:
(a) the Fiduciary shall make his decision regarding the merits of the denied claim within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after following his receipt of the request for review. The notice will explain what review (or within 120 days after such receipt, in a case where there are special circumstances make requiring extension of time for reviewing the appealed claim). He shall deliver the decision to the claimant in writing. If an extension necessary of time for reviewing the appealed claim is required because of special circumstances, written notice of the extension shall be furnished to the Employee prior to the commencement of the extension. If the decision on review is not furnished within the prescribed time, the claim shall be deemed denied on review; and
(b) the decision on review shall set forth specific reasons for the decision, and indicate shall cite specific references to the date a final pertinent Agreement provisions on which the decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 2 contracts
Samples: Collateral Assignment Split Dollar Insurance Agreement, Collateral Assignment Split Dollar Insurance Agreement (Dana Corp)
Claims Procedure. To initiate a claim with respect (a) Any person entitled to benefits under the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) Agreement (the “"Claimant”") must file a written claim request with the Company. Upon receipt person authorized by the Board to fulfill the responsibilities of such claimthe Corporation as Plan Administrator, on a form provided by the Company Plan Administrator.
(b) A claim for benefits will advise be denied if the Corporation determines that the Claimant within ninety (90) days of receipt of is not entitled to receive benefits under the claim whether the claim is deniedAgreement. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified The Plan Administrator shall provide adequate notice in writing within ninety (90) days of filing to any Claimant whose claim for benefits under the claims than Agreement has been denied, and the Company requires up notice to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth claimant shall set forth:
(i) the The specific reason(s) reason for the denial of the claim, or any part of it, ;
(ii) specific reference(s) Specific references to pertinent provisions of the Plan or this award upon Agreement on which such the denial was is based, ;
(iii) a A description of any additional material or and information necessary needed for the Claimant to perfect the claim, his claim and an explanation of why such the material or information is necessary, needed; and
(iv) an explanation A statement that the claimant may; - Request a review of his claim upon written application to the Corporation, which is the Named Fiduciary under the Agreement; - Review pertinent documents affecting his claim; and - Submit issues and comments in writing.
(c) Any appeal the Claimant wishes to make of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within must be made by the Claimant in writing to the Plan Administrator within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review receipt of the written notice of denial of the claim. The failure of the Claimant or his duly authorized representative may, but need not, review to appeal the pertinent documents and submit issues and comments denial to the Plan Administrator in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the Plan Administrator's determination final, binding, and conclusive.
(d) If the Claimant should appeal to the Plan Administrator, he, or his duly authorized representative, may submit, in writing, whatever issues and comments he, or his duly authorized representative, feels are pertinent. The Plan Administrator shall re-examine all facts related to the appeal and make a final determination as to whether the denial of benefits is justified under the circumstances. The Plan Administrator shall advise the Claimant of its decision within sixty (60) days of the Claimant's written request for review, unless special circumstances (such as soon as possiblea hearing) would make a rendering of a decision within the sixty- (60) day period infeasible, but in no event shall the Plan Administrator render a decision with respect to a denial for a claim for benefits later than one hundred twenty (120) days after receipt of the a request for review. The notice will explain what special circumstances make an extension necessary A written statement stating the decision on review, the specific reasons for the decision, and indicate the date a final specific provisions of the Agreement on which the decision is expected based shall be mailed or delivered to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthe claimant within such sixty- (60) (or one hundred twenty- (120)) day period.
Appears in 2 contracts
Samples: Deferred Compensation Agreement (BGF Industries Inc), Deferred Compensation Agreement (BGF Industries Inc)
Claims Procedure. To initiate a Any controversy or claim arising out of or relating to this Agreement shall be filed with respect the Fiduciary which shall make all determinations concerning such claim. Any decision by the Fiduciary denying such claim shall be in writing and shall be delivered to the settlement of Restricted Stock Units deferred all parties in interest in accordance with the notice provisions of Section 5(b)5.3 hereof. Such decision shall set forth the reasons for denial in plain language. Pertinent provisions of the Agreement shall be cited and, Grantee (or where appropriate, an explanation as to how the person to whom ownership rights may have passed by Employee can perfect the claim will or be provided. This notice of denial of benefits will be provided within 90 days of the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon Fiduciary's receipt of such the Employee's claim for benefits. If the Fiduciary fails to notify the Employee of his decision regarding his claim, the Company will advise claim shall be considered denied, and the Claimant Employee shall then be permitted to proceed with his appeal as provided in this Section. An Employee who has been completely or partially denied a benefit shall be entitled to appeal this denial of his claim by filing a written statement of his position with the Fiduciary no later than sixty (60) days after receipt of the written notification of such claim denial. The Fiduciary shall schedule an opportunity for a full and fair review of the issue within ninety thirty (9030) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to replyappeal. The notice will explain what special circumstances make an extension necessary decision on review shall set forth specific reasons for the decision, and indicate shall cite specific references to the date a final pertinent Agreement provisions on which the decision is expected to be madebased. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description Following his review of any additional material information submitted by the Employee, either through the hearing process or information necessary for otherwise, the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) Fiduciary shall render a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a decision on his review of the denial denied claim in the following manner:
(a) The Fiduciary shall make his decision regarding the merits of the claim. The Claimant or denied claim within 60 days following his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what review (or within 120 days after such receipt, in a case where there are special circumstances make requiring extension of time for reviewing the appealed claim). He shall deliver the decision to the claimant in writing. If an extension necessary of time for reviewing the appealed claim is required because of special circumstances, written notice of the extension shall be furnished to the Employee prior to the commencement of the extension. If the decision on review is not furnished within the prescribed time, the claim shall be deemed denied on review.
(b) The decision on review shall set forth specific reasons for the decision, and indicate shall cite specific references to the date a final pertinent Agreement provisions on which the decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 2 contracts
Samples: Collateral Assignment Split Dollar Insurance Agreement (Dana Corp), Split Dollar Assignment Insurance Agreement (Niagara Mohawk Power Corp /Ny/)
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (a) Participant or the person to whom ownership rights may have passed by will or the laws of descent and distribution) his designated Beneficiary (the “Claimantclaimant”) must file shall have the right to request any benefit under the Plan by filing a written request claim for any such benefit with the CompanyAdministrator on a form provided by the Administrator for such purpose. Upon The Administrator shall give such claim due consideration and shall either approve or deny it in whole or in part. Within ninety (90) days following receipt of such claimclaim by the Administrator, notice of any denial thereof, in whole or in part, shall he delivered to, and a receipt therefor shall be obtained from, the Company will advise claimant or his duly authorized representative or such notice of denial shall be sent by registered mail to the Claimant claimant, or his duly authorized representative, at the address shown on the claim form or such individual’s last known address. The ninety (90) day response period may he extended to one hundred eighty (180) days after receipt of the claimant’s claim if special circumstances exist and if written notice of the extension to one hundred eighty (180) days indicating the special circumstances involved and the date by which a decision is expected to he made is furnished to the claimant within ninety (90) days of after receipt of the claim whether the claim is deniedclaimant’s claim. If special circumstances require more than ninety (90) days for processing, the Claimant will Such notice of denial shall be notified written in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language manner calculated to be understood by the Claimant, setting forth claimant and shall:
(i) the Set forth a specific reason(s) reason or reasons for the denial of the claim, or any part of it, denial,
(ii) Make specific reference(s) reference to the pertinent provisions of the Plan or this award upon on which such any denial was of benefits is based, ,
(iii) a description of Describe any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of explain why such material or information is necessary, and
(iv) an explanation Explain the claim review procedure of subparagraph 6.5(b). If such notice of denial is not provided to the claimant within the applicable ninety (90) day or one hundred eighty (180) day period, the claimant’s claim shall be considered denied for purposes of the claim appeal review procedure set forth in Section 13(cof subparagraph 6.5(b), below; and .
(vb) a statement of the Claimant’s right A Participant or Beneficiary whose claim filed pursuant to bring a civil action under section 502(asubparagraph 6.5
(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant may, within sixty (60) days following receipt of notice of such denial, or following the Claimant’s duly authorized representativeexpiration of the applicable period provided for in subparagraph 6.5(a) may file with for notifying the Company a claimant of the decision on the claim if no notice of denial is provided, make written request application to the Board for a review of such claim, which application shall be filed with the denial Board. For purposes of such review, the claim. The Claimant claimant or his duly authorized representative may, but need not, may review Plan documents pertinent to such claim and may submit to the pertinent documents and submit Board written issues and comments in writing for consideration by the Companyrespecting such claim. If the Claimant does not request The Board may schedule and hold a hearing. The Board shall make a full and fair review of the initial determination within such sixty (60) days periodany denial of a claim for benefits and issue its decision thereon promptly, the Claimant will be barred and estopped from challenging the determination. Within but in no event later than sixty (60) days after receipt by the Company’s receipt Board of a the claimant request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after such receipt if a hearing is to be held or if other special circumstances exist and if written notice of the extension to one hundred twenty (120) days is furnished to the claimant within sixty (60) days after the receipt of the claimant’s request for a review, Such decision shall be in writing, delivered to the claimant and shall:
(i) Include specific reasons for the decision,
(ii) Be written in a manner calculated to be understood by the claimant, and
(iii) Contain specific references to the pertinent Plan provisions on which the decision is based. The notice will explain what special circumstances make an extension necessary and indicate the date a final Board’s decision is expected to be made. Any decision on appeal will made in good faith shall be final, conclusive and binding upon all parties.
Appears in 2 contracts
Samples: Supplemental Executive Retirement Agreement (Mainstreet Bankshares Inc), Supplemental Executive Retirement Agreement (Mainstreet Bankshares Inc)
Claims Procedure. To initiate (a) The administrator for purposes of this Agreement shall be ProAssurance (“Administrator”), whose address is 000 Xxxxxxxxx Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000; Telephone: (000) 000-0000. The “Named Fiduciary” as defined in Section 402(a) (2) or ERISA, also shall be ProAssurance. ProAssurance shall have the right to designate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. ProAssurance shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim with respect for benefits by the Executive (“the claimant”) shall be stated in writing by the Administrator and delivered or mailed to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee claimant within ten (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (9010) days of after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 10-day period. In no event shall such extension exceed a period of ten (ii10) days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the claim appeal procedure set forth in Section 13(c), below; and (v) a statement best of the ClaimantAdministrator’s right to bring ability in a civil action under section 502(amanner that may be understood without legal or actuarial counsel.
(c) of ERISA following an adverse determination upon appeal. Within sixty A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (6010) days after receiving a notice from following the Company that a claim has been deniedreceipt of such denial, in whole or in parta writing addressed to the Administrator, a Claimant (review of such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant’s duly authorized representative) claimant shall consider relevant to a determination of the claim, and the claimant may file with the Company include a written request for a hearing in person before the Administrator. Prior to submitting the request, the claimant shall be entitled to review of such documents as the denial of Administrator shall agree are pertinent to the claim. The Claimant or his duly authorized representative claimant may, but need notat all stages of review, review the pertinent documents and submit issues and comments in writing for consideration be represented by the Company. If the Claimant does not request a review counsel, legal or otherwise, of the initial determination within such sixty (60) days period, the Claimant will claimant’s choice. All requests for review shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionpromptly resolved. The manner and content of the final Administrator’s decision will include the same information described above in Section 13(b) with respect to any such review shall be set forth in writing and shall be mailed to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no claimant not later than one hundred ten (10) days following receipt by the Administrator of the claimant’s request unless special circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case the Administrator’s decision shall be so mailed not later than twenty (12020) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiessuch request.
Appears in 2 contracts
Samples: Release and Severance Compensation Agreement (Proassurance Corp), Employment Agreement (Proassurance Corp)
Claims Procedure. To initiate Any person claiming a claim with respect benefit under the Agreement (a "Claimant") shall present the claim, in writing, to the settlement of Restricted Stock Units deferred Bank, and the Bank shall respond in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madewriting. If the claim is denied in whole or in partdenied, the Claimant will be provided a written opinionnotice of denial shall state, in language a manner calculated to be understood by the Claimant, setting forth :
(i) The specific reason or reasons for denial, with specific references to the specific reason(s) for Agreement provisions on which the denial of the claim, or any part of it, is based;
(ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a A description of any additional material or information necessary for the Claimant to perfect the claimhis, her or its claim and an explanation of why such material or information is necessary, ; and
(iviii) an An explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of Agreement's claims review procedure. The written notice denying or granting the Claimant’s right 's claim shall be provided to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty the Claimant within ninety (6090) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial Bank's receipt of the claim, unless special circumstances require an extension of time for processing the claim. The If such an extension is required, written notice of the extension shall be furnished by the Bank to the Claimant within the initial ninety (90) day period. Any extension notice shall indicate the special circumstances requiring the extension and the date on which the Bank expects to render a decision on the claim. Any claim not granted or his duly denied within the period noted above shall be deemed to have been denied. Any Claimant whose claim is denied, or deemed to be denied under the preceding sentence, or such Claimant's authorized representative representative, may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s Claimant's receipt of notice of the denial, or after the date of the deemed denial, request a review of the denial by notice given, in writing, to the Bank. Upon such a request for review, it will review the initial determination. After considering all materials presented claim shall be reviewed by the Claimant, without regard to whether such materials were submitted Bank (or considered in its designated representative). In connection with the initial review, the Company will render a written opinionClaimant may have representation, may examine pertinent documents, and may submit issues and comments in writing. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the on review normally shall be made within sixty (60) day time period be extended, days of the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after Bank's receipt of the request for review. The notice will explain what special circumstances make If an extension necessary of time is required due to special circumstances, the Claimant shall be notified, in writing, by the Bank, and indicate the date time limit for the decision on review shall be extended to one hundred twenty (120) days. The decision on review shall be in writing and shall state, in a final manner calculated to be understood by the Claimant, the specific reasons for the decision and shall include references to the relevant Agreement provisions on which the decision is expected to be madebased. Any The written decision on appeal will review shall be finalgiven to the Claimant within the sixty (60) day (or, conclusive if applicable, the one hundred twenty (120) day) time limit discussed above. If the decision on review is not communicated to the Claimant within the sixty (60) day (or, if applicable, the one hundred twenty (120) day) period described above, the claim shall be deemed to have been denied upon review. All decisions on review shall be final and binding upon with respect to all concerned parties.
Appears in 2 contracts
Samples: Endorsement Split Dollar Insurance Agreement (Florida Business Bancgroup Inc), Endorsement Split Dollar Insurance Agreement (Florida Business Bancgroup Inc)
Claims Procedure. To initiate Any person claiming a claim with respect to benefit under the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee Agreement (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the a “Claimant”) must file a written request with shall present the Company. Upon receipt of such claim, in writing, to the Company will advise Bank, and the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified Bank shall respond in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madewriting. If the claim is denied in whole or in partdenied, the Claimant will be provided a written opinionnotice of denial shall state, in language a manner calculated to be understood by the Claimant, setting forth :
(i) The specific reason or reasons for denial, with specific references to the specific reason(s) for Agreement provisions on which the denial of the claim, or any part of it, is based;
(ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a A description of any additional material or information necessary for the Claimant to perfect the claimhis, her or its claim and an explanation of why such material or information is necessary, ; and
(iviii) an An explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of Agreement’s claims review procedure. The written notice denying or granting the Claimant’s right claim shall be provided to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty the Claimant within ninety (6090) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the ClaimantBank’s duly authorized representative) may file with the Company a written request for a review of the denial receipt of the claim, unless special circumstances require an extension of time for processing the claim. The If such an extension is required, written notice of the extension shall be furnished by the Bank to the Claimant within the initial ninety (90) day period. Any extension notice shall indicate the special circumstances requiring the extension and the date on which the Bank expects to render a decision on the claim. Any claim not granted or his duly denied within the period noted above shall be deemed to have been denied. Any Claimant whose claim is denied, or deemed to be denied under the preceding sentence, or such Claimant’s authorized representative representative, may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the CompanyClaimant’s receipt of notice of the denial, or after the date of the deemed denial, request a review of the denial by notice given, in writing, to the Bank. Upon such a request for review, it will review the initial determination. After considering all materials presented claim shall be reviewed by the Claimant, without regard to whether such materials were submitted Bank (or considered in its designated representative). In connection with the initial review, the Company will render a written opinionClaimant may have representation, may examine pertinent documents, and may submit issues and comments in writing. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the on review normally shall be made within sixty (60) day time period be extended, days of the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after Bank’s receipt of the request for review. The notice will explain what special circumstances make If an extension necessary of time is required due to special circumstances, the Claimant shall be notified, in writing, by the Bank, and indicate the date time limit for the decision on review shall be extended to one hundred twenty (120) days. The decision on review shall be in writing and shall state, in a final manner calculated to be understood by the Claimant, the specific reasons for the decision and shall include references to the relevant Agreement provisions on which the decision is expected to be madebased. Any The written decision on appeal will review shall be finalgiven to the Claimant within the sixty (60) day (or, conclusive if applicable, the one hundred twenty (120) day) time limit discussed above. If the decision on review is not communicated to the Claimant with the sixty (60) day (or, if applicable, the one hundred twenty (120) day) period discussed above, the claim shall be deemed to have been denied upon review. All decisions on review shall be final and binding upon with respect to all concerned parties.
Appears in 1 contract
Samples: Endorsement Split Dollar Insurance Agreement (Alliance Bancorp Inc of Pennsylvania)
Claims Procedure. To initiate a claim with respect to (a) The administrator for purposes of this Agreement shall be the settlement of Restricted Stock Units deferred in accordance with Section 5(bCompany ("Administrator"), Grantee whose address is 555 Briarwood Circle, P.O. Box 1588, Ann Arbor, Michigan 48108, and xxxxx xxxxxxxxx xxxxer xx (or the person to whom ownership rights may have passed by will or the laws of descent and distribution000) (the “Claimant”000-0000. Xxx "Xxxxx Xxxxxxxxx" as defined in Section 402(a)(2) must file a written request with xx XXXXX, xxso shall be the Company. Upon receipt of such claimThe Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the Company will advise the Claimant within ninety (90) days of receipt address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim whether for benefits by the claim is denied. If special circumstances require more than ninety Executive (90"the claimant") days for processing, the Claimant will shall be notified stated in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) Administrator and delivered or mailed to the specific reason(s) for the denial claimant within 10 days after receipt of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, (ii) written notice of the extension shall be furnished to the claimant prior to THE termination of the initial 10-day period. In no event shall such extension exceed a period of 10 days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the claim appeal procedure set forth in Section 13(c), below; and (v) a statement best of the Claimant’s right to bring Administrator's ability in a civil action under section 502(amanner that may be understood without legal or actuarial counsel.
(c) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a A claimant whose claim for benefits has been deniedwholly or partially denied by the Administrator may request, within 10 days following the date of such denial, in whole or in parta writing addressed to the Administrator, a Claimant (review of such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant’s duly authorized representative) claimant shall consider relevant to a determination of the claim, and the claimant may file with the Company include a written request for a hearing in person before the Administrator. Prior to submitting the request, the claimant shall be entitled to review of such documents as the denial of Administrator shall agree are pertinent to the claim. The Claimant or his duly authorized representative claimant may, but need notat all stages of review, review the pertinent documents and submit issues and comments in writing for consideration be represented by the Company. If the Claimant does not request a review counsel, legal or otherwise, of the initial determination within such sixty (60) days period, the Claimant will claimant's choice. All requests for review shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionpromptly resolved. The manner and content of the final Administrator's decision will include the same information described above in Section 13(b) with respect to any such review shall be set forth in writing and shall be mailed to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no claimant not later than one hundred twenty (120) 10 days following receipt by the Administrator of the claimant's request unless special circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case the Administrator's decision shall be so mailed not later than 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this Section, but who has not obtained full relief on the claim for benefits, may, within 60 days following the claimant's receipt of the Administrator's written decision on review, apply in writing to the Administrator for binding arbitration of the claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Ann Arbor, Michigan, in accordance with the arbitration rules of the American Arbitration Association, as then in effect. If the parties are unable to mutually agree upon an arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of which shall be designated by the Company, one of which shall be designated by the claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the arbitration rules referenced above. The notice will explain what special circumstances make an extension necessary arbitrator(s) sole authority shall be to interpret and indicate apply the date a final decision is expected provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of the Agreement's provisions. The arbitrator(s) shall have the power to be madecompel attendance of witnesses at the hearing. Any decision on appeal will court having jurisdiction may enter a judgment based upon such arbitration. All decisions of the arbitrator(s) shall be final, conclusive final and binding upon all partieson the claimant and the Company without appeal to any court. Upon execution of this Agreement, the Executive shall be deemed to have waived any right to commence litigation proceedings outside of arbitration without the express written consent of the Company.
Appears in 1 contract
Samples: Change in Control Severance Agreement (Comshare Inc)
Claims Procedure. To initiate Claim forms or claim information as to the subject policy can be obtained by contacting: Kaeding, Ernst & Company, 21 McGrath Highway, Suite 503, Quincy Centxx, XX 00000.
(a) Claims Xxxxx xxx Xxxxxx--When the Named Fiduciary has a claim with respect to which may be covered under the settlement of Restricted Stock Units deferred provisions described in accordance with Section 5(b)the Policy, Grantee (he or she should contact the office or the person named above who will either complete a claim form and forward it to whom ownership rights may have passed by will an authorized representative of the Insurer or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant Named Fiduciary what further requirements are necessary. The Insurer will evaluate the claim and make a decision as to payment within ninety (90) 90 days of receipt of the claim whether date the claim is denied. If special circumstances require more than ninety (90) days for processing, received by the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madeInsurer. If the claim is denied in whole payable, a benefit check will be issued to the Named Fiduciary or in partother party or parties entitled to payment under the Policy and forwarded through the office or person named above. In the event that a claim is not payable under the Policy, the Claimant Insurer will notify the Named Fiduciary of the denial. Such notification will be provided made in writing within 90 days of the date the claim is received and will be transmitted through the office or person named above. The notification will include the specific reasons for the denial as well as specific reference to the policy provisions upon which the denial is based. The Named Fiduciary will also be informed as to the steps which may be taken to have the claim denial reviewed. A decision as to the validity of a written opinionclaim will ordinarily be made within 10 working days of the date the claim is received by the Insurer. Occasionally, however, certain questions may prevent the Insurer from rendering a decision on the validity of the claim within the specific 90-day period. If this occurs, the Named Fiduciary will be notified of the reasons for the delay as well as the anticipated length of the delay, in language calculated writing and through the office or person named above. If further information or other material is required, the Named Fiduciary will be so informed. If the Named Fiduciary is dissatisfied with the denial of the claim or the amount paid, he or she has 60 days from the date he or she receives notice of a claim denial to be understood file his or her objections to the action taken by the ClaimantInsurer. If the Named Fiduciary wishes to contest a claim denial, setting forth he or she should notify the person or office named above who will assist in making inquiry to the insurer. All objections to the Insurer's actions should be in writing and submitted to the person or office named above for transmittal to the Insurer. The Insurer will review the claim denial and render a decision on such objections. The Named Fiduciary will be informed in writing of the decision of the Insurer within 60 days of the date the claim request is received by the Insurer.
(ib) Claims Under the Plan--Claims for any benefits due under the plan or the surrender of the Policy may be made in writing by the Corporation or the Corporation's designated beneficiary and Employee or his designated beneficiary, as the case may be, to the Named Fiduciary. In the event a claim for benefits is wholly or party denied or disputed, the Named Fiduciary shall, within a reasonable period of time after receipt of the claim, notify the Corporation or the designated beneficiary and Employee or his designated beneficiary, as the case may be, of such total or partial denial or dispute listing:
(a) The specific reason(s) reason or reasons for the denial of the claim, or any part of it, dispute;
(iib) specific reference(s) Specific reference to pertinent plan provisions of the Plan or this award upon which such the denial was or dispute is based, ;
(iiic) a A description of any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and,
(ivd) an An explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appealplan's review procedure. Within sixty (60) 60 days after receiving a of denial or notice from of claim under the Company that a claim has been denied, in whole or in partplan, a Claimant (or claimant may request that the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration claim be reviewed by the CompanyNamed Fiduciary in a full and fair hearing. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will A final decision shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented rendered by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) Named Fiduciary within 60 days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 1 contract
Claims Procedure. To initiate a claim with respect (a) If the Purchaser or the Company becomes aware of any Tax Claim it will as soon as reasonably practicable and in any event within 5 Business Days of becoming aware of the Tax Claim give notice to the settlement Seller, provided that the giving of Restricted Stock Units deferred such notice will not be a condition precedent to the liability of the Seller under paragraph 2 (Covenant) or for breach of any of the Tax Warranties.
(b) Subject to paragraph 6(c) and provided that the Seller indemnifies the Company, the Purchaser and all other members of the Purchaser’s Group against all losses, costs, damages and expenses (including interest or surcharge on overdue Taxation) which may be reasonably and properly incurred thereby, the Purchaser will procure that the Company takes such action and gives such information and assistance in accordance connection with Section 5(bits Taxation affairs as the Seller may reasonably and promptly request to dispute, appeal against, settle or compromise any Tax Claim, including applying to postpone (so far as legally possible) the payment of any Taxation.
(c) Subject to paragraphs 6(d) and 6(e), Grantee (or and to compliance by the person Seller with paragraph 6(b) in relation to whom ownership rights may have passed by any Dispute, the Purchaser will or the laws of descent not, and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, will procure that the Company will advise not, without the Claimant within ninety (90) days of receipt prior written consent of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processingSeller, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected such consent not to be made. If the claim is denied in whole unreasonably withheld or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth delayed:
(i) the specific reason(stransmit any material communication (whether written or otherwise) for the denial of the claim, or to any part of it, Taxation Authority;
(ii) specific reference(s) to pertinent provisions of settle or compromise the Plan or this award upon which such denial was based, relevant Tax Claim; or
(iii) a description of agree any additional material or information necessary for matter which is likely to affect the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation amount of the claim appeal procedure set forth in Section 13(c), below; and relevant Tax Claim.
(vd) a statement of the Claimant’s right The Purchaser will not be required to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company take or procure that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opiniontake any action mentioned in paragraph 6(b), and nor will the provisions of paragraph 6(c). The manner and content apply in relation to any action, which:
(i) It reasonably considers is unlawful or materially prejudicial to the business or Taxation affairs of the final decision Company, the Purchaser or any other member of the Purchaser’s Group; or
(ii) involves contesting a Tax Claim beyond the first appellate body (excluding the Taxation Authority which has made the Tax Claim) in the jurisdiction concerned unless the Seller obtains (at the Seller’s cost and expense) the opinion of independent tax counsel of at least five years’ call that it is reasonable in all circumstances to make such an appeal.
(e) If the Seller fails promptly (and in any event within 10 Business Days of the Purchaser giving notice requiring the Seller to do so) to duly pay under the indemnity described in paragraph 6(b) or to inform the Purchaser of any action which the Seller requests the Purchaser to procure the Company to take under that paragraph, or no action is required to be taken by virtue of any of the provisions of paragraph 6(d), the Purchaser will include be entitled to procure that the same information Company settles or compromises any Tax Claim on such terms as it determines in its absolute discretion. For the avoidance of doubt, the indemnity described above in Section 13(bparagraph 6(b) with respect shall not apply to the initial determination. If special circumstances require extent that the sixty Purchaser does not take (60) day time period be extended, or does not procure that the Company will so notify takes) any action referred to in paragraph 6(b), 6(c) or 6(d), including where the Claimant and will render Purchaser or the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesCompany invokes this paragraph 6(e).
Appears in 1 contract
Claims Procedure. To initiate (a) The Committee shall prescribe a claim with respect form for the presentation of claims under the terms of this Agreement.
(b) Upon presentation to the settlement Committee of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or claim on the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claimprescribed form, the Company will advise Committee shall make the Claimant determination of the validity thereof. If the determination is adverse to the claimant, the Committee shall furnish to the claimant within ninety (90) 90 days of after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, notice setting forth the following:
(i) the The specific reason(s) reason or reasons for the denial of the claim, or any part of it, denial;
(ii) specific reference(s) Specific references to pertinent provisions of the Plan or this award upon Agreement on which such the denial was is based, ;
(iii) a A description of any additional material materials or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and
(iv) an explanation of Appropriate information as to the steps to be taken if the claimant wishes to submit his or her claim appeal procedure set forth in Section 13(c)for review and the time limits applicable to such procedures, below; and (v) a statement of including the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty ERISA.
(60c) days after receiving In the event of a notice from denial of a claim, the Company that a claim has been denied, in whole claimant or in part, a Claimant (his or the Claimant’s her duly authorized representative) representative may file with appeal such denial to the Company Committee for a written full and fair review of the adverse determination. The claimant’s request for a review must be in writing and made to the Committee within 60 days after receipt by the claimant of the denial of written notification required under paragraph (b) above; provided, however, such 60-day period shall be extended if the claimcircumstances so warrant. The Claimant claimant or his or her duly authorized representative may, but need not, review the pertinent documents and may submit issues and comments in writing for which will be given full consideration by the CompanyCommittee in its review.
(d) The Committee may, in its sole discretion, conduct a hearing. If A request for a hearing made by the Claimant does not request a review of the initial determination within claimant will be given full consideration. At such sixty (60) days periodhearing, the Claimant will claimant shall be barred entitled to appear and estopped from challenging the determination. Within sixty present evidence and to be represented by counsel.
(60e) days after the Company’s receipt of The Committee shall make a decision on a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no not later than one hundred twenty (120) 60 days after receipt of the request request; provided, however, in the event of a hearing or other special circumstances, such decision shall be made not later than 120 days after receipt of such request. If it is necessary to extend the period of time for review. making a decision beyond 60 days after the receipt of the request, the claimant shall be notified in writing of the extension of time prior to the beginning of such extension.
(f) The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any Committee’s decision on appeal will review shall state in writing the specific reasons and references to the provisions of the Agreement upon which it is based, that the claimant is entitled to receive, upon request and free of charge, and have reasonable access to and copies of all documents, records and other information relevant to the claim for benefits and that the claimant may bring an action under section 502(a) of ERISA. Such decision shall be finalpromptly provided to the claimant. If the decision on review is not furnished in accordance with the foregoing, conclusive and binding upon all partiesthe claim shall be deemed denied on review.
Appears in 1 contract
Samples: Supplemental Executive Retirement Plan Agreement (Tasty Baking Co)
Claims Procedure. To initiate a claim with respect (a) No later than ten (10) Business Days following the expiration of any applicable Survival Period, Acquiror may deliver to the settlement Shareholder a written notice (a “Claim Notice”) (i) stating that an Indemnified Party has paid, incurred, suffered, sustained, reserved or accrued, or in good faith believes that it may pay, incur, suffer, sustain, reserve or accrue, Losses, (ii) stating the amount of Restricted Stock Units deferred such Losses (which, in the case of Losses not yet paid, incurred, suffered, sustained, reserved or accrued, may be the maximum amount believed by Acquiror in good faith to be incurred, paid, reserved, accrued or demanded by a third party), and (iii) specifying in reasonable detail the individual items of such Losses included in the amount so stated and the nature of the claim to which such Losses are related, in the case of clauses (ii) and (iii) to the extent known by such Indemnified Party at the time of the Claim Notice. No delay in providing such Claim Notice within the applicable Survival Period shall affect an Indemnified Party’s rights hereunder, unless and only to the extent the Shareholder is actually and materially prejudiced thereby. Any Claim Notice may be updated and amended from time to time by Acquiror delivering an updated or amended Claim Notice, so long as the delivery of the original Claim Notice was made within the applicable Survival Period.
(b) If the Shareholder does not within the twenty (20)-day period after receipt of a Claim Notice deliver a written notice of objection to Acquiror and Escrow Agent containing a reasonably detailed description of the facts and circumstances supporting an objection to the Claim Notice (a “Claim Objection Notice”), such failure to so object shall be an irrevocable acknowledgment by the Shareholder that the Indemnified Party is entitled to the full amount of the claim for Losses set forth in such Claim Notice. In such event, Acquiror and the Shareholder shall deliver a joint release instruction to the Escrow Agent to, and the Escrow Agent shall, promptly release to the applicable Indemnified Party from the Indemnity Escrow Fund an amount of cash equal to the Losses set forth in such Claim Notice.
(c) If the Shareholder shall deliver to Acquiror and Escrow Agent a Claim Objection Notice in accordance with Section 5(b), Grantee 8.5(b) within such twenty (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt 20)-day period after delivery of such claimClaim Notice, the Company will advise the Claimant within ninety (90) days Shareholder and Acquiror shall attempt in good faith for a period of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from Acquiror’s receipt of such Claim Objection Notice to agree upon the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review rights of the denial respective parties with respect to each of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Companysuch claims. If the Claimant does not request Shareholder and Acquiror should so agree, a review memorandum setting forth such agreement shall be prepared and signed by both parties and, in the case of a claim to be recovered from the initial determination within Indemnity Escrow Fund, Acquiror and the Shareholder shall deliver a joint release instruction to the Escrow Agent directing the release of such claim amount.
(d) If no such agreement can be reached during the sixty (60)-day period for good faith negotiation, but in any event upon the expiration of such sixty (60) days 60)-day period, either the Claimant will Shareholder or Acquiror may bring a Proceeding in accordance with the terms of Section 9.11 to resolve the matter. The judgment in such Proceeding as to the validity and amount of any claim in such Claim Notice shall be barred non-appealable, binding and estopped conclusive upon the parties to this Agreement, and the Escrow Agent shall be entitled to act in accordance with such decision. The non-prevailing party in such Proceeding shall pay its own fees and expenses and the fees and expenses of the prevailing party, including attorneys’ fees and costs, reasonably incurred in connection with such Proceeding.
(e) The Escrow Agent shall be entitled to rely on any such instruction or Order referenced in this Section 8.5 and make distributions from challenging the determinationIndemnity Escrow Fund in accordance with the terms thereof. Within sixty (60) days after In such event, the Company’s receipt Escrow Agent shall promptly release from the Indemnity Escrow Fund an amount of a request for reviewcash equal to the Losses set forth in such instruction or Order referenced in this Section 8.5. Should the amount held in the Indemnity Escrow Fund, it will review if any, be insufficient to satisfy in whole the initial determination. After considering all materials presented amount to be paid to an Indemnified Party by the ClaimantShareholder in accordance with such instruction or Order, without regard to whether then the Shareholder shall, within ten (10) Business Days following the date of such materials were submitted instruction or considered Order referenced in the initial reviewthis Section 8.5, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect pay to the initial determination. If special circumstances require that the sixty (60) day time period be extendedIndemnified Party, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiessuch shortfall.
Appears in 1 contract
Samples: Share Purchase Agreement (Ceva Inc)
Claims Procedure. To initiate (a) The administrator for purposes of this Agreement shall be ProAssurance ("Administrator"), whose address is 000 Xxxxxxxxx Xxxxx, Xxxxxxxxxx,· Xxxxxxx 00000; Telephone: (000) 000-0000. The "Named Fiduciary" as defined in Section 402(a) (2) or ERISA, also shall be ProAssurance. ProAssurance shall have the right to designate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. ProAssurance shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim with respect for benefits by the Executive (lithe claimant") shall be stated in writing by the Administrator and delivered or mailed to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee claimant within ten (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90l0) days of after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 10-day period. In no event shall such extension exceed a period of ten (ii10) days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the claim appeal procedure set forth in Section 13(c), below; and (v) a statement best of the Claimant’s right to bring Administrator's ability in a civil action under section 502(amanner that may be understood without legal or actuarial counsel.
(c) of ERISA following an adverse determination upon appeal. Within sixty A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (6010) days after receiving a notice from following the Company that a claim has been deniedreceipt of such denial, in whole or in parta writing addressed to the Administrator, a Claimant (review of such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant’s duly authorized representative) claimant shall consider relevant to a determination of the claim, and the claimant may file with the Company include a written request for a hearing in person before the Administrator. Prior to submitting the request, the claimant shall be entitled to review of such documents as the denial of Administrator shall agree are pertinent to the claim. The Claimant or his duly authorized representative claimant may, but need notat all stages of review, review the pertinent documents and submit issues and comments in writing for consideration be represented by the Company. If the Claimant does not request a review counsel, legal or otherwise, of the initial determination within such sixty (60) days period, the Claimant will claimant's choice. All requests for review shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionpromptly resolved. The manner and content of the final Administrator's decision will include the same information described above in Section 13(b) with respect to any such review shall be set forth in writing and shall be mailed to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no claimant not later than one hundred ten (10) days following receipt by the Administrator of the claimant's request unless special circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case the Administrator's decision shall be so mailed not later than twenty (12020) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiessuch request.
Appears in 1 contract
Samples: Retention and Severance Compensation Agreement (Proassurance Corp)
Claims Procedure. To initiate Claim forms or claim information as to the subject Policy can be obtained by contacting: Xxxxxx & Xxxxxxx Financial Services, Inc. ---------------------------------------------------------------------- . -------- (Agent or Agency) When the Named Fiduciary has a claim with respect to which may be covered under the settlement of Restricted Stock Units deferred provisions described in accordance with Section 5(b)an insurance Policy, Grantee (he or she should contact the office or the person named above who will either complete a claim form and forward it to whom ownership rights may have passed by will an authorized representative of the Insurer or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant Named Fiduciary what further requirements are necessary. The Insurer will evaluate the claim and make a decision as to payment within ninety (90) 90 days of receipt of the claim whether date the claim is denied. If special circumstances require more than ninety (90) days for processing, received by the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madeInsurer. If the claim is denied in whole payable, a benefit check will be issued to the Named Fiduciary and forwarded through the office or in partperson named above. In the event that a claim is not eligible under a Policy, the Claimant Insurer will notify the Named Fiduciary of the denial. Such notification will be provided made in writing within 90 days of the date the claim is received and will be transmitted through the office or person named above. The notification will include the specific reasons for the denial as well as specific reference to the policy provisions upon which the denial is based. The Named Fiduciary will also be informed as to the steps which may be taken to have the claim denial reviewed. A decision as to the validity of a written opinionclaim will ordinarily be made within 10 working days of the date the claim is received by the Insurer. Occasionally, however, certain questions may prevent the Insurer from rendering a decision on the validity of the claim within the specific 90-day period. If this occurs, the Named Fiduciary will be notified of the reasons for the delay as well as the anticipated length of the delay, in language calculated to writing and through the office or person named above. If further information or other material is required, the Named Fiduciary will be understood by so informed. If the Claimant, setting forth (i) the specific reason(s) for Named Fiduciary is dissatisfied with the denial of the claimclaim or the amount paid, he or she has 60 days from the date he or she receives notice of a claim denial to file his or her objections to the action taken by the Insurer. If the `Named Fiduciary wishes to contest a claim denial, he or she should notify the person or office named above who will assist in making inquiry to the Insurer. All objections to the Insurer's actions should be in writing and submitted to the person or office named above for transmittal to the Insurer. The Insurer will review the claim denial and render a decision on such objections. The Named Fiduciary will be informed in writing of the decision of the Insurer within 60 days of the date the claim request is received by the Insurer. This decision will be final. Once a decision has been rendered as to the distribution of Policy proceeds under the claim procedure described above, claims for any part of it, (ii) specific reference(s) to pertinent provisions of benefits due under the Plan or this award the surrender of a Policy may be made in writing by the Bank or the Bank's designated representative and Employee or his designated beneficiary, as the case may be, to the Named Fiduciary. In the event a claim for benefits is wholly or partly denied or disputed, the Named Fiduciary shall, within a reasonable period of time after receipt of the claim, notify the Bank or the Bank's designated representative and Insured or his designated beneficiary, as the case may be, of such total or partial denial or dispute listing:
A. The specific reason or reasons for the denial or dispute;
B. Specific reference to pertinent plan provisions upon which such the denial was or dispute is based, (iii) a ;
C. A description of any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of why such material or information is necessary, (iv) an ; and,
D. An explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appealPlan's review procedure. Within sixty (60) 60 days after receiving a of denial or notice from of claim under the Company that a claim has been denied, in whole or in partPlan, a Claimant (or claimant may request that the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration claim be reviewed by the CompanyNamed Fiduciary in a full and fair hearing. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will A final decision shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented rendered by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) Named Fiduciary within 60 days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 1 contract
Claims Procedure. To initiate Claim forms or claim information as to the subject policy can be obtained by contacting: Kaeding, Ernst & Company, 21 McGrath Highway, Suite 503, Quincy Centxx, XX 00000.
(a) Claims Xxxxx xxx Xxxxxx--When the Named Fiduciary has a claim with respect to which may be covered under the settlement of Restricted Stock Units deferred provisions described in accordance with Section 5(b)the Policy, Grantee (he or she should contact the office or the person named above who will either complete a claim form and forward it to whom ownership rights may have passed by will an authorized representative of the Insurer or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant Named Fiduciary what further requirements are necessary. The Insurer will evaluate the claim and make a decision as to payment within ninety (90) 90 days of receipt of the claim whether date the claim is denied. If special circumstances require more than ninety (90) days for processing, received by the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madeInsurer. If the claim is denied in whole payable, a benefit check will be issued to the Named Fiduciary or in partother party or parties entitled to payment under the Policy and forwarded through the office or person named above. In the event that a claim is not eligible under the Policy, the Claimant Insurer will notify the Named Fiduciary of the denial. Such notification will be provided made in writing within 90 days of the date the claim is received and will be transmitted through the office or person named above. The notification will include the specific reasons for the denial as well as specific reference to the policy provisions upon which the denial is based. The Named Fiduciary will also be informed as to the steps which may be taken to have the claim denial reviewed. A decision as to the validity of a written opinionclaim will ordinarily be made within 10 working days of the date the claim is received by the Insurer. Occasionally, however, certain questions may prevent the Insurer from rendering a decision on the validity of the claim within the specific 90-day period. If this occurs, the Named Fiduciary will be notified of the reasons for the delay as well as the anticipated length of the delay, in language calculated writing and through the office or person named above. If further information or other material is required, the Named Fiduciary will be so informed. If the Named Fiduciary is dissatisfied with the denial of the claim or the amount paid, he or she has 60 days from the date he or she receives notice of a claim denial to be understood file his or her objections to the action taken by the ClaimantInsurer. If the Named Fiduciary wishes to contest a claim denial, setting forth he or she should notify the person or office named above who will assist in making inquiry to the insurer. All objections to the Insurer's actions should be in writing and submitted to the person or office named above for transmittal to the Insurer. The Insurer will review the claim denial and render a decision on such objections. The Named Fiduciary will be informed in writing of the decision of the Insurer within 60 days of the date the claim request is received by the Insurer.
(ib) Claims Under the Plan--Claims for any benefits due under the plan or the surrender of the Policy may be made in writing by the Corporation or the Corporation's designated beneficiary and Employee or his designated beneficiary, as the case may be, to the Named Fiduciary. In the event a claim for benefits is wholly or party denied or disputed, the Named Fiduciary shall, within a reasonable period of time after receipt of the claim, notify the Corporation or the designated beneficiary and Employee or his designated beneficiary, as the case may be, of such total or partial denial or dispute listing:
(a) The specific reason(s) reason or reasons for the denial of the claim, or any part of it, dispute;
(iib) specific reference(s) Specific reference to pertinent plan provisions of the Plan or this award upon which such the denial was or dispute is based, ;
(iiic) a A description of any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and,
(ivd) an An explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appealplan's review procedure. Within sixty (60) 60 days after receiving a of denial or notice from of claim under the Company that a claim has been denied, in whole or in partplan, a Claimant (or claimant may request that the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration claim be reviewed by the CompanyNamed Fiduciary in a full and fair hearing. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will A final decision shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented rendered by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) Named Fiduciary within 60 days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 1 contract
Claims Procedure. To initiate (a) A Participant or the Participant’s spouse or Beneficiary shall have the right to submit a claim with respect for benefits in writing or by another method permitted by applicable rules or regulations to the settlement Claims Reviewer. The claim must specify the basis of Restricted Stock Units deferred in accordance with Section 5(b), Grantee it and the amount of the benefit claimed.
(b) The Claims Reviewer shall act to deny or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant accept said claim within ninety (90) days of the receipt of the claim whether by notifying the claim is denied. If Participant or the spouse or the Beneficiary of the Claims Reviewer’s action, unless special circumstances require more than the extension of such ninety (90) day period. If such extension is necessary, the Claims Reviewer shall provide the Participant or the spouse or Beneficiary with notification in writing or by another method permitted by applicable rules or regulations of such extension before the expiration of the initial ninety (90) day period. Such notice shall specify the reason or reasons for such extension and the date by which a final decision can be expected. In no event shall such extension exceed a period of ninety (90) days for processing, from the Claimant will be notified in writing within end of the initial ninety (90) days of filing day period.
(c) In the claims than event the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If Claims Reviewer denies the claim is denied of a Participant or the spouse or Beneficiary in whole or in part, the Claimant will be provided a written opinionClaims Reviewer’s notification in writing or by another method permitted by applicable rules or regulations shall specify, in language a manner calculated to be understood by the Claimant, setting forth claimant:
(i1) the The reason or reasons for denial;
(2) The specific reason(s) for the denial of the claim, section or any part of it, (ii) specific reference(s) to pertinent provisions sections of the Plan or this award upon which such the denial was is based, ;
(iii3) a A description of any additional material or information information, if any, necessary for the Claimant claimant to perfect the his or her claim, and an explanation of as to why such information or material or information is necessary;
(4) A statement that the claimant will be provided, on request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant’s claim for benefits;
(iv5) an An explanation of the claim appeal review procedure set forth specified in Section 13(c), belowthe Plan; and and
(v6) a A statement of the Claimantclaimant’s right to bring a civil action under section pursuant to Section 502(a) of ERISA following an adverse determination upon appeal. Within sixty a continued denial of the claimant’s claim after appeal review.
(60d) days after receiving a notice from Should the Company that a claim has been denied, be denied in whole or in partpart and should the claimant be dissatisfied with the Claims Reviewer’s disposition of the claimant’s claim, the claimant may have a Claimant (full and fair review of the claim by the Administrator upon request therefore in writing or by another method permitted by applicable rules or regulations submitted by the claimant or the Claimantclaimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration received by the Company. If the Claimant does not request a review of the initial determination Administrator within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Companyclaimant receives notification in writing or by another method permitted by applicable rules or regulations that the claimant’s claim has been denied.
(e) In connection with such review in Subsection (d), the claimant or the claimant’s duly authorized representative shall be entitled to review pertinent documents and submit the claimant’s views as to the issues in writing or by another method permitted by applicable rules or regulations. The Administrator shall act to deny or accept the claim within sixty (60) days after receipt of a the claimant’s request in writing or by another method permitted by applicable rules or regulations for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If unless special circumstances require that the extension of such sixty (60) day time period be extendedperiod. If such extension is necessary, the Company will so notify Administrator shall provide the Claimant and will render claimant with notification in writing or by another method permitted by applicable rules or regulations of such extension before the decision as soon as possibleexpiration of such initial sixty (60) day period.
(f) In all events, but no later than the Administrator shall act to deny or accept the claim within one hundred twenty (120) days after of the receipt of the claimant’s request for reviewreview in writing or by another method permitted by applicable rules or regulations. The action of Administrator shall be in the form of a notice will explain what special circumstances make an extension necessary in writing or by another method permitted by applicable rules or regulations to the claimant and indicate its contents shall include all of the date requirements for action on the original claim.
(g) In no event may a final decision is expected to be made. Any decision on appeal will be final, conclusive claimant commence legal action for benefits the claimant believes are due the claimant until the claimant has exhausted all of the remedies and binding upon all partiesprocedures afforded the claimant by this section.
Appears in 1 contract
Samples: Investment, Savings and Employee Stock Ownership Plan (Toro Co)
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) If any communication or notice is received by a Purchaser Indemnified Perso n from a Tax Authority (“Tax Notice”) in respect of a Tax Claim arising out of Clause 6.2(a) and the specific reason(s) for the denial of the claimPurchaser Indemnified Person intends to make an indemnity claim pursuant to this Clause 6.2, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claimit shall promptly, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but any event no later than one hundred twenty the earlier of (120A) days 3 (Three) Business Days after receipt of the request for reviewTax Notice, and (B) if the Tax Notice is received sufficiently in advance, 3 (Three) Business Days prior to the deadline given by the Tax Authority to submit the response, provide a copy of the Tax Notice (along with relevant information and documents) to the Seller (a “Tax Notice Intimation”). Any failure to deliver the Tax Notice Intimation within the period mentioned in the preceding sentence shall not relieve the Seller of its indemnification obligations under this Agreement unless (and only to the extent that) the Seller’s ability to contest the claim is materially prejudiced by such delay or failure to notify.
(ii) The notice Seller shall promptly and in any event no later than 5 (five) Business Days after receipt of the Tax Notice Intimation or the Due Date if the Tax Notice is received sufficiently in advance, whichever is earlier, inform the Purchaser in writing, whether it will explain what special circumstances make an extension necessary payment of all amounts claimed under the Tax Notice including tax, interest, penalties, and indicate all additional Tax Losses incurred after the date of the Tax Notice (“Tax Claim Amounts”) or contest the Tax Notice before the relevant Tax Authority.
(iii) Subject to 6.2(b)(i) and 6.3, the Seller, shall, at least 3 (three) Business Days prior to expiry of the time period for payment of the Tax Claim Amount (such prior date, the “Due Date”), pay the entire Tax Claim Amounts: (A) directly to the Tax Authorities on its own account and simultaneously with such payment, provide the Purchaser Indemnified Persons evidence of such payment provided such payment by the Seller unequivocally discharges the Purchaser Indemnified Persons for the liability towards such Tax Claim Amount; or (B) if permitted by the Applicable Law, directly to the relevant Tax Authority (on behalf of the Purchaser Indemnified Persons) in the manner as stipulated in the Tax Notice and simultaneously with such payment, provide the Purchaser Indemnified Persons evidence of such payment; or (C) to the Purchaser Indemnified Persons, if the Seller is not permitted by Applicable Law to make payment of the Tax Claim Amounts to the Tax Authorities directly on behalf of the Purchaser Indemnified Persons; provided the Purchaser Indemnified Perso n shall forthwith make the payment to the relevant Tax Authority and shall notify the Seller in writing, as soon as practicable, and in any case no later than 5 (five) Business Days from the date of the payment along with evidence of such payment. Further, in such a final decision case, any Losses arising on account of any delay by the Purchaser Indemnified Persons to make such payment to the Tax Authority within the prescribed Due Date shall be to the account of the Purchaser Indemnified Persons. It is expected clarified that the Seller shall be entitled to exercise all legal remedies available including to seek a stay, injunction or deferral of the payment (“Tax Injunctive Order”) of any amounts that are claimed to be made. Any decision on appeal will paid by the Purchaser Indemnified Parties to the Tax Authority, if permitted by Applicable Law, and for as long as the Tax Injunctive Order suspends the obligation to make such payments, the Seller shall not be final, conclusive and binding upon all partiesobligated to make payment to the Purchaser Indemnified Parties or the Tax Authority.
Appears in 1 contract
Samples: Share Purchase Agreement
Claims Procedure. To initiate If Employee believes that he has been incorrectly denied a claim with respect benefit or are entitled to a greater benefit than the benefit Employee received under the Plan, Employee may submit a signed, written application to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) Employer’s Chief Financial Officer (the “Claimant”) must file a written request with "Claims Representative"). Employee will be notified in writing of the Company. Upon receipt approval or denial of such claim, the Company will advise the Claimant this claim within ninety (90) days of receipt of the claim whether date that the claim is denied. If Claims Representative receives the claim, unless special circumstances require more than an extension of time for processing the claim. In the event an extension is necessary, Employee will be provided written notice prior to the end of the initial ninety (90) day period indicating the special circumstances requiring the extension and the date by which the Claims Representative expects to notify Employee of approval or denial of the claim. In no event will an extension extend beyond ninety (90) days for processing, after the Claimant will be notified in writing within end of the initial ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madeday period. If the Employee's claim is denied in whole or in partdenied, the Claimant written notification will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the state specific reason(s) reasons for the denial of the claimdenial, or any part of it, (ii) make specific reference(s) reference to pertinent provisions of the Plan or this award upon provision(s) on which such the denial was is based, (iii) and provide a description of any additional material or information necessary for the Claimant Employee to perfect the claim, claim and an explanation of why such material or information is necessary, (iv) an explanation . The written notification will also provide a description of the claim appeal procedure set forth in Section 13(c)Plan's review procedures and the applicable time limits, below; and (v) including a statement of the Claimant’s Employee's right to bring a civil action suit under section 502(a) of ERISA following an adverse determination upon appealdenial of Employee's claim on review. Within Employee will have sixty (60) days after receiving from receipt of the written notification of the denial of Employee's claim to file a notice from the Company that a claim has been deniedsigned, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a full and fair review of the denial by a review panel which will be a named fiduciary of the Plan for purposes of such review. This request should include the reasons Employee is requesting a review and may include facts supporting Employee's request and any other relevant comments, documents, records and other information relating to Employee's claim. The Claimant Upon request and free of charge, Employee will be provided with reasonable access to, and copies of, all documents, records and other information relevant to Employee's claim, including any document, record or his duly authorized representative mayother information that was relied upon in, but need notor submitted, review considered or generated in the pertinent documents and submit issues and comments in writing course of, denying Employee's claim. A final, written determination of Employee's eligibility for consideration by the Company. If the Claimant does not request a review of the initial determination benefits shall be made within such sixty (60) days periodof receipt of Employee's request for review, unless special circumstances require an extension of time for processing the Claimant claim, in which case Employee will be barred provided written notice of the reasons for the delay within the initial sixty (60) day period and estopped from challenging the determinationdate by which Employee should expect notification of approval or denial of Employee's claim. Within This review will take into account all comments, documents, records and other information submitted by Employee relating to Employee's claim, whether or not submitted or considered in the initial review of Employee's claim. In no event will an extension extend beyond sixty (60) days after the Company’s receipt end of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extendedperiod. If an extension is required because Employee fails to submit information that is necessary to decide Employee's claim, the Company period for making the benefit determination on review will so notify be tolled from the Claimant and will render date the decision as soon as possible, but no later than one hundred twenty (120) days after receipt notice of extension is sent to Employee until the date on which Employee responds to the request for additional information. If Employee's claim is denied on review, the written notification will state specific reasons for the denial, make specific reference to the Plan provision(s) on which the denial is based and state that Employee is entitled to receive upon request, and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to Employee's claim, including any document, record or other information that was relied upon in, or submitted, considered or generated in the course of, denying Employee's claim. The written notification will also include a statement of Employee's right to bring an action under section 502(a) of ERISA. If Employee's claim is initially denied or is denied upon review, Employee is entitled to receive upon request, and free of charge, reasonable access to, and copies of, any document, record or other information that demonstrates that (1) Employee's claim was denied in accordance with the terms of the Plan, and (2) the provisions of the Plan have been consistently applied to similarly situated Plan participants, if any. In pursuing any of Employee's rights set forth in this section, Employee's authorized representative may act on Employee's behalf. If Employee does not receive notice will explain what special circumstances make an extension necessary and indicate within the date a final decision is expected to be made. Any decision time periods described above, whether on appeal initial determination or review, Employee will be final, conclusive deemed to have exhausted the Plan's administrative appeals provisions and binding upon all partiesEmployee may initiate a lawsuit under Section 502(a) of ERISA.
Appears in 1 contract
Samples: Employment Agreement (National Technical Systems Inc /Ca/)
Claims Procedure. To initiate a Any controversy or claim arising out of ---------------- or relating to this Agreement shall be filed with respect the Fiduciary which shall make all determinations concerning such claim. Any decision by the Fiduciary denying such claim shall be in writing and shall be delivered to the settlement of Restricted Stock Units deferred all parties in interest in accordance with the notice provisions of Section 5(b)5.3 hereof. Such decision shall set forth, Grantee (or in plain language, the person reasons for denial. Pertinent provisions of the Agreement shall be cited and, where appropriate, an explanation as to whom ownership rights may have passed by how the Employee can perfect the claim will or be provided. This notice of denial of benefits will be provided within 90 days of the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon Fiduciary's receipt of such the Employee's claim for benefits. If the Fiduciary fails to notify the Employee of his decision regarding his claim, the Company will advise claim shall be considered denied, and the Claimant Employee shall then be permitted to proceed with his appeal as provided in this Section. If Employee has been completely or partially denied a benefit, the Employee shall be entitled to appeal this denial of his claim by filing a written statement of his position with the Fiduciary no later than sixty (60) days after receipt of the written notification of such claim denial. The Fiduciary shall schedule an opportunity for a full and fair review of the issue within ninety thirty (9030) days of receipt of the claim whether appeal. The decision on review shall set forth specific reasons for the claim decision, and shall cite specific references to the pertinent Agreement provisions on which the decision is deniedbased. If special circumstances require more than ninety (90) days for processingFollowing the Fiduciary's review of any additional information submitted by the Employee, either through the hearing process or otherwise, the Claimant will be notified Fiduciary shall render a decision on his review of the appealed claim in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth following manner:
(i) The Fiduciary shall make its decision regarding the specific reason(s) for the denial merits of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the appealed claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA within 60 days following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for reviewreview (or within 120 days after such receipt in a case where there are special circumstances requiring extension of time for reviewing the appealed claim). The notice will explain what special circumstances make Fiduciary shall deliver the decision to the claimant in writing. If an extension necessary of time for reviewing the appealed claim is required because of special circumstances, written notice of the extension shall be furnished to the Employee prior to the commencement of the extension. If the decision on review is not furnished within the prescribed time, the claim shall be deemed denied on review.
(ii) The decision on review shall set forth specific reasons for the decision, and indicate shall cite specific references to the date a final pertinent Agreement provisions on which the decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 1 contract
Claims Procedure. (a) To initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. .
(b) If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. .
(c) Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. .
(d) Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 1 contract
Samples: Restricted Stock Unit Award Agreement (Interdigital Communications Corp)
Claims Procedure. To initiate a claim with respect (a) Any person entitled to benefits under the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) Agreement (the “"Claimant”") must file a written claim request with the Company. Upon receipt person authorized by the Board to fulfill the responsibilities of such claimthe Corporation as Plan Administrator, on a form provided by the Company Plan Administrator.
(b) A claim for benefits will advise be denied if the Corporation determines that the Claimant within ninety (90) days of receipt of is not entitled to receive benefits under the Agreement. The Plan Administrator shall provide adequate notice in writing to any Claimant whose claim whether for benefits under the claim is Agreement has been denied. If special circumstances require more than ninety (90) days for processing, and the notice to the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth shall set forth:
(i) the The specific reason(s) reason for the denial of the claim, or any part of it, ;
(ii) specific reference(s) Specific references to pertinent provisions of the Plan or this award upon Agreement on which such the denial was is based, ;
(iii) a A description of any additional material or and information necessary needed for the Claimant to perfect the claim, his claim and an explanation of why such the material or information is necessary, needed; and
(iv) an explanation A statement that the Claimant may; - Request a review of his claim upon written application to the Corporation, which is the Named Fiduciary under the Agreement; - Review pertinent documents affecting his claim; and - Submit issues and comments in writing.
(c) Any appeal the Claimant wishes to make of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within must be made by the Claimant in writing to the Plan Administrator within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review receipt of the written notice of denial of the claim. The failure of the Claimant or his duly authorized representative may, but need not, review to appeal the pertinent documents and submit issues and comments denial to the Plan Administrator in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the Plan Administrator's determination final, binding, and conclusive.
(d) If the Claimant should appeal to the Plan Administrator, he, or his duly authorized representative, may submit, in writing, whatever issues and comments he, or his duly authorized representative, feels are pertinent. The Plan Administrator shall re-examine all facts related to the appeal and make a final determination as to whether the denial of benefits is Justified under the circumstances. The Plan Administrator shall advise the Claimant of its decision within sixty (60) days of the Claimant's written request for review, unless special circumstances (such as soon as possiblea hearing) would make a rendering of a decision within the sixty (60) day period infeasible, but in no event shall the Plan Administrator render a decision with respect to a denial for a claim for benefits later than one hundred twenty (120) days after receipt of the a request for review. The notice will explain what special circumstances make an extension necessary A written statement stating the decision on review, the specific reasons for the decision, and indicate the date a final specific provisions of the Agreement on which the decision is expected based shall be mailed or delivered to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthe Claimant within such sixty (60) (or one hundred twenty (120)) day period.
Appears in 1 contract
Samples: Deferred Compensation Agreement (BGF Industries Inc)
Claims Procedure. To initiate (a) A Participant or Beneficiary shall make claim for a claim benefit by filing a signed written request identifying the benefit requested with respect the Administrator. The Administrator and the Plan Administrator have the sole power in their discretion to determine the settlement rights and eligibility of Restricted Stock Units deferred in accordance with Section 5(b)employees, Grantee (Participants and their beneficiaries to their respective benefits under the Plan. Benefits under the Plan will be paid only if the Administrator or the person Plan Administrator decides in its discretion that the applicant is entitled to whom ownership rights may have passed by will or the laws of descent and distributionthem.
(b) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim Administrator determines that the individual who has claimed a right to receive benefits under the Plan is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated not entitled to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, receive all or any part of itthe benefits claimed, the Administrator shall inform the claimant in writing of its determination and the reasons therefor in xxxxxx’x terms. The notice of denial shall include the following information:
(ii1) the specific reference(sreason or reasons for the adverse determination;
(2) reference to pertinent the specific Plan provisions of on which the Plan or this award upon which such denial was benefit determination is based, ;
(iii3) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and
(iv4) an explanation a description of the claim appeal Plan’s review procedure set forth in Section 13(c)and the time limits applicable to such procedures, below; and (v) including a statement of the Claimantclaimant’s right to bring a civil action under section 502(a) of ERISA following an adverse benefit determination on review. If the notice of denial is for a Disability Claim (as defined below), the notice shall also include any internal rule, guideline, protocol, or other similar criterion which was relied upon appeal. Within sixty in making the adverse determination, or a statement that such a rule, guideline, protocol, or other similar criterion was relied upon in making the adverse determination and that a copy of such rule, guideline, protocol, or other criterion will be provided free of charge to the claimant upon request.
(60c) The notice denying a claim shall be issued within a reasonable period of time but not later than 90 days after receiving receipt of the claim (45 days for a Disability Claim) unless special circumstances require an extension of the time for processing. If such an extension of time is required, the Administrator shall furnish written notice of the extension to the claimant prior to the termination of the initial 90 day period. The extension notice shall indicate the special circumstances requiring an extension of time and the date by which the Administrator expects to render a final decision. In no event shall such extension exceed a period of 90 days from the Company end of the initial period. For a Disability Claim, instead of a 90 day extension, the Administrator may have two 30 day extensions of time. In order to obtain such an extension, the Administrator must determine that the extension is needed due to matters beyond the control of the Plan and provide notice to the claimant of the extension before the date that such claim would otherwise need to be decided. Any notice of extension with respect to a Disability Claim shall notify the claimant of: (i) the circumstances requiring the extension of time; (ii) the date by which the Plan expects to render a determination; (iii) the standards on which entitlement to a benefit is based, (iv) the unresolved issues that prevent a decision on the claim; and (v) the additional information needed to resolve those issues. The claimant shall have 45 days to provide any additional information required to perfect a Disability Claim.
(d) Within 60 days of the receipt by the claimant of the written notice of denial of the claim has been denied(180 days for a Disability Claim), in whole or in part, a Claimant (or the Claimant’s duly authorized representative) claimant may file with the Company a written request for with the Plan Administrator to conduct a full and fair review of the denial of the claimclaimant’s claim for benefits. In connection with the claimant’s appeal, the claimant may:
(1) submit to the Plan Administrator written comments, documents, records, and other information relating to the claim for benefits; and
(2) request of the Plan Administrator, and be provided, free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claimant’s claim for benefits. The Claimant or his duly authorized representative Plan Administrator shall afford to any claimant so requesting review, a full and fair review of the decision denying the claim and may, but need notin its sole discretion, hold a hearing to review the pertinent documents and submit issues and comments in writing for consideration raised by the Companyclaimant. The Plan Administrator’s review shall take into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. If the Claimant does not request claim is a Disability Claim, the following rules shall apply:
(1) The review of the decision denying the claim shall not afford deference to the initial adverse benefit determination;
(2) If an adverse benefit determination within such sixty (60) days periodis based in whole or in part on a medical judgment, the Claimant will Plan Administrator shall consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment and who was not consulted in connection with the initial adverse benefit determination nor is a subordinate of such individual; and
(3) The Plan Administrator must identify the medical or vocational experts whose advice was obtained on behalf of the Plan in connection with the claimant’s adverse benefit determination regardless of whether the advice was relied upon in making the benefit determination.
(e) The Plan Administrator shall promptly advise the claimant of its decision on the claimant’s request for review. The decision on review shall be barred and estopped from challenging the determination. Within sixty made no later than 60 days (6045 days for a Disability Claim) days after the CompanyPlan’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If unless special circumstances require a further extension of time for processing. In that the sixty (60) day time period event, a decision shall be extended, the Company will so notify the Claimant and will render the decision rendered as soon as possible, but no not later than one hundred twenty 120 days (12090 days for a Disability Claim) days after following receipt of the request for review. Written notice of any such extension shall be furnished to the claimant prior to the commencement of the extension and such notice shall indicate the special circumstances requiring an extension of time and the date by which the Plan expects to render the determination on review.
(f) The notice to the claimant of the Plan Administrator’s decision shall include the following:
(1) specific reason or reasons for the adverse benefit determination,
(2) reference to the specific Plan provisions on which the benefit determination is based;
(3) a statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant’s claim for benefits; and
(4) a statement of the claimant’s right to bring an action under section 502(a) of ERISA. If the claim is a Disability Claim, the Plan Administrator’s notice to the claimant shall also include:
(5) any internal rule, guideline, protocol, or other similar criterion which was relied upon in making the adverse determination or a statement that such rule, guideline, protocol, or other similar criterion was relied upon in making the adverse determination and that a copy of the rule, guideline, protocol, or other similar criterion will explain be provided free of charge to the claimant upon request; and
(6) the following statement: “You and your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what special circumstances may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency.”
(g) The period of time within which an initial benefit determination or a benefit determination on review is required to be made shall begin at the time a claim is filed in the case of an initial benefit determination and at the time an appeal is filed in the case of an appeal, and without regard in both cases to whether all the information necessary to make the initial benefit determination or a benefit determination on review, as the case may be, accompanies the filing. If, either in the case of an extension initial benefit determination with respect to a Disability Claim or a benefit determination on review for any claim, the period of time within which to decide the claim is extended due to a claimant’s failure to submit information necessary and indicate to decide a claim, the period for making the initial benefit determination or the benefit determination on review shall be tolled from the date a final decision the notification of the extension is expected sent to be made. Any decision the claimant until the date on appeal will be final, conclusive and binding upon all partieswhich the claimant responds to the request for additional information.
Appears in 1 contract
Samples: Retirement Plan (Ametek Inc/)
Claims Procedure. To initiate (a) (i) Claim forms or claim information as to the Policy can be obtained by contacting the Director of Human Resources of Xxxxx Bank N.A., at the address listed in paragraph 15(a) of this Agreement.
(ii) When a claimant has a claim with respect to which may be covered under the settlement of Restricted Stock Units deferred in accordance with Section 5(b)Policy, Grantee (he or she should contact the Named Fiduciary who will contact the office or the person named above, who will either complete a claim form and forward it to whom ownership rights may have passed by an authorized representative of the Insurer or advise the Named Fiduciary what further requirements are necessary. Under normal circumstances, the Insurer will or evaluate the laws of descent claim and distribution) (the “Claimant”) must file make a written request with the Company. Upon decision as to payment within 45 days after receipt of such the claim. However, if special circumstances require an extension of time to process a claim, the Company will advise the Claimant within ninety (90) a final decision may be deferred up to 90 days of after receipt of the claim whether if prior to the claim end of the initial 45-day period the Named Fiduciary is denied. If furnished written notice of the special circumstances require more than ninety (90) days for processing, requiring the Claimant will be notified in writing within ninety (90) days extension and the anticipated date of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madedecision. If the claim is denied in whole or in partwithin the applicable period of time set out above, the Claimant will be provided a Named Fiduciary shall receive written opinionnotification of the denial, in language calculated to be understood by the Claimant, setting which notice shall set forth (i) the specific reason(s) reasons for the denial of denial, the claim, or any part of it, (ii) specific reference(s) to pertinent relevant provisions of the Plan or this award upon Policy on which such the denial was is based, and the claim review procedure under the Policy.
(iii) If the claim is payable, a description benefit check will be issued to Executive's Named Beneficiary in an amount equal to the benefits payable to such person(s) pursuant to paragraph 7 above and a benefit check will be issued to Xxxxx in an amount equal to the remaining Policy Proceeds. Benefit checks will be forwarded through the Director of Human Resources of Xxxxx Bank N.A.
(iv) In the event a claim is denied or in the event no action is taken on the claim within the above-described period(s) of time, the following procedure shall be used:
(A) First, in the event that the Named Fiduciary does not timely receive the above-described written notification, the Named Fiduciary's request for benefits shall be deemed to be denied as of the last day of the relevant period.
(B) Second, the Named Fiduciary shall, in its discretion, take any additional material or information and all reasonable action as it deems necessary for the Claimant to perfect the claim.
(i) Once a decision has been rendered as to the distribution of proceeds under the claim procedure described above as to the Policy, and claims for any benefits due under this Agreement may be made in writing by Xxxxx or the Executive's Named Beneficiary, as the case may be, to the Named Fiduciary. Under normal circumstances, a final decision on a claimant's request for benefits shall be made within 45 days after receipt of the claim. However, if special circumstances require an explanation extension of why such material or information is necessarytime to process a claim, (iv) an explanation a final decision may be deferred up to 90 days after receipt of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement if prior to the end of the Claimant’s right to bring initial 45-day period the claimant is furnished written notice of the special circumstances requiring the extension and the anticipated date of a civil action under section 502(a) of ERISA following an adverse determination upon appealfinal decision. Within sixty (60) days after receiving a notice from If the Company that a claim has been is denied, in whole or in part, within the applicable period of time set out above, the claimant shall receive written notification of the denial, which notice shall set forth the specific reasons for the denial, the relevant provisions of the Agreement on which the denial is based, and the claim review procedure under the Agreement.
(ii) In the event a Claimant claim is denied or in the event no action is taken on the claim within the above-described period(s) of time, the following procedure shall be used:
(A) First, in the event that the claimant does not timely receive the above-described written notification, the claimant's request for benefits shall be deemed to be denied as of the last day of the relevant period.
(B) Second, a claimant is entitled to a full review of his or her claim after actual or constructive notification of a denial. A claimant desiring a review must make a written request to the Claimant’s duly authorized representativeNamed Fiduciary requesting such a review, which may include whatever comments or arguments the claimant wishes to submit. Incident to the review, the claimant may represent himself or herself or appoint a representative to do so, and will have the right to inspect all documents pertaining to the issue. The Named Fiduciary, in its sole discretion, may schedule any meeting(s) may file with the Company claimant and/or the claimant's representative it deems necessary or appropriate to facilitate or expedite its review of a written denied claim.
(iii) A request for a review of must be filed with the Named Fiduciary within 60 days after the denial of the claim. The Claimant claim for benefits was actually or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration constructively received by the Companyclaimant. If no request is received within the Claimant does not request a review of the initial determination within such sixty (60) days period-day time limit, the Claimant denial of benefits will be barred and estopped from challenging the determinationfinal. Within sixty (60) days after the Company’s receipt of However, if a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial reviewof a denied claim is timely filed, the Company will Named Fiduciary must render a written opinion. The manner and content its decision under normal circumstances within 45 days of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what In special circumstances make an extension necessary the decision may be delayed if prior to expiration of the initial 45-day period the claimant is notified of the extension, but must in any event be rendered no later than 90 days after the receipt of the request. If the decision on review is not furnished to the claimant within the applicable time period(s) set out above, the claim shall be deemed denied on the last day of the relevant period. All decisions of the Named Fiduciary shall be in writing and indicate shall include specific reasons for whatever action has been taken, and the date a final provisions of the Agreement on which the decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 1 contract
Samples: Split Dollar Life Insurance Agreement (Riggs National Corp)
Claims Procedure. To initiate The Committee shall notify a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified Participant in writing within ninety (90) 90 days of filing the Participant's written application for benefits of the Participant's eligibility or non-eligibility for benefits under the Plan; provided, however, benefit distribution shall not be contingent upon a Participant's application for benefits. If the Committee determines a Participant is not eligible for benefits or full benefits, the notice shall set forth: (a) the specific reasons for such denial; (b) a specific reference to the provision of the Plan on which the denial is based; (c) a description of any additional information or material necessary for the Participant to perfect the claim, and a description of why it is needed; and (d) an explanation of the Plan's claims than review procedure and other appropriate information as to the Company requires up steps to an additional ninety (90) days be taken if the Participant wishes to replyhave the claim reviewed. The notice will explain what If the Committee determines there are special circumstances requiring additional time to make an extension necessary a decision, the Committee shall notify the Participant of the special circumstances and indicate the date by which a final decision is expected to be made, and may extend the time for up to an additional 90-day period. If a Participant is determined by the Committee to be not eligible for benefits, or if a Participant believes he or she is entitled to greater or different benefits, the Participant shall have the opportunity to have the Participant's claim reviewed by the Committee by filing a petition for review with the Committee within 60 days after receipt by the Participant of the notice issued by the Committee. The petition shall state the specific reasons the Participant believes the Participant is denied in whole entitled to benefits or greater or different benefits. Within 60 days after receipt by the Committee of the petition, the Committee shall afford the Participant (and the Participant's counsel, if any) an opportunity to present the Participant's position to the Committee orally or in partwriting, and the Claimant will be provided Participant (or counsel) shall have the right to review the pertinent documents, and the Committee shall notify the Participant of its decision in writing within the 60-day period, stating specifically the basis of the decision written in a written opinion, in language manner calculated to be understood by the Claimant, setting forth (i) Participant and the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or on which the decision is based. If, because of the need for a hearing, the 60-day period is not sufficient, the decision may be deferred for up to another 60-day period at the election of the Committee, but notice of this award upon which such deferral shall be given to the Participant. If a Participant does not appeal on time, the Participant will lose the right to appeal the denial was based, (iii) a description of any additional material or information necessary for and the Claimant right to perfect the claimfile suit under ERISA, and the Participant will have failed to exhaust the Plan's internal administrative appeal process, which is generally a prerequisite to bringing suit. In the event an explanation appeal of why such material or information is necessary, (iv) an explanation a denial of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been for benefits is denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of any lawsuit to challenge the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review such claim must be brought within one year of the initial determination within such sixty (60) days period, date the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date Committee has rendered a final decision is expected on the appeal. In the case of a Participant's death, the same procedures shall apply to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthe Beneficiary.
Appears in 1 contract
Claims Procedure. (a) To the extent the issuance of Shares hereunder is deferred until cessation of employment or beyond, this Agreement is intended to constitute part of a “top-hat” plan described in Section 201(2) of ERISA. Therefore, to initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b)Units, Grantee the Participant (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. .
(b) If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award Agreement upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and -9-
(vc) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his or her duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. .
(d) Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b17(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 1 contract
Claims Procedure. To initiate (a) The administrator for purposes of this Agreement shall be ProAssurance ("Administrator"), whose address is 100 Xxxxxxxxx Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000; Xelephone: (200) 000-0000. Xhe "Named Fiduciary" as defined in Section 402(a)(2) or ERISA, also shall be ProAssurance. ProAssurance shall have the right to designate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. ProAssurance shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim with respect for benefits by the Executive ("the claimant") shall be stated in writing by the Administrator and delivered or mailed to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee claimant within ten (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (9010) days of after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 10-day period. In no event shall such extension exceed a period of ten (ii10) days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the claim appeal procedure set forth in Section 13(c), below; and (v) a statement best of the Claimant’s right to bring Administrator's ability in a civil action under section 502(amanner that may be understood without legal or actuarial counsel.
(c) of ERISA following an adverse determination upon appeal. Within sixty A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (6010) days after receiving a notice from following the Company that a claim has been deniedreceipt of such denial, in whole or in parta writing addressed to the Administrator, a Claimant (review of such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant’s duly authorized representative) claimant shall consider relevant to a determination of the claim, and the claimant may file with the Company include a written request for a hearing in person before the Administrator. Prior to submitting the request, the claimant shall be entitled to review of such documents as the denial of Administrator shall agree are pertinent to the claim. The Claimant or his duly authorized representative claimant may, but need notat all stages of review, review the pertinent documents and submit issues and comments in writing for consideration be represented by the Company. If the Claimant does not request a review counsel, legal or otherwise, of the initial determination within such sixty (60) days period, the Claimant will claimant's choice. All requests for review shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionpromptly resolved. The manner and content of the final Administrator's decision will include the same information described above in Section 13(b) with respect to any such review shall be set forth in writing and shall be mailed to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no claimant not later than one hundred twenty ten (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.10)
Appears in 1 contract
Samples: Release and Severance Compensation Agreement (Proassurance Corp)
Claims Procedure. To initiate In general, Benefit distributions are automatic and no claim for the Benefit needs to be filed; however, the Executive or a designated beneficiary may submit a claim with respect for the Benefit to the settlement of Restricted Stock Units deferred Administrator in accordance with Section 5(b), Grantee writing. The following procedure shall apply in such a case:
(a) If such claim for the Benefit is wholly or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claimpartially denied, the Company will advise Administrator shall notify the Claimant within ninety (90) days claimant of receipt the denial of the claim whether the claim is denied. If special circumstances require more within a reasonable period of time, but no later than ninety (90) days after receipt of the written claim, unless special circumstances require an extension of time for processingprocessing the claim. In such event, written notice of the Claimant will extension shall be notified in writing within furnished to the claimant prior to the end of the ninety (90) day period and shall indicate the special circumstances requiring the extension and the date by which a final decision is expected. In no event shall the extension period exceed ninety (90) days from the end of filing the claims than the Company requires up to an additional initial ninety (90) days to replyday period. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth of denial shall include: (i) the specific reason(s) reasons for the denial of the claim, or any part of it, denial; (ii) specific reference(s) reference to pertinent the Benefit provisions of the Plan or this award upon which such the denial was is based, ; (iii) a description of any additional material materials or information necessary for the Claimant claimant to perfect the claim, ; and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and Benefit claims review procedure.
(vb) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a of the receipt by the claimant of the written notice from of denial, or if the Company that a claim has not been deniedgranted within the applicable time period, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) claimant may file with the Company a written request for with the Administrator that it conduct a review of the denial of the claim. The Claimant or his duly authorized representative mayIn connection with the claimant’s appeal, but need not, the claimant may review the pertinent documents and may submit issues and comments in writing for consideration by writing.
(c) The Administrator shall deliver to the Company. If claimant a written decision on the Claimant does claim promptly, but not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within later than sixty (60) days after the Company’s receipt of a the claimant’s request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If except that if there are special circumstances which require that an extension of time for processing, the sixty (60) day time period shall be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than extended to a maximum of one hundred and twenty (120) days after receipt days, in which case written notice of the request for reviewextension shall be furnished to the claimant prior to the end of the sixty (60) day period. The notice will explain what special circumstances make an extension necessary Administrator’s decision shall include (i) the specific reasons for its decision and indicate (ii) reference to the date a final Benefit provisions on which its decision is expected based. If a decision is not given to be made. Any decision the claimant within the review period, the claim is deemed denied on appeal will be finalthe last day of the review period.
(d) In all cases, conclusive the Executive or a designated beneficiary must submit any and binding upon all partiesclaims relating to the Benefit and exhaust all administrative remedies relating to any such claims with the Administrator before serving a Demand for Arbitration on any party.
Appears in 1 contract
Claims Procedure. To initiate a Any claim with respect for benefits under Article 5 of this ---------------- Agreement by the Employee shall be made in writing and sent to the settlement of Restricted Stock Units deferred Employer at its principal offices in accordance with Section 5(bMechanicsburg, Pennsylvania, or such other place as the Employer shall hereafter designate in writing. If the Employee, or any beneficiary following the Employee's death (collectively, the "Claimant"), Grantee (believes she has been denied any benefits or payments under Article 5 of this Agreement, either in total or in an amount less than the person full benefit or payment to whom ownership rights may have passed by will or which the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claimClaimant would normally be entitled, the Company will Employer shall advise the Claimant in writing of the amount of the benefit, or payment, if any, and the specific reasons for the denial within ninety thirty (9030) days of the receipt of the claim whether the claim is deniedClaimant's claim. If special circumstances require more than ninety (90) days for processing, The Employer shall also furnish the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided at that time with a written opinion, in language calculated to be understood by the Claimant, setting forth notice containing:
(iA) the A specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) reference to pertinent provisions of the Plan or this award upon which such denial was based, Agreement;
(iiiB) a A description of any additional material or of information necessary for the Claimant to perfect the claimclaim if possible, and an explanation of why such material or information is necessary, needed; and
(ivC) an An explanation of the claim appeal review procedure set forth in this Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal5.03. Within sixty (60) days after receiving of receipt of the information described above, the Claimant shall, if further review is desired, file a notice written request of reconsideration of the Employer's decision with the Appeal Committee. The Appeal Committee shall consist of those individuals who were serving as the Compensation Committee of the Board of Directors of the Employer immediately prior to the Change of Control. The Appeal Committee shall select from its membership a chairperson and a secretary and may adopt such rules and procedures as it deems necessary to carry out its functions. In the Company that event any individual is unable to serve on the Appeal Committee, then the chairperson of the Appeal Committee shall appoint a claim has successor provided such successor must have been denied, in whole or in part, a Claimant member of the Board of Directors of the Employer prior to the Change of Control (or "Prior board Member"). So long as the Claimant’s 's request for review is pending with the Appeal Committee (including such 60-day period), the Claimant, or her duly authorized representative) , may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and may submit issues and comments in writing for consideration to the Appeal Committee. A final and binding decision shall be made by the Company. If Appeal Committee within thirty (30) days of the filing by the Claimant does not request a review of the initial determination within such sixty (60) days period, request for reconsideration. The Appeal Committee's decision shall be conveyed to the Claimant will in writing and shall include specific reasons for the decision and specific references to the pertinent provisions of this Agreement on which the decision is based. The Appeal Committee shall discharge its duties under this claims procedure in accordance with the fiduciary standards of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), and in doing so, to the extent permitted by law, shall be barred indemnified and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented held harmless by the Claimant, without regard Employer (to whether such materials were submitted the extent not indemnified or considered saved harmless under any liability insurance or other indemnification arrangement with the Employer) for or against all liability to which the Appeal Committee may be subjected by reason of any act done in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) good faith with respect to the initial determinationadjudication of any claim under Article 5 of this Agreement, including reasonable expenses. If special circumstances require that Notwithstanding anything to the sixty (60) day time period be extendedcontrary herein contained, the Company will so notify Claimant shall be entitled to submit her claim for determination to any court having competent jurisdiction regardless of whether she has first exercised her right to have the Claimant and will render Employer's decision reconsidered by the decision Appeal Committee."
3. Except as soon as possibleamended hereby, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesEmployment Agreement shall continue in effect in accordance with its terms.
Appears in 1 contract
Claims Procedure. To initiate Claim forms or claim information as to the subject policy can be obtained by contacting: Kaeding, Ernst & Company, 21 McGrath Highway, Suite 503, Quincy Centxx, XX 00000.
(a) Claims Xxxxx xxx Xxxxxx--When the Named Fiduciary has a claim with respect to which may be covered under the settlement of Restricted Stock Units deferred provisions described in accordance with Section 5(b)the Policy, Grantee (he or she should contact the office or the person named above who will either complete a claim form and forward it to whom ownership rights may have passed by will an authorized representative of the Insurer or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant Named Fiduciary what further requirements are necessary. The Insurer will evaluate the claim and make a decision as to payment within ninety (90) 90 days of receipt of the claim whether date the claim is denied. If special circumstances require more than ninety (90) days for processing, received by the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madeInsurer. If the claim is denied in whole payable, a benefit check will be issued to the Named Fiduciary or in partother party or parties entitled to payment under the Policy and forwarded through the office or person named above. In the event that a claim is not payable under the Policy, the Claimant Insurer will notify the Named Fiduciary of the denial. Such notification will be provided made in writing within 90 days of the date the claim is received and will be transmitted through the office or person named above. The notification will include the specific reasons for the denial as well as specific reference to the policy provisions upon which the denial is based. The Named Fiduciary will also be informed as to the steps which may be taken to have the claim denial reviewed. A decision as to the validity of a written opinionclaim will ordinarily be made within 10 working days of the date the claim is received by the Insurer. Occasionally, however, certain questions may prevent the Insurer from rendering a decision on the validity of the claim within the specific 90-day period. If this occurs, the Named Fiduciary will be notified of the reasons for the delay as well as the anticipated length of the delay, in language calculated writing and through the office or person named above. If further information or other material is required, the Named Fiduciary will be so informed. If the Named Fiduciary is dissatisfied with the denial of the claim or the amount paid, he or she has 60 days from the date he or she receives notice of a claim denial to be understood file his or her objections to the action taken by the ClaimantInsurer. If the Named Fiduciary wishes to contest a claim denial, setting forth he or she should notify the person or office named above who will assist in making inquiry to the insurer. All objections to the Insurer's actions should be in writing and submitted to the person or office named above for transmittal to the Insurer. The Insurer will review the claim denial and render a decision on such objections. The Named Fiduciary will be informed in writing of the decision of the Insurer within 60 days of the date the claim request is received by the Insurer.
(ib) Claims Under the Plan--Claims for any benefits due under the plan or the surrender of the Policy may be made in writing by the Corporation or the Corporation's designated beneficiary and Employee or his designated beneficiary, as the case may be, to the Named Fiduciary. In the event a claim for benefits is wholly or partly denied or disputed, the Named Fiduciary shall, within a reasonable period of time after receipt of the claim, notify the Corporation or the designated beneficiary and Employee or his designated beneficiary, as the case may be, of such total or partial denial or dispute listing:
(a) The specific reason(s) reason or reasons for the denial of the claim, or any part of it, dispute;
(iib) specific reference(s) Specific reference to pertinent plan provisions of the Plan or this award upon which such the denial was or dispute is based, ;
(iiic) a A description of any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and,
(ivd) an An explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appealplan's review procedure. Within sixty (60) 60 days after receiving a of denial or notice from of claim under the Company that a claim has been denied, in whole or in partplan, a Claimant (or claimant may request that the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration claim be reviewed by the CompanyNamed Fiduciary in a full and fair hearing. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will A final decision shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented rendered by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) Named Fiduciary within 60 days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 1 contract
Claims Procedure. To initiate a Any claim with respect for benefits under this Letter Agreement by you shall be made in writing and sent to the settlement of Restricted Stock Units deferred Company at its principal offices in accordance with Section 5(bMechanicsburg, Pennsylvania, or such other place as the Company shall hereafter designate in writing. If you, or any beneficiary following your death (collectively, the Claimant), Grantee (believes he or she has been denied any benefits or payments under this Letter Agreement, either in total or in an amount less than the person full benefit or payment to whom ownership rights may have passed by will or which the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claimClaimant would normally be entitled, the Company will shall advise the Claimant in writing of the amount of the benefit, or payment, if any, and the specific reasons for the denial within ninety thirty (9030) days of the receipt of the claim whether the claim is deniedClaimant’s claim. If special circumstances require more than ninety (90) days for processing, The Company shall also furnish the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided at that time with a written opinion, in language calculated to be understood by the Claimant, setting forth notice containing:
(iA) the A specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) reference to pertinent provisions of the Plan or this award upon which such denial was based, Letter Agreement;
(iiiB) a A description of any additional material or information necessary for the Claimant to perfect the claimclaim if possible, and an explanation of why such material or information is necessary, needed; and
(ivC) an An explanation of the claim appeal review procedure set forth in this Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal7. Within sixty (60) days after receiving of receipt of the information described above, the Claimant shall, if further review is desired, file a notice from written request of reconsideration of the Company’s decision with the Appeal Committee. The Appeal Committee shall consist of those individuals who were serving as the Compensation Committee of the Board of Directors of the Company that immediately prior to the Change of Control. The Appeal Committee shall select from its membership a claim has chairperson and a secretary and may adopt such rules and procedures as it deems necessary to carry out its functions. In the event any individual is unable to serve on the Appeal Committee, then the chairperson of the Appeal Committee shall appoint a successor provided such successor must have been denied, in whole or in part, a Claimant member of the Board of Directors of the Company prior to the Change of Control (or Prior Board Member). So long as the Claimant’s duly authorized representative) may file request for review is pending with the Company a written request for a review of Appeal Committee (including such 60-day period), the denial of the claim. The Claimant Claimant, or his duly authorized representative mayrepresentative, but need not, may review the pertinent documents and may submit issues and comments in writing for consideration to the Appeal Committee. A final and binding decision shall be made by the Company. If Appeal Committee within thirty (30) days of the filing by the Claimant does not request a review of the initial determination within such sixty (60) days period, request for reconsideration. The Appeal Committee’s decision shall be conveyed to the Claimant will in writing and shall include specific reasons for the decision and specific references to the pertinent provisions of this Letter Agreement on which the decision is based. The Appeal Committee shall discharge its duties under this claims procedure in accordance with the fiduciary standards of the Employee Retirement Income Security Act of 1974, as amended (ERISA), and in doing so, to the extent permitted by law, shall be barred indemnified and estopped from challenging held harmless by the determination. Within sixty Company (60) days after to the extent not indemnified or saved harmless under any liability insurance or other indemnification arrangement with the Company’s receipt ) for or against all liability to which the Appeal Committee may be subjected by reason of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered any act done in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) good faith with respect to the initial determinationadjudication of any claim under this Letter Agreement, including reasonable expenses. If special circumstances require that Notwithstanding anything to the sixty (60) day time period be extendedcontrary herein contained, the Company will so notify Claimant shall be entitled to submit his or her claim for determination to any court having competent jurisdiction regardless of whether he or she has first exercised his or her right to have the Claimant and will render Company’s decision reconsidered by the decision Appeal Committee.
4. Except as soon as possibleamended hereby, but no later than one hundred twenty (120) days after receipt the Letter Agreement shall continue in effect in accordance with its terms. Please indicate your acceptance of the request for reviewabove Amendment by signing below in the space indicated. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be finalVery truly yours,
Rxxxxx X. Xxxxxxxx, conclusive and binding upon all parties.President
Appears in 1 contract
Claims Procedure. To initiate a Any claim with respect for benefits under this Letter Agreement by you shall be made in writing and sent to the settlement of Restricted Stock Units deferred Company at its principal offices in accordance with Section 5(b)Mechanicsburg, Grantee Pennsylvania, or such other place as the Company shall hereafter designate in writing. If you, or any beneficiary following your death (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (collectively, the “Claimant”) must file a written request with ), believes he or she has been denied any benefits or payments under this Letter Agreement, either in total or in an amount less than the Company. Upon receipt of such claimfull benefit or payment to which the Claimant would normally be entitled, the Company will shall advise the Claimant in writing of the amount of the benefit, or payment, if any, and the specific reasons for the denial within ninety thirty (9030) days of the receipt of the claim whether the claim is deniedClaimant’s claim. If special circumstances require more than ninety (90) days for processing, The Company shall also furnish the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided at that time with a written opinion, in language calculated to be understood by the Claimant, setting forth notice containing:
(ia) the A specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) reference to pertinent provisions of the Plan or this award upon which such denial was based, Letter Agreement;
(iiib) a A description of any additional material or information necessary for the Claimant to perfect the claimclaim if possible, and an explanation of why such material or information is necessary, needed; and
(ivc) an An explanation of the claim appeal review procedure set forth in this Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal6. Within sixty (60) days after receiving of receipt of the information described above, the Claimant shall, if further review is desired, file a notice from written request of reconsideration of the Company’s decision with the Appeal Committee. The Appeal Committee shall consist of those individuals who were serving as the Compensation Committee of the Board of Directors of the Company that immediately prior to the Change of Control. The Appeal Committee shall select from its membership a claim has chairperson and a secretary and may adopt such rules and procedures as it deems necessary to carry out its functions. In the event any individual is unable to serve on the Appeal Committee, then the chairperson of the Appeal Committee shall appoint a successor provided such successor must have been denied, in whole or in part, a Claimant member of the Board of Directors of the Company prior to the Change of Control (or “Prior Board Member”). So long as the Claimant’s duly authorized representative) may file request for review is pending with the Company a written request for a review of Appeal Committee (including such 60-day period), the denial of the claim. The Claimant Claimant, or his duly authorized representative mayrepresentative, but need not, may review the pertinent documents and may submit issues and comments in writing for consideration to the Appeal Committee. A final and binding decision shall be made by the Company. If Appeal Committee within thirty (30) days of the filing by the Claimant does not request a review of the initial determination within such sixty (60) days period, request for reconsideration. The Appeal Committee’s decision shall be conveyed to the Claimant will in writing and shall include specific reasons for the decision and specific references to the pertinent provisions of this Letter Agreement on which the decision is based. The Appeal Committee shall discharge its duties under this claims procedure in accordance with the fiduciary standards of the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), and in doing so, to the extent permitted by law, shall be barred indemnified and estopped from challenging held harmless by the determination. Within sixty Company (60) days after to the extent not indemnified or saved harmless under any liability insurance or other indemnification arrangement with the Company’s receipt ) for or against all liability to which the Appeal Committee may be subjected by reason of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered any act done in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) good faith with respect to the initial determinationadjudication of any claim under this Letter Agreement, including reasonable expenses. If special circumstances require that Notwithstanding anything to the sixty (60) day time period be extendedcontrary herein contained, the Company will so notify Claimant shall be entitled to submit his or her claim for determination to any court having competent jurisdiction regardless of whether he or she has first exercised his or her right to have the Claimant and will render Company’s decision reconsidered by the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesAppeal Committee.
Appears in 1 contract
Samples: Agreement in the Event of a Change of Control (Select Medical Corp)
Claims Procedure. To initiate (a) The administrator for purposes of this Agreement shall be First Acceptance Corporation ("Administrator"), whose address is 3813 Green Hills Village Dr., Nashville, Tennessee, 37215, Telephone: (000) 000-0000. Xxx "Xxxxx Xxxxxxxxx" xx xxxxxxx xx Xxxtion 402(a)(2) xx XXXXX, xxso shall be First Acceptance Corporation. First Acceptance Corporation shall have the right to designate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. First Acceptance Corporation shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim with respect for benefits by the Executive ("the claimant") shall be stated in writing by the Administrator and delivered or mailed to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee claimant within ten (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (9010) days of after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 10-day period. In no event shall such extension exceed a period of ten (ii10) days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the claim appeal procedure set forth in Section 13(c), below; and (v) a statement best of the Claimant’s right to bring Administrator's ability in a civil action under section 502(amanner that may be understood without legal or actuarial counsel.
(c) of ERISA following an adverse determination upon appeal. Within sixty A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (6010) days after receiving a notice from following the Company that a claim has been deniedreceipt of such denial, in whole or in parta writing addressed to the Administrator, a Claimant (review of such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant’s duly authorized representative) claimant shall consider relevant to a determination of the claim, and the claimant may file with the Company include a written request for a hearing in person before the Administrator. Prior to submitting the request, the claimant shall be entitled to review of such documents as the denial of Administrator shall agree are pertinent to the claim. The Claimant or his duly authorized representative claimant may, but need notat all stages of review, review the pertinent documents and submit issues and comments in writing for consideration be represented by the Company. If the Claimant does not request a review counsel, legal or otherwise, of the initial determination within such sixty (60) days period, the Claimant will claimant's choice. All requests for review shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionpromptly resolved. The manner and content of the final Administrator's decision will include the same information described above in Section 13(b) with respect to any such review shall be set forth in writing and shall be mailed to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no claimant not later than one hundred ten (10) days following receipt by the Administrator of the claimant's request unless special circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case the Administrator's decision shall be so mailed not later than twenty (12020) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiessuch request.
Appears in 1 contract
Samples: Severance Compensation Agreement (First Acceptance Corp /De/)
Claims Procedure. To initiate a Any claim with respect for benefits under this Letter Agreement by you shall be made in writing and sent to the settlement of Restricted Stock Units deferred Company at its principal offices in accordance with Section 5(bMechanicsburg, Pennsylvania, or such other place as the Company shall hereafter designate in writing. If you, or any beneficiary following your death (collectively, the Claimant), Grantee (believes he or she has been denied any benefits or payments under this Letter Agreement, either in total or in an amount less than the person full benefit or payment to whom ownership rights may have passed by will or which the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claimClaimant would normally be entitled, the Company will shall advise the Claimant in writing of the amount of the benefit, or payment, if any, and the specific reasons for the denial within ninety thirty (9030) days of the receipt of the claim whether the claim is deniedClaimant’s claim. If special circumstances require more than ninety (90) days for processing, The Company shall also furnish the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided at that time with a written opinion, in language calculated to be understood by the Claimant, setting forth notice containing:
(iA) the A specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) reference to pertinent provisions of the Plan or this award upon which such denial was based, Letter Agreement;
(iiiB) a A description of any additional material or information necessary for the Claimant to perfect the claimclaim if possible, and an explanation of why such material or information is necessary, needed; and
(ivC) an An explanation of the claim appeal review procedure set forth in this Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal7. Within sixty (60) days after receiving of receipt of the information described above, the Claimant shall, if further review is desired, file a notice from written request of reconsideration of the Company’s decision with the Appeal Committee. The Appeal Committee shall consist of those individuals who were serving as the Compensation Committee of the Board of Directors of the Company that immediately prior to the Change of Control. The Appeal Committee shall select from its membership a claim has chairperson and a secretary and may adopt such rules and procedures as it deems necessary to carry out its functions. In the event any individual is unable to serve on the Appeal Committee, then the chairperson of the Appeal Committee shall appoint a successor provided such successor must have been denied, in whole or in part, a Claimant member of the Board of Directors of the Company prior to the Change of Control (or Prior Board Member). So long as the Claimant’s duly authorized representative) may file request for review is pending with the Company a written request for a review of Appeal Committee (including such 60-day period), the denial of the claim. The Claimant Claimant, or his duly authorized representative mayrepresentative, but need not, may review the pertinent documents and may submit issues and comments in writing for consideration to the Appeal Committee. A final and binding decision shall be made by the Company. If Appeal Committee within thirty (30) days of the filing by the Claimant does not request a review of the initial determination within such sixty (60) days period, request for reconsideration. The Appeal Committee’s decision shall be conveyed to the Claimant will in writing and shall include specific reasons for the decision and specific references to the pertinent provisions of this Letter Agreement on which the decision is based. The Appeal Committee shall discharge its duties under this claims procedure in accordance with the fiduciary standards of the Employee Retirement Income Security Act of 1974, as amended (ERISA), and in doing so, to the extent permitted by law, shall be barred indemnified and estopped from challenging held harmless by the determination. Within sixty Company (60) days after to the extent not indemnified or saved harmless under any liability insurance or other indemnification arrangement with the Company’s receipt ) for or against all liability to which the Appeal Committee may be subjected by reason of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered any act done in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) good faith with respect to the initial determinationadjudication of any claim under this Letter Agreement, including reasonable expenses. If special circumstances require that Notwithstanding anything to the sixty (60) day time period be extendedcontrary herein contained, the Company will so notify Claimant shall be entitled to submit his or her claim for determination to any court having competent jurisdiction regardless of whether he or she has first exercised his or her right to have the Claimant and will render Company’s decision reconsidered by the decision Appeal Committee.
4. Except as soon as possibleamended hereby, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesLetter Agreement shall continue in effect in accordance with its terms.
Appears in 1 contract
Claims Procedure. To initiate (i) Benefits will be provided to each Designated Employee as specified in this Plan. If a claim Designated Employee believes that he has not been provided with respect benefits due under the Plan, then the Designated Employee (who is hereafter referred to as the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or "Claimant") has the person right to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file make a written request with claim for benefits under the CompanyPlan. Upon receipt Written claims for severance pay benefits shall be governed by the following procedures; any written claims for health or welfare benefits shall be governed by the claims procedures of the applicable health or welfare plan. If such a written claim is made, and the Administrator wholly or partially denies the claim, the Company will advise Administrator shall provide the Claimant within ninety (90) days with written notice of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processingsuch denial, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinionsetting forth, in language a manner calculated to be understood by the Claimant, setting forth :
(iA) the specific reason(sreason or reasons for such denial;
(B) for specific reference to pertinent Plan provisions on which the denial of the claim, or any part of it, is based;
(ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iiiC) a description of any additional material or information necessary for the Claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and
(ivD) an explanation of the claim appeal Plan's claims review procedure set forth in Section 13(c)and time limits applicable to those procedures, below; and (v) including a statement of the Claimant’s 's right to bring a civil action under section ERISA Section 502(a) if the claim is denied on appeal.
(ii) The written notice of ERISA following any claim denial pursuant to Section 6(a)(i) shall be given not later than thirty (30) days after receipt of the claim by the Administrator, unless the Administrator determines that special circumstances require an adverse determination upon appeal. Within extension of time for processing the claim, in which event:
(A) written notice of the extension shall be given by the Administrator to the Claimant prior to thirty (30) days after receipt of the claim;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day period for giving notice of a claim denial; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Administrator expects to render the benefit determination.
(iii) The decision of the Administrator shall be final unless the Claimant, within sixty (60) days after receiving a receipt of notice of the claims denial from the Company that a claim has been deniedAdministrator, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company submits a written request to the Board of Directors of Perspecta, or its delegate, for a review an appeal of the denial of the claimdenial. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such During that sixty (60) days day period, the Claimant will shall be barred provided, upon request and estopped from challenging free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the determinationclaim for benefits. Within sixty The Claimant shall be provided the opportunity to submit written comments, documents, records, and other information relating to the claim for benefits as part of the Claimant's appeal. The Claimant may act in these matters individually, or through his or her authorized representative.
(60iv) After receiving the written appeal, if the Board of Directors of Perspecta, or its delegate, shall issue a written decision notifying the Claimant of its decision on review, not later than thirty (30) days after the Company’s receipt of the written appeal, unless the Board of Directors of Perspecta or its delegate determines that special circumstances require an extension of time for reviewing the appeal, in which event:
(A) written notice of the extension shall be given by the Board of Directors of Perspecta or its delegate prior to thirty (30) days after receipt of the written appeal;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day review period; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Board of Directors of Perspecta or its delegate expects to render the appeal decision. The period of time within which a benefit determination on review is required to be made shall begin at the time an appeal is received by the Board of Directors of Perspecta or its delegate, without regard to whether all the information necessary to make a benefit determination on review accompanies the filing of the appeal. If the period of time for reviewing the appeal is extended as permitted above, due to a claimant's failure to submit information necessary to decide the claim on appeal, then the period for making the benefit determination on review shall be tolled from the date on which the notification of the extension is sent to the claimant until the date on which the claimant responds to the request for reviewadditional information.
(v) In conducting the review on appeal, it will review the initial determination. After considering Board of Directors of Perspecta or its delegate shall take into account all materials presented comments, documents, records, and other information submitted by the Claimantclaimant relating to the claim, without regard to whether such materials were information was submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial benefit determination. If special circumstances require the Board of Directors of Perspecta or its delegate upholds the denial, the written notice of decision from the Board of Directors of Perspecta or its delegate shall set forth, in a manner calculated to be understood by the Claimant:
(A) the specific reason or reasons for the denial;
(B) specific reference to pertinent Plan provisions on which the denial is based;
(C) a statement that the sixty Claimant is entitled to be receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claim for benefits; and
(60D) day time period be extendeda statement of the Claimant's right to bring a civil action under XXXXX 502(a).
(vi) If the Plan or any of its representatives fail to follow any of the above claims procedures, the Company will so notify Claimant shall be deemed to have duly exhausted the administrative remedies available under the plan and shall be entitled to pursue any available remedies under ERISA Section 502(a), including but not limited to the filing of an action for immediate declaratory relief regarding benefits due under the Plan.
(vii) If the Board of Directors of Perspecta or its delegate upholds the denial on review of a severance pay claim, or if a health or welfare benefit claim is denied on review under the applicable health or welfare plan and/or the administrative remedies thereunder have been exhausted, then the Claimant and will render shall have the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date right to bring a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiescivil action under ERISA Section 502(a).
Appears in 1 contract
Samples: Severance Plan (Perspecta Inc.)
Claims Procedure. To initiate Each Employee, Participant, or Beneficiary shall submit his claim for benefits to the Committee in writing in such a form as is permitted by the Committee. A Participant or Beneficiary shall have no right to seek review of a denial of benefits, or to bring any action in any court to enforce a claim with respect for benefits prior to his filing a claim for benefits and exhausting his rights to review under this Article. When a claim for benefits has been filed properly, such claim for benefits shall be evaluated and the settlement claimant shall be notified of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (the approval or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant denial within ninety (90) days of after the receipt of such claim unless special circumstances require an extension of time for processing the claim. If such an extension of time for processing is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial ninety (90) day period which shall specify the special circumstances requiring an extension and the date by which a final decision will be reached (which date shall not be later than one hundred eighty (180) days after the date on which the claim was filed). A claimant shall be given a written notice on which the claimant shall be advised as to whether the claim is granted or denied, in whole or in part. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will claimant shall be provided a given written opinion, in language calculated to be understood by the Claimant, setting forth notice which shall contain (ia) the specific reason(s) reasons for the denial of the claim, or any part of itdenial, (iib) specific reference(s) references to pertinent Plan provisions of on which the Plan or this award upon which such denial was is based, (iiic) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, and (ivd) an explanation the claimant's rights to seek review of the denial. If a claim appeal procedure set forth is denied in Section 13(c)whole or in part, below; and the claimant shall have the right to request that the Committee review the denial, provided that the claimant files a written request for review with the Committee within sixty (v60) a statement days after the date on which the claimant received written notification of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appealdenial. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review is received, the review shall be made and the claimant shall be advised in writing of the decision on review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If unless special circumstances require that an extension of time for processing the review, in which case the claimant shall be given a written notification within such initial sixty (60) day time period specifying the reasons for the extension and when such review shall be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than completed (provided that such review shall be completed within one hundred twenty (120) days after receipt of the date on which the request for reviewreview was filed). The notice will explain what special circumstances make an extension necessary decision on review shall be forwarded to the claimant in writing and indicate shall include specific reasons for the date a final decision and references to Plan provisions upon which the decision is expected to be madebased. Any A decision on appeal will review shall be final, conclusive final and binding upon on all partiespersons for all purposes. If a claimant shall fail to file a request for review in accordance with the procedures herein outlined, such claimant shall have no rights to review and shall have no right to bring action in any court and the denial of the claim shall become final and binding on all persons for all purposes.
Appears in 1 contract
Samples: 401(k) Retirement Savings Plan (Information Resources Inc)
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b6.01. The Executive or his or her beneficiary ("Claimant"), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) duly authorized representative, must file a written request claim for benefits in writing with the Company. Upon receipt of such claimNathan S. Eckhart, the Company will advise Xxxxxxxx xxxxxxxxtative, who for purposes of this Agreement is referred to as the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to replyProgram Administrator. The notice Employer reserves the right to change the Program Administrator from time to time, and will explain what special circumstances make an extension necessary and indicate notify the date a final decision is expected to be madeExecutive of any such change.
6.02. If the claim is denied in whole or in part, written notice of the decision will be furnished to the Claimant within a reasonable time after receipt of the claim. The notice will be provided prepared in a written opinion, in language manner calculated to be understood by the Claimant, setting forth Claimant and will (i1) state the specific reason(s) reason or reasons for the denial of the claim, or any part of itdenial, (ii2) specific reference(s) refer specifically to the pertinent Program provisions of on which the Plan or this award upon which such denial was is based, (iii3) a description of describe any additional material or information necessary for the Claimant to perfect the claim, a claim and an explanation of as to why such material or information is necessary, and (iv4) an explanation of provide appropriate information as to the steps to be taken by the Claimant if the Claimant wishes to submit the claim appeal procedure set forth in Section 13(c)for review.
6.03. A denied claim is appealable to the Program's Named Fiduciary for review. Allen Organ Company is xxx Xrogram's Named Fiduciary. The Employer reserves the right to change the Named Fiduciary from time to time. The Claimant, below; and (v) a statement of or the Claimant’s right to bring 's duly authorized representative, must request a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within review in writing no later than sixty (60) days after receiving a receipt of notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant Claimant, or his the Claimant's duly authorized representative mayrepresentative, but need not, may review the pertinent documents and submit issues and comments in writing for consideration by the Companywriting. If the Claimant does not request The Named Fiduciary may, at his discretion, hold a review hearing. The Named Fiduciary will make a written decision following receipt of the initial determination within such request for review. Absent special circumstances, the decision will be, made no later than sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after following receipt of the request for review. The notice decision on review will explain what special circumstances make an extension necessary include specific reasons for the decision and indicate will be written in a manner calculated to be understood by the date a final Claimant. The decision will also include specific references to the pertinent Program provisions on which the decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 1 contract
Claims Procedure. To initiate (i) Benefits will be provided to each Designated Employee as specified in this Plan. If a claim Designated Employee believes that he has not been provided with respect benefits due under the Plan, then the Designated Employee may elect the arbitration procedure in Section 7(b) of this Plan, or alternatively, the Designated Employee (who is hereafter referred to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (as the “Claimant”) must file has the right to make a written request with claim for benefits under the CompanyPlan. Upon receipt Written claims for severance pay benefits shall be governed by the following procedures; any written claims for health or welfare benefits shall be governed by the claims procedures of the applicable health or welfare plan. If such a written claim is made, and the Administrator wholly or partially denies the claim, the Company will advise Administrator shall provide the Claimant within ninety (90) days with written notice of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processingsuch denial, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinionsetting forth, in language a manner calculated to be understood by the Claimant, setting forth :
(iA) the specific reason(sreason or reasons for such denial;
(B) for specific reference to pertinent Plan provisions on which the denial of the claim, or any part of it, is based;
(ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iiiC) a description of any additional material or information necessary for the Claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and
(ivD) an explanation of the Plan’s claims review procedure and time limits applicable to those procedures, including a statement of the Claimant’s right to bring a civil action under ERISA Section 502(a) if the claim appeal procedure set forth is denied on appeal.
(ii) The written notice of any claim denial pursuant to Section 7.11(a)(i) shall be given not later than thirty (30) days after receipt of the claim by the Administrator, unless the Administrator determines that special circumstances require an extension of time for processing the claim, in Section 13(c), belowwhich event:
(A) written notice of the extension shall be given by the Administrator to the Claimant prior to thirty (30) days after receipt of the claim;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day period for giving notice of a claim denial; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Administrator expects to render the benefit determination.
(iii) The decision of the Administrator shall be final unless the Claimant, within sixty (60) days after receipt of notice of the claims denial from the Administrator, submits a written request to the Board of Directors of CSC, or its delegate, for an appeal of the denial. During that sixty (60) day period, the Claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claim for benefits. The Claimant shall be provided the opportunity to submit written comments, documents, records, and other information relating to the claim for benefits as part of the Claimant’s appeal. The Claimant may act in these matters individually, or through his or her authorized representative.
(iv) After receiving the written appeal, if the Board of Directors of CSC, or its delegate, shall issue a written decision notifying the Claimant of its decision on review, not later than thirty (30) days after receipt of the written appeal, unless the Board of Directors of CSC or its delegate determines that special circumstances require an extension of time for reviewing the appeal, in which event:
(A) written notice of the extension shall be given by the Board of Directors of CSC or its delegate prior to thirty (30) days after receipt of the written appeal;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day review period; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Board of Directors of CSC or its delegate expects to render the appeal decision. The period of time within which a benefit determination on review is required to be made shall begin at the time an appeal is received by the Board of Directors of CSC or its delegate, without regard to whether all the information necessary to make a benefit determination on review accompanies the filing of the appeal. If the period of time for reviewing the appeal is extended as permitted above, due to a claimant’s failure to submit information necessary to decide the claim on appeal, then the period for making the benefit determination on review shall be tolled from the date on which the notification of the extension is sent to the claimant until the date on which the claimant responds to the request for additional information.
(v) In conducting the review on appeal, the Board of Directors of CSC or its delegate shall take into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. If the Board of Directors of CSC or its delegate upholds the denial, the written notice of decision from the Board of Directors of CSC or its delegate shall set forth, in a manner calculated to be understood by the Claimant:
(A) the specific reason or reasons for the denial;
(B) specific reference to pertinent Plan provisions on which the denial is based;
(C) a statement that the Claimant is entitled to be receive, upon request and free of charge, reasonable access to , and copies of, all documents, records and other information relevant to the claim for benefits; and
(D) a statement of the Claimant’s right to bring a civil action under section EXXXX 502(a).
(vi) If the Plan or any of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review its representatives fail to follow any of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days periodabove claims procedures, the Claimant will shall be barred deemed to have duly exhausted the administrative remedies available under the plan and estopped from challenging shall be entitled to pursue any available remedies under ERISA Section 502(a), including but not limited to the determination. Within sixty filing of an action for immediate declaratory relief regarding benefits due under the Plan.
(60vii) days after If the Company’s receipt Board of Directors of CSC or its delegate upholds the denial on review of a request for reviewseverance pay claim, it will or if a health or welfare benefit claim is denied on review under the initial determination. After considering all materials presented by applicable health or welfare plan and/or the Claimantadministrative remedies thereunder have been exhausted, without regard then the Claimant shall have the right to whether such materials were submitted or considered in the initial reviewbring a civil action under ERISA Section 502(a) or, alternatively, the Company will render a written opinion. The manner and content Claimant may invoke the arbitration provisions of the final decision will include the same information described above in Section 13(b7(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthis Plan.
Appears in 1 contract
Claims Procedure. To initiate In the event that benefits under this Agreement are not paid to the Executive (or his beneficiary in the case of the Executive’s death), and such person feels entitled to receive them, a claim with respect shall be made in writing to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant Plan Administrator within ninety (90) days of receipt of from the date payments are not made. Such claim whether shall be reviewed by the Plan Administrator and the Bank. If the claim is denied. If special circumstances require more than , in full or in part, the Plan Administrator shall provide a written notice within ninety (90) days setting forth the specific reasons for processingdenial, specific reference to the provisions of this Agreement upon which the denial is based, and any additional material or information necessary to perfect the claim, if any. Also, such written notice shall indicate the steps to be taken if a review of the denial is desired. If a claim is denied and a review is desired, the Claimant will be notified Executive (or his beneficiary in the case of the Executive’s death), shall notify the Plan Administrator in writing within ninety (90) days of filing receiving notice of said denial [and a claim shall be deemed denied if the claims than Plan Administrator does not take any action within the Company requires up to an additional aforesaid ninety (90) days day period]. In requesting a review, the Executive or his beneficiary may review this Agreement or any documents relating to replyit and submit any written issues and comments he or she may feel appropriate. The notice will explain what special circumstances make an extension necessary and indicate In its sole discretion the date a final decision is expected to be made. If Plan Administrator shall then review the claim is denied in whole or in part, the Claimant will be provided and provide a written opinion, in language calculated to be understood by the Claimant, setting forth decision within ninety (i90) days. This decision likewise shall state the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan Agreement on which the decision is based. If claimants continue to dispute the benefit denial based upon completed performance of this Agreement or this award upon which such denial was basedthe meaning and effect of the terms and conditions thereof, (iii) then claimants may submit the dispute to a description Board of any additional material or information necessary Arbitration for final arbitration. Said Board shall consist of one member selected by the Claimant to perfect claimant, one member selected by the claimBank, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of third member selected by the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claimfirst two members. The Claimant or his duly authorized representative mayBoard shall operate under any generally recognized set of arbitration rules. The parties hereto agree that they and their heirs, but need notpersonal representatives, review the pertinent documents successors and submit issues and comments in writing for consideration assigns shall be bound by the Company. If the Claimant does not request a review decision of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) Board with respect to the initial any controversy properly submitted to it for determination. If special circumstances require that Where a dispute arises as to the sixty (60) day time period Bank’s discharge of the Executive “for cause”, such dispute shall likewise be extended, submitted to arbitration as above described and the Company will so notify the Claimant and will render parties hereto agree to be bound by the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthereunder.
Appears in 1 contract
Samples: Executive Salary Continuation Agreement (Lyons Bancorp Inc)
Claims Procedure. To initiate Claims for benefits under the Plan shall be made in writing to the Committee. In the event a claim with respect to for 149 benefits is wholly or partially denied by the settlement Committee, the Committee shall, within a reasonable period of Restricted Stock Units deferred in accordance with Section 5(b)time, Grantee but no later than ninety (or the person to whom ownership rights may have passed by will or the laws of descent and distribution90) (the “Claimant”) must file a written request with the Company. Upon days after receipt of such the claim, notify the Company will advise claimant in writing of the Claimant denial of the claim. If the claimant shall not be notified in writing of the denial of the claim within ninety (90) days of receipt of after it is received by the Committee, the claim whether the claim is shall be deemed denied. If special circumstances require more than ninety (90) days for processing, the Claimant will A notice of denial shall be notified written in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language manner calculated to be understood by the Claimantclaimant, setting forth and shall contain (ia) the specific reason(s) reason or reasons for the denial of the claim, or any part of it, (iib) a specific reference(s) reference to the pertinent Plan provisions of the Plan or this award upon which such the denial was is based, (iiic) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and together with an explanation of why such material or information is necessary, and (ivd) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appealPlan's review procedure. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the receipt by the claimant of the written notice of denial of the claim. The Claimant , or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s claim is deemed denied as set forth above, if ap- plicable, the claimant may file a written request with the Committee that it conduct a full and fair review of the denial of the claimant's claim for benefits, including the conducting of a hearing, if deemed necessary by the Committee. In connection with the claimant's appeal of the denial of his benefit, the claimant may review pertinent documents and may submit issues and comments in writing. The Committee shall render a decision on the claim appeal promptly, but not later than sixty (60) days after the receipt of a the claimant's request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If unless special circumstances (such as the need to hold a hearing, if necessary), require that an extension of time for processing, in which case the sixty (60) day time period may be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than extended to one hundred and twenty (120) days after receipt of the request for reviewdays. The notice will explain what special circumstances make an extension necessary Committee shall notify the claimant in writing of any such extension. The decision upon review shall (a) include specific reasons for the decision, (b) be written in a manner calculated to be understood by the claimant and indicate (c) contain specific references to the date a final pertinent Plan provisions upon which the decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 1 contract
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (a) A Participant or the person to whom ownership rights may have passed by will or the laws of descent and distribution) Beneficiary (the “Claimant”"claimant") must file shall have the right to request any benefit under the Plan by filing a written request claim for any such benefit with the CompanyAdministrator on a form provided by the Administrator for such purpose. Upon The Administrator shall give such claim due consideration and shall either approve or deny it in whole or in part. Within ninety (90) days following receipt of such claimclaim by the Administrator, notice of any approval or denial thereof, in whole or in part, shall be delivered to the Company will advise claimant or his duly authorized representative or such notice of denial shall be sent by mail to the Claimant claimant or his duly authorized representative at the address shown on the claim form or such individual's last known address. The aforesaid ninety (90) day response period may be extended to one hundred eighty (180) days after receipt of the claimant's claim if special circumstances exist and if written notice of the extension to one hundred eighty (180) days indicating the special circumstances involved and the date by which a decision is expected to be made is furnished to the claimant within ninety (90) days of after receipt of the claim whether the claim is deniedclaimant's claim. If special circumstances require more than ninety (90) days for processing, the Claimant will Any notice of denial shall be notified written in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language manner calculated to be understood by the Claimant, setting forth claimant and shall:
(i) the Set forth a specific reason(s) reason or reasons for the denial of the claim, or any part of it, denial,
(ii) Make specific reference(s) reference to the pertinent provisions of the Plan or this award upon on which such any denial was of benefits is based, ,
(iii) a description of Describe any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of explain why such material or information is necessary, and
(iv) an explanation Explain the claim review procedure of subparagraph 8.8(b). If a notice of approval or denial is not provided to the claimant within the applicable ninety (90) day or one hundred eighty (180) day period, the claimant's claim shall be considered denied for purposes of the claim appeal review procedure set forth in Section 13(cof subparagraph 8.8(b), below; and .
(vb) a statement of the Claimant’s right A Participant or Beneficiary whose claim filed pursuant to bring a civil action under section 502(asubparagraph 8.8
(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant may, within sixty (60) days following receipt of notice of such denial, or following the Claimant’s duly authorized representativeexpiration of the applicable period provided for in subparagraph 8.8(a) may file with for notifying the Company a claimant of the decision on the claim if no notice of denial is provided, make written request application to the Administrator for a review of such claim, which application shall be filed with the denial Administrator. For purposes of such review, the claim. The Claimant claimant or his duly authorized representative may, but need not, may review Plan documents pertinent to such claim and may submit to the pertinent documents and submit Administrator written issues and comments in writing for consideration by the Companyrespecting such claim. If the Claimant does not request The Administrator may schedule and hold a hearing. The Administrator shall make a full and fair review of the initial determination within such sixty (60) days periodany denial of a claim for benefits and issue its decision thereon promptly, the Claimant will be barred and estopped from challenging the determination. Within but no later than sixty (60) days after receipt by the Company’s receipt Administrator of a the claimant's request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after such receipt if a hearing is to be held or if other special circumstances exist and if written notice of the extension to one hundred twenty (120) days is furnished to the claimant within sixty (60) days after the receipt of the claimant's request for a review. The notice will explain what special circumstances make an extension necessary Such decision shall be in writing, shall be delivered or mailed by the Administrator to the claimant or his duly authorized representative in the manner prescribed in subparagraph 8.8
(a) for notices of approval or denial of claims, and indicate shall:
(i) Include specific reasons for the date decision,
(ii) Be written in a final manner calculated to be understood by the claimant, and
(iii) Contain specific references to the pertinent Plan provisions on which the decision is expected to be madebased. Any The Administrator's decision on appeal will made in good faith shall be final, conclusive and binding upon all parties.
Appears in 1 contract
Claims Procedure. To initiate (a) The administrator for purposes of this Agreement shall be ProAssurance (“Administrator”), whose address is 000 Xxxxxxxxx Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000; Telephone: (000) 000-0000. The “Named Fiduciary” as defined in Section 402(a) (2) or ERISA, also shall be ProAssurance. ProAssurance shall have the right to designate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. ProAssurance shall give Adamo written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim with respect for benefits by Adamo (“the claimant”) shall be stated in writing by the Administrator and delivered or mailed to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee claimant within ten (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (9010) days of after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 10-day period. In no event shall such extension exceed a period of ten (ii10) days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the claim appeal procedure set forth in Section 13(c), below; and (v) a statement best of the ClaimantAdministrator’s right to bring ability in a civil action under section 502(amanner that may be understood without legal or actuarial counsel.
(c) of ERISA following an adverse determination upon appeal. Within sixty A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (6010) days after receiving a notice from following the Company that a claim has been deniedreceipt of such denial, in whole or in parta writing addressed to the Administrator, a Claimant (review of such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant’s duly authorized representative) claimant shall consider relevant to a determination of the claim, and the claimant may file with the Company include a written request for a hearing in person before the Administrator. Prior to submitting the request, the claimant shall be entitled to review of such documents as the denial of Administrator shall agree are pertinent to the claim. The Claimant or his duly authorized representative claimant may, but need notat all stages of review, review the pertinent documents and submit issues and comments in writing for consideration be represented by the Company. If the Claimant does not request a review counsel, legal or otherwise, of the initial determination within such sixty (60) days period, the Claimant will claimant’s choice. All requests for review shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionpromptly resolved. The manner and content of the final Administrator’s decision will include the same information described above in Section 13(b) with respect to any such review shall be set forth in writing and shall be mailed to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no claimant not later than one hundred ten (10) days following receipt by the Administrator of the claimant’s request unless special circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case the Administrator’s decision shall be so mailed not later than twenty (12020) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiessuch request.
Appears in 1 contract
Samples: Deferred Compensation Plan and Agreement (Proassurance Corp)
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred a. Benefits shall be payable in accordance with Section 5(b)the provisions of this Agreement. Should TRUSTEE OF TRUST TWO or any beneficiary of the Policies fail to receive benefits to which TRUSTEE OF TRUST TWO or such beneficiary believes it is entitled, Grantee (a claim may be filed. Any claim for a benefit hereunder shall be filed by TRUSTEE OF TRUST TWO or beneficiary by written communication which is reasonably calculated to bring the person claim to whom ownership rights may have passed by will the attention of the NAMED FIDUCIARY.
b. If a claim for a benefit is wholly or the laws of descent and distribution) (the “Claimant”) must file partially denied, a written request with notice of the Company. Upon receipt decision shall be furnished to the claimant by the NAMED FIDUCIARY or his designee within a reasonable period of such claim, the Company will advise the Claimant within ninety (90) days of time after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the ClaimantNAMED FIDUCIARY, setting forth which notice shall include the following information:
(i1) the The specific reason(s) reason or reasons for the denial of denial;
(2) Specific reference to the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, ;
(iii3) a A description of any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and
(iv4) an An explanation of the claim review procedures under this Agreement.
c. In order that a claimant may appeal procedure set forth in Section 13(c)a denial of a claim, below; and a claimant or his duly authorized representative:
(v1) May request a statement of review by written application submitted to the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within NAMED FIDUCIARY or his designee not later than sixty (60) days after receiving a notice from receipt by the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a claimant of written request for a review notification of the denial of the a claim. The Claimant or his duly authorized representative may, but need not, ;
(2) May review the pertinent documents and documents; and
(3) May submit issues and comments in writing for consideration by the Company. If the Claimant does not request a writing.
d. A decision on review of the initial determination within such sixty (60) days period, the Claimant will a denied claim shall be barred and estopped from challenging the determination. Within made not later than sixty (60) days after the Company’s NAMED FIDUCIARY'S receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If unless special circumstances require that the sixty (60) day an extension of time for processing, in which case a decision shall be rendered within a reasonable period be extended, the Company will so notify the Claimant and will render the decision as soon as possibleof time, but no not later than one hundred and twenty (120) days after receipt of the a request for review. The notice will explain what special circumstances make an extension necessary decision on review shall be in writing and indicate shall include the date a final specific reason(s) for the decision and the specific reference(s) to the pertinent provisions of this Agreement on which the decision is expected based.
e. Notwithstanding anything contained in this Paragraph to the contrary, any claim for a death benefit under an insurance policy subject to this Agreement shall be madefiled with the Insurer by the claimant or his authorized representative on the form or forms prescribed for such purpose by the Insurer. Any decision The Insurer shall have sole authority for determining whether a death claim shall or shall not be paid, either in whole or in part, in accordance with the terms of such authority or insurance contract which may have been purchased on appeal will be final, conclusive and binding upon all partiesthe life of EMPLOYEE.
Appears in 1 contract
Samples: Split Dollar Life Insurance Agreement (Petro Stopping Centers L P)
Claims Procedure. To initiate a claim with respect to (a) In the settlement event the Executive or her beneficiary in the case of Restricted Stock Units deferred in accordance with Section 5(b), Grantee the Executive's death or their authorized representative (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claimhereinafter, the Company will advise the Claimant within ninety (90"Claimant") days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processingasserts a right to a benefit under this Agreement which has not been received, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be must file with the Bank a claim for such benefit on forms provided a written opinion, in language calculated to be understood by the ClaimantBank. The Bank shall render its decision on the claim within ninety (90) days after receipt of the claim. If special circumstances apply, setting forth the ninety (90) day period may be extended by an additional ninety (90) days, provided written notice of the extension is given to the Claimant during the initial ninety (90) day period and such notice indicates the special circumstances requiring an extension of time and the date by which the Bank expects to render its decision on the claim. If the Bank wholly or partially denies the claim, the Bank shall provide written notice to the Claimant within the time limitations of this Section. Such notice shall set forth:
(i) the specific reason(s) reasons for the denial of the claim, or any part of it, ;
(ii) specific reference(s) reference to pertinent provisions of the Plan or this award upon Agreement on which such the denial was is based, ;
(iii) a description of any additional material or information necessary for the Claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ;
(iv) an explanation a description of the claim appeal procedure set forth in Section 13(c)Agreement's claims procedures, belowand the time limitations applicable to such procedures; and and
(v) a statement of the Claimant’s 's right to bring a civil action under section Section 502(a) of ERISA following an adverse determination upon appeal. Within the Employee Retirement Income Security Act of 1974, as amended, ("ERISA") if the claim denial is appealed to the Bank and the Bank fully or partially denies the claim pursuant to Section 7(c).
(b) A Claimant whose application for benefits is denied in whole or in part may request a full and fair review of the decision denying the claim by filing, in accordance with such procedures as the Bank may reasonably establish, a written appeal which sets forth the documents, records and other information relating to the claim within sixty (60) days after receiving a receipt of the notice from of the Company that a claim has been denied, in whole or in partdenial by the Bank. In connection with such appeal and upon request by the Claimant, a Claimant may review (or receive free copies of) all documents, records or other information relevant to the Claimant’s duly authorized representative) 's claim for benefit, all in accordance with such procedures as the Bank may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Companyreasonably establish. If the a Claimant does not request a review of the initial determination fails to file an appeal within such sixty (60) days day period, she shall have no further right to appeal.
(c) A decision on the appeal by the Bank shall include a review by the Bank that takes into account all comments, documents, records and other information submitted by the Claimant will be barred and estopped from challenging relating to the claim, without regard to whether such information was submitted or considered in the initial claim determination. Within The Bank shall render its decision on the appeal no later than sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content Bank of the final decision will include the same information described above in Section 13(b) with respect to the initial determinationappeal. If special circumstances require that apply, the sixty (60) day period may be extended by an additional sixty (60) days, provided written notice of the extension is given to the Claimant during the initial sixty (60) day period and such notice indicates the special circumstances requiring an extension of time period be extendedand the date by which the Bank expects to render its decision on the claim on appeal. If the Bank wholly or partly denies the claim on appeal, the Company will so notify Bank shall provide written notice to the Claimant and will render within the decision as soon as possible, but no later than one hundred twenty time limitations of this Section. Such notice shall set forth:
(120i) days after receipt the specific reasons for the denial of the claim;
(ii) specific reference to pertinent provisions of the Agreement on which the denial is based;
(iii) a statement of the Claimant's right to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Claimant's claim for reviewbenefits; and
(iv) a Statement of the Claimant's right to bring a civil action under Section 502(a) of ERISA,
(d) The Bank shall be the Plan Administrator with respect to this Agreement.
(e) As Plan Administrator, the Bank shall have complete authority, in its sole and absolute discretion, to interpret the provisions of this Agreement and make determinations regarding eligibility. The notice will explain what special circumstances make an extension necessary Without limiting the foregoing, it is the Bank's intent that the Agreement be administered in a manner compliant with the provisions of Section 409A of the Code, and indicate regulations and rulings issued thereunder so as not to subject the date a final decision is expected benefits accruing hereunder to be made. Any decision on appeal will be final, conclusive and binding upon all partiestaxation pursuant to said Section 409A(a)(1).
Appears in 1 contract
Samples: Supplemental Executive Retirement Agreement (First Litchfield Financial Corp)
Claims Procedure. To initiate a Any claim with respect for benefits under the Plan shall be made in writing and submitted to the settlement of Restricted Stock Units deferred in accordance with Section 5(b)Plan Administrator, Grantee who shall reach a decision as soon as reasonable under the circumstances and notify the claimant, or his duly authorized representative, thereof promptly (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claimand, the Company will advise the Claimant except as provided herein, within ninety (90) days of the receipt of the claim whether claim) in writing by mail addressed to the claim is deniedlast known address of the claimant or such representative, as the case may be, appearing on the records of the Plan Administrator. If the Plan Administrator determines that special circumstances require more than ninety (90) days an extension of time for processingprocessing the claim, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires Plan Administrator shall have up to an additional ninety (90) 90 days to reply. The respond provided he gives notice will explain what special circumstances make an extension necessary of the extension, the reasons therefor, and indicate the expected date a final decision is expected of response to be madethe claimant prior to the end of the initial 90-day period. If the claim is denied shall be denied, in whole or in part, the Claimant will notice thereof shall be provided a written opinionby certified mail, return receipt requested, and shall set forth, in language a manner reasonably calculated to be understood by the Claimant, setting forth understood:
(ia) the specific reason(s) reason or reasons for the denial of the claim, or any part of it, denial;
(iib) specific reference(s) reference to pertinent Plan provisions of on which the Plan or this award upon which such denial was is based, ;
(iiic) a description of any additional material or information necessary for to be submitted by the Claimant claimant in order to perfect the his claim, and an explanation of why such material or information is necessary, ; and
(ivd) an explanation of the Plan’s claim appeal review procedure set forth in Section 13(c)and time limits, below; and (v) a statement of the Claimantclaimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeallawsuit. Within sixty (60) days after receiving a notice from the Company that a claim has been deniedUpon denial, in whole or in part, of a Claimant (or claim by the Claimant’s duly authorized representative) may file with Plan Administrator, the Company a written request for a review of the denial of the claim. The Claimant claimant, or his duly authorized representative representative, as the case may be, may, but need notwithin the period ending ninety (90) days from the date of receipt of the denial as aforesaid:
(e) request review thereof, by filing a written application with the Trustees or a committee thereof;
(f) upon request, review pertinent documents, records, and other information and obtain copies free of charge; and
(g) submit comments, documents, records, and other information relating to the pertinent documents claim in writing. Documents, records, and submit issues other information are “pertinent” if they were relied upon in making the determination on the claim or if they were submitted, considered, or generated in the course of making the benefit determination. The Trustees, or a committee thereof shall constitute the review board, which shall fully review such request, review all comments, documents, records, and comments other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination, hold any hearing deemed appropriate by such review board, and notify the claimant or his duly authorized representative, as the case may be, of the decision in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days periodas soon as practicable, the Claimant will be barred and estopped from challenging the determination. Within but in no event later than sixty (60) days after the Company’s receipt of a the written request for review; provided, it will review however, if a hearing is requested or if the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial reviewTrustees determine that special circumstances exist, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect Trustees shall have up to the initial determination. If special circumstances require that the an additional sixty (60) day time period be extendeddays to respond provided they give notice of the extension, the Company will so notify reasons therefor, and the Claimant and will render expected date of response to the decision as soon as possibleclaimant prior to the end of the initial 60-day period; provided further, but no later than one hundred twenty if the Trustees have regularly scheduled quarterly meetings, their response date shall be up to five (1205) days after the next regularly scheduled meeting which comes at least thirty (30) days after their receipt of the request for review. The In no event, however, shall the Trustees respond later than five (5) days following the third regularly scheduled meeting after the receipt of the request for review. Such notice will explain what special circumstances make an extension necessary and indicate of the date a final decision is expected to be made. Any decision on appeal will shall be finalwritten in a manner reasonably calculated to be understood, conclusive shall include the specific reasons for the decision, and binding upon all partiesshall set forth specific references to the Plan provisions on which the decision rests. The use of the claims procedure of this Subsection is mandatory in pursuing claims for benefits. Except as otherwise provided, failure to file a claim by the end of the Plan Year following the Plan Year in which the individual knew or should have known of the claim shall constitute an irrevocable waiver of the claim unless it shall be shown not to have been reasonably possible to furnish proof within the specified time period, and that proof was furnished as soon as was reasonably possible, in which case failure to furnish proof within the time provided shall not invalidate nor reduce the claim. Failure to raise issues or present evidence at any stage in the claims procedure shall preclude those issues or evidence from being presented in a judicial review of the claim. If any time limitation of the Plan with respect to furnishing proof of loss or bringing of an action at law or in equity is less than that permitted by ERISA, such limitation is hereby extended to agree with the minimum period permitted by such law. In the event the Plan Administrator or the Trustees extend the time for response due to the claimant’s failure to provide information necessary to decide the claim, the period for the benefit determination shall be tolled from the date notice of the extension is sent to the claimant until the claimant responds to the request for additional information. The Plan Administrator may implement reasonable procedures for ensuring that an individual has been authorized to act on behalf of a claimant.
Appears in 1 contract
Claims Procedure. To initiate (i) Following its receipt of a claim Claim Notice, the Representative and, as applicable in the case of claims against one or more Principal Stockholders, the Indemnifying Party or Parties (as a single group, if applicable) shall have thirty (30) calendar days to object to any item(s) or amount(s) set forth therein by delivering written notice thereof (an “Objection Notice”) to the Indemnified Party submitting such Claim Notice at the address of such Indemnified Party set forth in such Claim Notice, with a copy to the Escrow Agent (if and to the extent that the Indemnified Party is seeking recourse against the Escrow Amount). In the event that the Representative or the Indemnifying Party or Parties, as applicable, shall fail to object, pursuant to this Section 10.6, to any item or amount set forth in a Claim Notice within the foregoing thirty (30) calendar day period, the Representative or the Indemnifying Party or Parties, as applicable, shall be deemed to have irrevocably agreed and consented to each such item or amount. With respect to claims against the Escrow Amount, upon the expiration of such thirty (30) calendar day period, if no Objection Notice shall have been delivered to the Escrow Agent, the Escrow Agent shall promptly release from the Escrow Amount and deliver to any Indemnified Party that has previously delivered the Claim Notice only an amount equal to any item(s) and amount(s) that the Indemnifying Party is deemed to have accepted pursuant to this Section 10.6, if such amounts, together with all prior amounts, exceeds the Threshold, if applicable; provided, however, that the amount so released shall be in the same proportion to the aggregate Escrow Amount as contemplated by Section 2.5.3 (i.e., fifty percent (50%) in the form of Parent Stock valued on the basis of the Parent Stock FMV and fifty percent (50%) in the form of cash).
(ii) In the event that the Representative or an Indemnifying Party or Parties, as applicable, shall object, pursuant to Section 10.6(b)(i) hereof, to any item(s) or amount(s) set forth in any Claim Notice, the Indemnifying Party or Parties, as applicable, and the Indemnified Party shall attempt in good faith to agree upon the rights of the respective parties with respect to each of such claims. If the settlement Indemnifying Party or Parties, as applicable, and the Indemnified Party should so agree, a memorandum setting forth such agreement shall be prepared and signed by both parties and, in the case of Restricted Stock Units deferred a claim against the Escrow Amount, shall be furnished to the Escrow Agent together with a joint instruction as contemplated by Section 4(a) of the Escrow Agreement. The Escrow Agent shall be entitled to rely on any such memorandum and joint instruction and make distributions from the Escrow Amount in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent terms hereof and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, thereof.
(iii) If no such agreement can be reached after good faith negotiation and prior to thirty (30) calendar days after delivery of an Objection Notice, either the Indemnifying Party or Parties, as applicable, or the Indemnified Party may demand arbitration of the matter unless the amount of the Loss that is at issue is the subject of a description pending litigation with a third party, in which event arbitration shall not be commenced (if at all) until such amount is finally determined or both parties agree to arbitration, and in either such event the matter shall be settled by arbitration conducted by one arbitrator mutually agreeable to the Indemnifying Party or Parties, as applicable, and the Indemnified Party. In the event that, within thirty (30) calendar days after submission of any additional material dispute to arbitration, the Indemnifying Party or information necessary for the Claimant to perfect the claimParties, as applicable, and an explanation the Indemnified Party cannot mutually agree on one arbitrator, then, within fifteen (15) calendar days after the end of why such material thirty (30) calendar-day period, the Indemnifying Party or information is necessaryParties, as applicable, and the Indemnified Party shall each select one (1) arbitrator. The two (2) arbitrators so selected shall select a third arbitrator, who shall have relevant industry experience, to conduct the arbitration.
(iv) an explanation Any such arbitration shall be held in King County, Washington, under the rules then in effect of the American Arbitration Association. The arbitrator(s) shall determine how all expenses relating to the arbitration shall be paid, including the respective expenses of each party, the fees of each arbitrator and the administrative fee of the American Arbitration Association. The arbitrator or arbitrators, as the case may be, shall set a limited time AGREEMENT AND PLAN OF MERGER -77- period and establish procedures designed to reduce the cost and time for discovery while allowing the parties an opportunity, adequate in the sole judgment of the arbitrator or majority of the three arbitrators, as the case may be, to discover relevant information from the opposing parties about the subject matter of the dispute. The arbitrator, or a majority of the three arbitrators, as the case may be, shall rule upon motions to compel or limit discovery and shall have the authority to impose sanctions, including attorneys’ fees and costs, to the same extent as a competent court of law or equity, should the arbitrators or a majority of the three arbitrators, as the case may be, determine that discovery was sought without substantial justification or that discovery was refused or objected to without substantial justification. The decision of the arbitrator or a majority of the three arbitrators, as the case may be, as to the validity and amount of any claim appeal procedure in such Claim Notice shall be final, binding, and conclusive upon the Indemnifying Party or Parties, as applicable, and the Indemnified Party. Such decision shall be written and shall be supported by written findings of fact and conclusions which shall set forth the award, judgment, decree or order awarded by the arbitrator(s). With respect to claims against the Escrow Amount, the Escrow Agent shall be entitled to rely on, and make distributions from the Escrow Amount in Section 13(c)accordance with, below; and the terms of such award, judgment, decree or order as applicable. Within fifteen (15) calendar days of a decision of the arbitrator(s) requiring payment by one (1) party to another, such party shall make the payment to such other party, including any distributions out of the Escrow Amount.
(v) a statement of Judgment upon any award rendered by the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representativearbitrator(s) may file with be entered in any court having jurisdiction.
(vi) The foregoing arbitration provisions shall apply to any dispute among any Indemnifying Party or Parties, as applicable, and the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.Indemnified Parties under this Article X.
Appears in 1 contract
Samples: Merger Agreement (Drugstore Com Inc)
Claims Procedure. To initiate If any Participant or Beneficiary shall claim benefits for which the Committee has determined he is ineligible, or shall dispute the amount or timing of benefits determined by the Committee to be payable hereunder, he shall be entitled to make a claim with respect for benefits pursuant to this Paragraph (H). All claims for benefits under this Agreement, whether made by a Participant or Beneficiary, shall be in writing addressed and delivered to the settlement of Restricted Stock Units deferred in accordance with Section 5(b)Committee, Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with any member thereof, at the Company. Upon receipt of such claim's main office, shall contain the Company will advise the Claimant within ninety (90) days of receipt of claimant's name, mailing address, and telephone number, if any, and shall identify the claim whether in a manner reasonably calculated to make the claim is denied. If special circumstances require more than ninety (90) days for processing, understandable to the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madeCommittee. If the claim is defective in any foregoing respect, the Committee may at any time within ten days after said delivery give the claimant not less than ten days' written notice specifying the defect or defects and the deadline for correction. A claim shall be deemed to be effectively made when and if it is timely corrected in writing (addressed and delivered as aforesaid), or when it is timely and correctly prepared and delivered in the first place, or when it (or a revision thereof) is timely delivered as aforesaid if the Committee does not give written notice of any defect therein within ten days after said delivery. It is further agreed:
(1) If a claim is (or is deemed to be) effectively made, the Committee, shall within 60 days thereafter notify the claimant in writing whether the claim has been granted or has been denied in whole or in part, the Claimant will . Such notice shall be provided written in a written opinion, in language manner calculated to be understood by the Claimantclaimant, setting forth shall make specific reference to the Plan, and, if adverse in whole or in part, shall set forth:
(ia) the The specific reason(s) reason or reasons for the denial of the claim, or any part of it, denial;
(iib) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a A description of any additional material or information necessary for the Claimant claimant to perfect the claim, and together with an explanation of why such material or information is necessary, ; and
(ivc) an An explanation of the claim appeal review procedure set forth in Section 13(c), below; (3) and (v4) a statement below.
(2) If within said 60 days the claim has not been granted, it shall be deemed to have been denied for purposes of the Claimant’s right to bring a civil action claim review procedure set forth in (3) below, even if notice of denial has not been given under section 502(a(1) above.
(3) Upon denial of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (the claimant or the Claimant’s his duly authorized representative) may representative shall have 60 days within which to file with the Company Committee or any member thereof a written request for a review of the denial such denial, whereupon-
(a) The Committee shall as promptly as is practicable, but not later than 60 days after receipt of the such request, schedule a hearing to review said claim. .
(b) The Claimant claimant or his duly authorized representative mayshall, but need notpending and/or at said hearing, be permitted at all reasonable hours to review the pertinent documents and also be entitled to submit issues and comments in writing for consideration by writing.
(4) The hearing mentioned in (3) above shall be held at the Company's main office during normal business hours, unless a different time and/or place are mutually agreed upon. If the Claimant does not request It shall be attended by at least a review majority of the initial determination within such sixty (60) days periodCommittee. A decision on the claim shall be rendered thereat or as soon as possible thereafter, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) but in no event later than 120 days after the Company’s Committee's receipt of a the written request for review, it will review the initial determination. After considering all materials presented ; shall be in writing and include specific reasons; shall be written in a manner calculated to be understood by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner claimant; and content of the final decision will include the same information described above in Section 13(b) with respect shall contain specific reference to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render pertinent Plan provisions on which the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 1 contract
Samples: Employee Stock Ownership and 401(k) Savings Plan and Trust Agreement (Pavilion Bancorp Inc)
Claims Procedure. To initiate a Any controversy or claim arising out of or relating to this Agreement shall be filed with respect the Fiduciary who shall make all determinations concerning such claim. Any decision by the Fiduciary denying such claim shall be in writing and shall be delivered to the settlement of Restricted Stock Units deferred all parties in interest in accordance with the notice provisions of Section 5(b)7.5 hereof. Such decision shall set forth the reasons for denial in plain language. Pertinent provisions of the Agreement and any of the applicable documents shall be cited and, Grantee (or where appropriate, an explanation as to how the person to whom ownership rights may have passed by Employee can perfect the claim will or be provided. This notice of denial of benefits will be provided within 90 days of the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon Fiduciary’s receipt of such the Employee’s claim for benefits. If the Fiduciary fails to notify the Employee of the Fiduciary’s decision regarding the Employee’s claim, the Company will advise claim shall be considered denied, and the Claimant within ninety Employee shall then be permitted to proceed with an appeal as provided in this Section. An Employee shall be entitled to appeal this denial of the claim by filing a written statement of his or her position with the Fiduciary no later than sixty (9060) days after receipt of the written notification of such claim denial. The Fiduciary shall schedule an opportunity for a full and fair review of the issue with thirty (30) days of receipt of the appeal. Following the Fiduciary’s review of any additional information of the Employee submits, either through the hearing process or otherwise, the Fiduciary shall render a decision on his or her review of the denied claim whether in the following manner:
(a) The Fiduciary shall make his decision regarding the merits of the denied claim within 60 days following his receipt of material from the Employee (or within 120 days after such receipt, in a case where there are special circumstances requiring extension of time for reviewing the appealed claim). The Fiduciary shall deliver the decision to the Employee in writing. If an extension of time for reviewing the appealed claim is denied. If required because of special circumstances require more than ninety (90) days for processingcircumstances, the Claimant will be notified in writing within ninety (90) days Fiduciary shall furnish written notice of filing the claims than extension to the Company requires up Employee prior to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madecommencement of the extension. If the claim decision on review is denied in whole or in partnot furnished within the prescribed time, the Claimant will claim shall be provided a written opinion, in language calculated to be understood by the Claimant, setting deemed denied on review.
(b) The decision on review shall set forth (i) the specific reason(s) reasons for the denial of decision, and shall cite specific references to the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon Agreement and any other applicable documents on which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 1 contract
Samples: Split Dollar Collateral Assignment Insurance Plan Agreement (Duke Energy CORP)
Claims Procedure. To initiate a Any controversy or claim with respect arising out of or ---------------- relating to the settlement of Restricted Stock Units deferred Program shall be filed with the Committee which shall make all determinations concerning such claim. Any decision by the Committee denying such claim shall be in writing and shall be delivered to all parties in interest in accordance with the notice provisions of Section 5(b)9.02 hereof. Such decision shall set forth the reasons for denial in plain language. Pertinent provisions of the Program shall be cited and, Grantee (or where appropriate, an explanation as to how the person to whom ownership rights may have passed by Executive can perfect the claim will or be provided. This notice of denial of benefits will be provided within 90 days of the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon Committee's receipt of such the Executive's claim for benefits. If the Committee fails to notify the Executive of its decision regarding the claim, the Company will advise claim shall be considered denied, and the Claimant Executive shall then be permitted to proceeds with the appeal as provided in this Section. An Executive who has been completely or partially denied a benefit shall be entitled to appeal this denial of his/her claim by filing a written statement of his/her position with the Committee no later than sixty (60) days after receipt of the written notification of such claim denial. The Committee shall schedule an opportunity for a full and fair review of the issue within ninety thirty (903) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to replyappeal. The notice will explain what special circumstances make an extension necessary decision on review shall set forth specific reasons for the decision, and indicate shall cite specific references to the date a final pertinent Program provisions on which the decision is expected to be madebased. If Following the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description review of any additional material information submitted by the Executive, either through the hearing process or information necessary for otherwise, the Claimant to perfect Committee shall render a decision on the claim, and an explanation of why such material or information is necessary, (iv) an explanation review of the denied claim appeal procedure set forth in Section 13(c), below; and (v) a statement the following manner:
a. The Committee shall make its decision regarding the merits of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within denied claim with sixty (60) days after receiving a notice from following receipt of the Company that a claim has been denied, in whole or in part, a Claimant request for review (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one one-hundred twenty (120) days after receipt such receipt, in a case where there are special circumstances requiring extension of time for reviewing the appealed claim). The Committee shall deliver the decision to the claimant in writing. If an extension of time for reviewing the appealed claim is required because of special circumstances, written notice of the request extension shall be furnished to the Executive prior to the commencement of the extension. If the decision on review is not furnished within the prescribed time, the claim shall be deemed denied on review.
b. The decision on review shall set forth specific reasons for review. The notice will explain what special circumstances make an extension necessary the decision, and indicate shall cite specific references to the date a final pertinent Program provisions on which the decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 1 contract
Samples: Split Dollar Life Insurance Agreement (Schein Pharmaceutical Inc)
Claims Procedure. To initiate If an indemnified party is of the opinion that he, she or it has or may acquire a claim with respect right to the settlement of Restricted Stock Units deferred in accordance with indemnification under this Section 5(b10.2 (each, an “Indemnification Claim”), Grantee such indemnified party shall so notify the Indemnitor in a written notice (or the person to whom ownership rights may have passed by will or the laws of descent each such notice and distribution) (the including a Claim Notice under Section 10.2(c), an “ClaimantIndemnification Claim Certificate”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claimstating that such indemnified party has directly or indirectly paid, sustained or incurred Damages, or reasonably anticipates that he, she or it will directly or indirectly pay, sustain or incur any part of itDamages, (ii) specific reference(s) to pertinent provisions specifying in reasonable detail the individual items of Damages included in the Plan amount so stated (and the method of computation of each such item of Damages; if applicable), the date each such item of Damages was paid, sustained or this award upon which incurred, or the basis for such denial was basedreasonably anticipated Damages, (iii) a brief description in reasonable detail (to the extent available to such indemnified party) of any additional material the facts, circumstances or information necessary for the Claimant events giving rise to perfect the claimeach item of Damages based on such indemnified party’s good faith belief thereof, and an explanation of why such material or information is necessary, (iv) an explanation the basis for indemnification under Section 10.2 to which such item of Damages is related (including, if applicable, the specific nature of the claim appeal procedure misrepresentation, or the breach of warranty or covenant). If the Indemnitor does not object in writing to the indemnified party within thirty (30) days after Indemnitor’s receipt of such Indemnification Claim Certificate, the Indemnitor shall be conclusively deemed to have acknowledged and irrevocably consented to and agreed with the indemnified party’s recovery of the full amount of all such items of Damages set forth in Section 13(c)such Indemnification Claim Certificate. In the event that the Indemnitor, below; and within thirty (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (6030) days after receiving a notice from the Company that a claim has been deniedreceipt of such Indemnification Claim Certificate, objects in whole writing to any or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review all of the denial Damages set forth in the Indemnification Claim Certificate, the Indemnitor and the indemnified party shall attempt in good faith to agree upon the rights of the claim. The Claimant or his duly authorized representative may, but need not, review respective parties with respect to the pertinent documents and submit issues and comments in writing for consideration by the Companydisputed items of Damages. If the Claimant does not request parties should so agree, a review memorandum setting forth the agreement reached by the parties with respect to such disputed items of the initial determination Damages shall be prepared and signed by both parties. If within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the CompanyIndemnitor’s receipt of a request for reviewsuch Indemnification Claim Certificate, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial reviewand after good faith negotiations, the Company will render a written opinion. The manner and content parties are unable to agree on the rights of the final decision will include the same information described above in Section 13(b) respective parties with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extendedany disputed items of Damages set forth in an Indemnification Claim Certificate, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected indemnified party shall be entitled to be made. Any decision on appeal will be final, conclusive and binding upon exercise all partieslegal remedies available to it under this Agreement.
Appears in 1 contract
Claims Procedure. To initiate Claim forms or claim information as to the subject policy can be obtained by contacting: Kaeding, Ernst & Company, 21 McGrath Highway, Suite 503, Quincy Centxx, XX 00000.
(a) Claims Xxxxx xxx Xxxxxx--When the Named Fiduciary has a claim with respect to which may be covered under the settlement of Restricted Stock Units deferred provisions described in accordance with Section 5(b)the Policy, Grantee (he or she should contact the office or the person named above who will either complete a claim form and forward it to whom ownership rights may have passed by will an authorized representative of the Insurer or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant Named Fiduciary what further requirements are necessary. The Insurer will evaluate the claim and make a decision as to payment within ninety (90) 90 days of receipt of the claim whether date the claim is denied. If special circumstances require more than ninety (90) days for processing, received by the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madeInsurer. If the claim is denied in whole payable, a benefit check will be issued to the Named Fiduciary or in partother party or parties entitled to payment under the Policy and forwarded through the office or person named above. In the event that a claim is not eligible under the Policy, the Claimant Insurer will notify the Named Fiduciary of the denial. Such notification will be provided made in writing within 90 days of the date the claim is received and will be transmitted through the office or person named above. The notification will include the specific reasons for the denial as well as specific reference to the policy provisions upon which the denial is based. The Named Fiduciary will also be informed as to the steps which may be taken to have the claim denial reviewed. A decision as to the validity of a written opinionclaim will ordinarily be made within 10 working days of the date the claim is received by the Insurer. Occasionally, however, certain questions may prevent the Insurer from rendering a decision on the validity of the claim within the specific 90-period. If this occurs, the Named Fiduciary will be notified of the reasons for the delay as well as the anticipated length of the delay, in language calculated writing and through the office or person named above. If further information or other material is required, the Named Fiduciary will be so informed. If the Named Fiduciary is dissatisfied with the denial of the claim or the amount paid, he or she has 60 days from the date he or she receives notice of a claim denial to be understood file his or her objections to the action taken by the ClaimantInsurer. If the Named Fiduciary wishes to contest a claim denial, setting forth he or she should notify the person or office named above who will assist in making inquiry to the insurer. All objections to the Insurer's actions should be in writing and submitted to the person or office named above for transmittal to the Insurer. The Insurer will review the claim denial and render a decision on such objections. The Named Fiduciary will be informed in writing of the decision of the Insurer within 60 days of the date the claim request is received by the Insurer.
(ib) Claims Under the Plan--Claims for any benefits due under the plan or the surrender of the Policy may be made in writing by the Corporation or the Corporation's designated beneficiary and Employee or his designated beneficiary, as the case may be, to the Named Fiduciary. In the event a claim for benefits is wholly or part denied or disputed, the Named Fiduciary shall, within a reasonable period of time after receipt of the claim, notify the Corporation or the designated beneficiary and Employee or his designated beneficiary, as the case may be, of such total or partial denial or dispute listing:
(a) The specific reason(s) reason or reasons for the denial of the claim, or any part of it, dispute;
(iib) specific reference(s) Specific reference to pertinent plan provisions of the Plan or this award upon which such the denial was or dispute is based, ;
(iiic) a A description of any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and,
(ivd) an An explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appealplan's review procedure. Within sixty (60) 60 days after receiving a of denial or notice from of claim under the Company that a claim has been denied, in whole or in partplan, a Claimant (or claimant may request that the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration claim be reviewed by the CompanyNamed Fiduciary in a full and fair hearing. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will A final decision shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented rendered by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) Named Fiduciary within 60 days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 1 contract
Claims Procedure. To initiate a claim with respect (a) In order to seek indemnification under this Article IX, Parent or the Parent Indemnitee must provide notice to the settlement Seller Representatives in a writing that (i) describes in reasonable detail the basis of Restricted Stock Units deferred the claim, to the extent then known by Parent or the Parent Indemnitee (including, to the extent then known, the facts underlying each particular claim and an identification of each section of this Agreement pursuant to which indemnification is being sought); (ii) sets forth a description and Parent’s or the Parent Indemnitee’s good faith estimate (based on information then known by Parent or the Parent Indemnitee) of the amount of damages incurred or reasonably expected to be incurred by the Parent Indemnitee and (iii) contains a demand for payment in the amount of such damages (a “Claim Notice”).
(b) Within twenty (20) calendar days after delivery of a Claim Notice, the Seller Representatives shall deliver to Parent a response, in which the Seller Representatives, on behalf of Sellers shall: (i) agree that Parent is entitled to receive all of the Claimed Amount, in which case each Seller shall deliver to Parent an amount in cash equal to its Pro Rata Portion of the Claimed Amount within two (2) Business Days after the later of (x) the delivery of such response by the Seller Representatives or (y) the delivery by Parent to the Seller Representatives of wire instructions for such payment, (ii) agree that the Parent is entitled to receive a portion of the Claimed Amount (the “Agreed Amount”), in which case each Seller shall deliver to Parent an amount in cash equal to the Pro Rata Portion of the Agreed Amount within two (2) Business Days after the later of (x) the delivery of such response by the Seller Representatives or (y) the delivery by Parent or Parent Indemnitee to the Seller Representatives of wire instructions for such payment or (iii) dispute that the Parent is entitled to receive any of the Claimed Amount (such response, a “Response”).
(c) During the 20-day period following the delivery of a Response that reflects a dispute, the Seller Representatives and Parent shall use good faith efforts to resolve the dispute. If the dispute is not resolved within such 20-day period or such longer period of time as may be mutually agreed between the Seller Representatives and Parent, such dispute shall be resolved in accordance with Section 5(b), Grantee 10.3.
(or the person to whom ownership rights may d) The Seller Representatives shall have passed by will or the laws of descent full power and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt authority on behalf of the claim whether Sellers to take any and all actions on behalf of, execute any and all instruments on behalf of, and execute or waive any and all rights of the claim is denied. If special circumstances require more than ninety (90) days for processingSeller, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to replyunder this Article IX. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected Seller Representatives shall have no Liability to be made. If the claim is denied in whole any Party, as applicable, for any action taken or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial omitted on behalf of the claimSellers, as applicable, pursuant to this Article IX, nor shall Parent or Purchaser have any part of it, (ii) specific reference(s) to pertinent provisions Liability for actions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesSeller Representatives.
Appears in 1 contract
Samples: Share Purchase and Contribution Agreement (Concentrix Corp)
Claims Procedure. To initiate (a) If a claim with respect Member, Beneficiary, alternate payee, or their authorized representative (hereinafter the "Claimant") asserts a right to a benefit under the settlement of Restricted Stock Units deferred in accordance with Section 5(b)Plan which has not been received, Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) Claimant must file a written request claim for such benefit with the CompanyCommittee on forms provided by the Committee. Upon receipt of such claim, The Committee shall render its decision on the Company will advise the Claimant claim within ninety (90) 90 days of after its receipt of the claim whether the claim is deniedclaim. If special circumstances require more than ninety (90) days for processingapply, the Claimant will 90-day period may be notified in writing within ninety (90) days of filing the claims than the Company requires up to extended by an additional ninety (90 days; provided, written notice of the extension is provided to the Claimant during the initial 90) days to reply. The -day period and such notice will explain what indicates the special circumstances make requiring an extension necessary of time and indicate the date a final by which the Committee expects to render its decision is expected to be madeon the claim. If the claim is denied in whole Committee wholly or in partpartially denies the claim, the Committee shall provide written notice to the Claimant will be provided a written opinion, in language calculated to be understood by within the Claimant, setting forth time limitations of the immediately preceding paragraph. Such notice shall set forth:
(i) the specific reason(s) reasons for the denial of the claim, or any part of it, ;
(ii) specific reference(s) reference to pertinent provisions of the Plan or this award upon on which such the denial was is based, ;
(iii) a description of any additional material or information necessary for the Claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ;
(iv) an explanation a description of the claim appeal procedure set forth in Section 13(c)Plan's claims review procedures, belowand the time limitations applicable to such procedures; and and
(v) a statement of the Claimant’s 's right to bring a civil action under section Section 502(a) of ERISA following an adverse determination upon appeal. Within sixty if the claim denial is appealed to the Committee and the Committee fully or partially denies the claim.
(60b) A Claimant whose application for benefits is denied may request a full and fair review of the decision denying the claim by filing, in accordance with such procedures as the Committee may establish, a written appeal which sets forth the documents, records and other information relating to the claim within 60 days after receiving a receipt of the notice of the denial from the Company that a claim has been denied, in whole or in partCommittee. In connection with such appeal and upon request by the Claimant, a Claimant may review (or receive free copies of) all documents, records or other information relevant to the Claimant’s duly authorized representative's claim for benefit, all in accordance with such procedures as the Committee may establish. If a Claimant fails to file an appeal within such 60-day period, he shall have no further right to appeal.
(c) may file with A decision on the Company a written request for appeal by the Committee shall include a review of by the denial of Committee that takes into account all comments, documents, records and other information submitted by the Claimant relating to the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were information was submitted or considered in the initial review, the Company will render a written opinionclaim determination. The manner and content Committee shall render its decision on the appeal not later than 60 days after the receipt by the Committee of the final decision will include the same information described above in Section 13(b) with respect to the initial determinationappeal. If special circumstances require that the sixty (60) day time period be extendedapply, the Company will so notify 60-day period may be extended by an additional 60 days; provided, written notice of the extension is provided to the Claimant during the initial 60-day period and will such notice indicates the special circumstances requiring an extension of time and the date by which the Committee expects to render its decision on the decision claim on appeal. If the Committee wholly or partly denies the claim on appeal, the Committee shall provide written notice to the Claimant within the time limitations of the immediately preceding paragraph. Such notice shall set forth:
(i) the specific reasons for the denial of the claim;
(ii) specific reference to pertinent provisions of the Plan on which the denial is based;
(iii) a statement of the Claimant's right to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Claimant's claim for benefits; and
(iv) a statement of the Claimant's right to bring a civil action under Section 502(a) of ERISA.
(d) In no event may a claim for benefits be filed by a Claimant more than 120 days after the applicable "Notice Date," as soon defined in (i) through (iii) below.
(i) In any case where benefits are paid to the Claimant as possiblea lump sum, but the Notice Date shall be the date of payment of the lump sum.
(ii) In any case where the Committee (prior to the filing of a claim for benefits under this Section 8.10) determines that an individual is not entitled to benefits from the Plan and the Committee provides written notice to such individual of its determination, the Notice Date shall be the date of the individual's receipt of such notice.
(iii) In any case where the Committee provides an individual, in connection with a distributable event under the Plan, a written statement of the vested account balance as of a specific date, the Notice Date shall be the latest date of the individual's receipt of such notice. In no event may any legal proceeding regarding entitlement to benefits or any aspect of benefits under the Plan be commenced later than the earliest of (i) two (2) years after the applicable Notice Date; or (ii) one hundred twenty (1201) days year after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final Claimant receives a decision is expected to be made. Any decision on appeal will be finalfrom the Committee regarding his appeal, conclusive and binding upon all partiesor (iii) the latest date otherwise prescribed by applicable law.
Appears in 1 contract
Samples: Employees' Stock Ownership Plan and Trust Agreement (Massbank Corp)
Claims Procedure. To initiate (a) A claim by a claim with respect Participant, former Participant, Spouse, beneficiary, or any other person shall be presented to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified Plan Administrator in writing within ninety the maximum time permitted by law or under Regulations promulgated by the Secretary of Labor or his delegate.
(90b) days of filing The Plan Administrator shall, within a reasonable time, consider the claims than the Company requires up to an additional ninety claim and shall issue its determination thereon in writing.
(90c) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in partgranted, the Claimant will appropriate distribution or payment shall be provided a made from the Trust Fund as soon as is administratively practicable following such grant.
(d) If the claim is wholly or partially denied, the Plan Administrator shall, within 90 days provide the claimant with written opinionnotice of such denial, setting forth, in language a manner calculated to be understood by the Claimant, setting forth claimant:
(i1) the specific reason(sreason or reasons for such denial;
(2) for specific references to pertinent Plan provisions on which the denial of the claim, or any part of it, is based,
(ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii3) a description of any additional material or information Information necessary for the Claimant claimant to perfect the claim, claim~ and an explanation of why such material or information is necessary, and
(iv4) an explanation of the Plan's claim appeal procedure set forth review procedure. The 90-day period described in Section 13(c), below; and (v) a statement the preceding sentence may be extended in special circumstances for up to an additional 90 days if the claimant is given written notice of the Claimant’s right extension that specifies the reason(s) for the extension.
(e) Each claimant shall have the opportunity to bring a civil action under section 502(a) appeal the Plan Administrator's denial of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, to the Employer in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request writing for a review of the denial of the claimfull and fair review. The Claimant claimant or his duly authorized representative mayrepresentative:
(1) may request a review by filing a written application with the Employer,
(2) may review pertinent documents, but need not, review the pertinent documents and and
(3) may submit issues and comments in writing for consideration writing.
(f) The Plan Administrator may establish such time limits within which a claimant may request review of a denied claim as are reasonable in relation to the nature of the benefit which is the subject of the claim and to other attendant circumstances, but which shall not be less than 60 days after receipt by the Company. If claimant of written notice of denial of his claim.
(g) The decision by the Claimant does not request a Plan Administrator on review of the initial determination within such sixty (60) days period, the Claimant will a claim shall be barred and estopped from challenging the determination. Within sixty (60) made not later than 60 days after the Company’s its receipt of a the request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If unless special circumstances require that the sixty (60) day an extension of time period for processing, in which case a decision shall be extended, the Company will so notify the Claimant and will render the decision rendered as soon as possiblepracticable, but in no event later than one hundred twenty (120) 120 days after receipt of the request for review. Written notice of the extension must be sent to the claimant prior to the commencement of the extension.
(h) The notice will explain what special circumstances make an extension necessary decision on review shall be in writing and indicate shall include specific reasons for the date decision, written in a final manner calculated to be understood by the claimant with specific references to the pertinent Plan provisions on which the decision is expected based.
(i) To the extent permitted by law, the decision of the Plan Administrator, if no review is properly requested, the decision at the Employer on review, as the case may be, shall be final and Binding on all parties. No legal action for benefits under the Plan shall be brought unless and until the claimant has exhausted his remedies under the Plan.
(j) If for any reason the written notice at denial described above is not furnished within 90 days at the Plan Administrator's receipt of a claim for benefits, the lain shall be deemed to be madedenied. Any Likewise, if for any reason the written decision on appeal will review described above Is not furnished within the time prescribed, the claim shall be finaldeemed to be denied on review.
(k) Notwithstanding any other provision of this Section, conclusive any controversy or claim arising out of or relating to a claim for benefits payable by this Plan may, at the option of the claimant, be submitted for settlement by arbitration in accordance with the Employee Benefit Plan Claims Arbitration Rules of the American Arbitration Association, and such rules are incorporated herein by reference. The decision of the arbitrator shall be final and binding on all parties thereto and judgment upon all partiesthe award may be entered in any court having competent jurisdiction.
Appears in 1 contract
Samples: Savings and Protection Plan Joinder Agreement (Petroleum Development Corp)
Claims Procedure. To initiate Any person claiming a claim with respect benefit under the Agreement (a "Claimant") shall present the claim, in writing, to the settlement of Restricted Stock Units deferred Bank, and the Bank shall respond in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madewriting. If the claim is denied in whole or in partdenied, the Claimant will be provided a written opinionnotice of denial shall state, in language a manner calculated to be understood by the Claimant, setting forth :
(i) The specific reason or reasons for denial, with specific references to the specific reason(s) for Agreement provisions on which the denial of the claim, or any part of it, is based;
(ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a A description of any additional material or information necessary for the Claimant to perfect the claimhis, her or its claim and an explanation of why such material or information is necessary, ; and
(iviii) an An explanation of the Agreement's claims review procedure. Upon receipt of any written claim appeal procedure set forth in Section 13(c)for benefits, below; the Bank shall be notified and (v) a statement of shall give due consideration to the Claimant’s right claim presented. If any Claimant claims to bring a civil action be entitled to benefits under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company Agreement and the Bank determines that a the claim has been denied, should be denied in whole or in part, the Bank shall, in writing notify such claimant within ninety (90) days of receipt of the claim that the claim has been denied. The Bank may extend the period of time for making a Claimant (or the Claimant’s duly authorized representative) may file determination with the Company a written request respect to any claim for a review period of up to ninety (90) days, provided that the denial Bank determines that such an extension is necessary because of special circumstances and notifies the claim. The Claimant or his duly authorized representative mayclaimant, but need not, review prior to the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review expiration of the initial determination within such sixty ninety (6090) days day period, of the circumstances requiring the extension of time and the date by which the Plan expects to render a decision. Any Claimant will whose claim is denied, or deemed to be barred and estopped from challenging denied under the determination. Within preceding sentence, or such Claimant's authorized representative, may, within sixty (60) days after the Company’s Claimant's receipt of notice of the denial, or after the date of the deemed denial, request a review of the denial by notice given, in writing, to the Bank. Upon such a request for review, it will the claim shall be reviewed by the Bank (or its designated representative). In connection with the review, the Claimant may have representation, may examine pertinent documents, and may submit issues and comments in writing. Upon receipt of an appeal the Bank shall promptly take action to give due consideration to the appeal. Such consideration may include a hearing of the parties involved, if the Bank feels such a hearing is necessary. In preparing for this appeal the Claimant shall be given the right to review pertinent documents and the initial determinationright to submit in writing a statement of issues and comments. After considering consideration of the merits of the appeal the Bank shall issue a written decision which shall be binding on all materials presented by parties subject to arbitration below. The decision shall specifically state its reasons and pertinent Plan provisions on which it relies. The Bank's decision shall be issued within sixty (60) days after the appeal is filed, except that the Bank may extend the period of time for making a determination with respect to any claim for a period of up to sixty (60) days, provided that the Bank determines that such an extension is necessary because of special circumstances and notifies the Claimant, without regard prior to whether such materials were submitted or considered in the expiration of the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day period, of the circumstances requiring the extension of time period and the date by which the Plan expects to render a decision. The Bank may designate any other person of its choosing to make any determination otherwise required under this Article. Any person so designated shall have the same authority and discretion granted to the Bank hereunder. A claimant whose appeal has been denied under this Section 14 shall have the right to submit said claim to final and binding arbitration pursuant to the rules of the American Arbitration Association in the state of Governing Law as provided for in Section 11 herein above. Any such requests for arbitration must be extended, filed by written demand to the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty American Arbitration Association within sixty (12060) days after receipt of the request for reviewdecision regarding the appeal. The notice will explain what special circumstances make an extension necessary costs and indicate expenses of arbitration, including the date fees of the arbitrators, shall be borne by the losing party. The prevailing party shall recover as expenses all reasonable attorneys' fees incurred by it in connection with the arbitration proceeding or any appeals therefrom. If a final decision is expected Claimant brings a lawsuit for benefits hereunder, to enforce any right hereunder or for other relief arising out of the terms of the Plan, the costs and expenses of litigation by any party shall be madeborne by the losing party. Any decision on appeal will be final, conclusive and binding upon The prevailing party shall recover as expenses all partiesreasonable attorney's fees incurred by it in connection with the proceedings or any appeals therefrom.
Appears in 1 contract
Samples: Endorsement Split Dollar Insurance Agreement (Prudential Bancorp Inc of Pennsylvania)
Claims Procedure. To initiate (i) Benefits will be provided to each Designated Employee as specified in this Plan. If a claim Designated Employee believes that he has not been provided with respect benefits due under the Plan, then the Designated Employee may elect the arbitration procedure in Section 7(b) of this Plan, or alternatively, the Designated Employee (who is hereafter referred to as the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or "Claimant") has the person right to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file make a written request with claim for benefits under the CompanyPlan. Upon receipt Written claims for severance pay benefits shall be governed by the following procedures; any written claims for health or welfare benefits shall be governed by the claims procedures of the applicable health or welfare plan. If such a written claim is made, and the Administrator wholly or partially denies the claim, the Company will advise Administrator shall provide the Claimant within ninety (90) days with written notice of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processingsuch denial, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinionsetting forth, in language a manner calculated to be understood by the Claimant, setting forth :
(iA) the specific reason(sreason or reasons for such denial;
(B) for specific reference to pertinent Plan provisions on which the denial of the claim, or any part of it, is based;
(ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iiiC) a description of any additional material or information necessary for the Claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and
(ivD) an explanation of the claim appeal Plan's claims review procedure set forth in Section 13(c)and time limits applicable to those procedures, below; and (v) including a statement of the Claimant’s 's right to bring a civil action under section ERISA Section 502(a) if the claim is denied on appeal.
(ii) The written notice of ERISA following any claim denial pursuant to Section 7.11(a)(i) shall be given not later than thirty (30) days after receipt of the claim by the Administrator, unless the Administrator determines that special circumstances require an adverse determination upon appeal. Within extension of time for processing the claim, in which event:
(A) written notice of the extension shall be given by the Administrator to the Claimant prior to thirty (30) days after receipt of the claim;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day period for giving notice of a claim denial; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Administrator expects to render the benefit determination.
(iii) The decision of the Administrator shall be final unless the Claimant, within sixty (60) days after receiving a receipt of notice of the claims denial from the Company that a claim has been deniedAdministrator, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company submits a written request to the Board of Directors of CSC, or its delegate, for a review an appeal of the denial of the claimdenial. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such During that sixty (60) days day period, the Claimant will shall be barred provided, upon request and estopped from challenging free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the determinationclaim for benefits. Within sixty The Claimant shall be provided the opportunity to submit written comments, documents, records, and other information relating to the claim for benefits as part of the Claimant's appeal. The Claimant may act in these matters individually, or through his or her authorized representative.
(60iv) After receiving the written appeal, if the Board of Directors of CSC, or its delegate, shall issue a written decision notifying the Claimant of its decision on review, not later than thirty (30) days after the Company’s receipt of the written appeal, unless the Board of Directors of CSC or its delegate determines that special circumstances require an extension of time for reviewing the appeal, in which event:
(A) written notice of the extension shall be given by the Board of Directors of CSC or its delegate prior to thirty (30) days after receipt of the written appeal;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day review period; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Board of Directors of CSC or its delegate expects to render the appeal decision. The period of time within which a benefit determination on review is required to be made shall begin at the time an appeal is received by the Board of Directors of CSC or its delegate, without regard to whether all the information necessary to make a benefit determination on review accompanies the filing of the appeal. If the period of time for reviewing the appeal is extended as permitted above, due to a claimant's failure to submit information necessary to decide the claim on appeal, then the period for making the benefit determination on review shall be tolled from the date on which the notification of the extension is sent to the claimant until the date on which the claimant responds to the request for reviewadditional information.
(v) In conducting the review on appeal, it will review the initial determination. After considering Board of Directors of CSC or its delegate shall take into account all materials presented comments, documents, records, and other information submitted by the Claimantclaimant relating to the claim, without regard to whether such materials were information was submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial benefit determination. If special circumstances require the Board of Directors of CSC or its delegate upholds the denial, the written notice of decision from the Board of Directors of CSC or its delegate shall set forth, in a manner calculated to be understood by the Claimant:
(A) the specific reason or reasons for the denial;
(B) specific reference to pertinent Plan provisions on which the denial is based;
(C) a statement that the sixty Claimant is entitled to be receive, upon request and free of charge, reasonable access to , and copies of, all documents, records and other information relevant to the claim for benefits; and
(60D) day time period be extendeda statement of the Claimant's right to bring a civil action under XXXXX 502(a).
(vi) If the Plan or any of its representatives fail to follow any of the above claims procedures, the Company will so notify Claimant shall be deemed to have duly exhausted the administrative remedies available under the plan and shall be entitled to pursue any available remedies under ERISA Section 502(a), including but not limited to the filing of an action for immediate declaratory relief regarding benefits due under the Plan.
(vii) If the Board of Directors of CSC or its delegate upholds the denial on review of a severance pay claim, or if a health or welfare benefit claim is denied on review under the applicable health or welfare plan and/or the administrative remedies thereunder have been exhausted, then the Claimant and will render shall have the decision as soon as possibleright to bring a civil action under ERISA Section 502(a) or, but no later than one hundred twenty (120alternatively, the Claimant may invoke the arbitration provisions of Section 7(b) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthis Plan.
Appears in 1 contract
Claims Procedure. To initiate a claim with respect to (a) The administrator for purposes of this Agreement shall be the settlement of Restricted Stock Units deferred in accordance with Section 5(bCompany ("Administrator"), Grantee whose address is Champion Enterprises, Inc., 0000 Xxxxxxxxx Xxxxx, Xxxxx 000, Xxxxxx Xxxxx, XX 00000 and whose telephone number is (or the person to whom ownership rights may have passed by will or the laws 000) 000-0000. The "Named Fiduciary" as defined in Section 402(a)(2) of descent and distribution) (the “Claimant”) must file a written request with ERISA, also shall be the Company. Upon receipt of such claimThe Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the Company will advise the Claimant within ninety (90) days of receipt address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim whether for benefits by the claim is denied. If special circumstances require more than ninety Executive (90"the claimant") days for processing, the Claimant will shall be notified stated in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) Administrator and delivered or mailed to the specific reason(s) for the denial claimant within 10 days after receipt of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, (ii) written notice of the extension shall be furnished to the claimant prior to the termination of the initial 10-day period. In no event shall such extension exceed a period of 10 days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the his/her claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the best of the Administrator's ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim appeal procedure for benefits has been wholly or partially denied by the Administrator may request, within 10 days following the date of such denial, in a writing addressed to the Administrator, a review of such denial. The claimant shall be entitled to submit Exhibit 10.27 such issues or comments in writing or otherwise, as he/she shall consider relevant to a determination of his/her claim, and he/she may include a request for a hearing in person before the Administrator. Prior to submitting his/her request, the claimant shall be entitled to review such documents as the Administrator shall agree are pertinent to his/her claim. The claimant may, at all stages of review, be represented by counsel, legal or otherwise, of his/her choice. All requests for review shall be promptly resolved. The Administrator's decision with respect to any such review shall be set forth in Section 13(c), below; writing and (v) a statement shall be mailed to the claimant not later than 10 days following receipt by the Administrator of the Claimant’s right claimant's request unless special circumstances, such as the need to bring hold a civil action under section 502(a) hearing, require an extension of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been deniedtime for processing, in whole or in part, a Claimant (or which case the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does Administrator's decision shall be so mailed not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this section, but who has not obtained full relief on his/her claim for benefits, may, within 90 days following his/her receipt of the Administrator's written decision on review, apply in writing to the Administrator for binding arbitration of his/her claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Detroit, Michigan, in accordance with the commercial arbitration rules of the American Arbitration Association, as then in effect. If the parties are unable to mutually agree upon an arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of which shall be designated by the Company, one of which shall be designated by the claimant and the third of which shall be designated by the first two arbitrators in accordance with the commercial arbitration rules referenced above. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.arbitrator
Appears in 1 contract
Samples: Change in Control Severance Agreement (Champion Enterprises Inc)
Claims Procedure. To initiate a claim with respect to (a) The administrator for purposes of this Agreement shall be the settlement of Restricted Stock Units deferred in accordance with Section 5(bCompany (“Administrator”), Grantee whose address is 40000 Xxxxxxx Xxxxx, Xxxxxxxx, Xxxxxxxx 00000, and whose telephone number is (or the person to whom ownership rights may have passed by will or the laws 000) 000-0000. The “Named Fiduciary” as defined in Section 402(a)(2) of descent and distribution) (the “Claimant”) must file a written request with ERISA, also shall be the Company. Upon receipt of such claimThe Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the Company will advise the Claimant within ninety (90) days of receipt address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim whether for benefits by the claim is denied. If special circumstances require more than ninety Executive (90“the claimant”) days for processing, the Claimant will shall be notified stated in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) Administrator and delivered or mailed to the specific reason(s) for the denial claimant within 10 days after receipt of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, (ii) written notice of the extension shall be furnished to the claimant prior to the termination of the initial 10-day period. In no event shall such extension exceed a period of 10 days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the claim appeal procedure set forth in Section 13(c), below; and (v) a statement best of the ClaimantAdministrator’s right to bring ability in a civil action under section 502(amanner that may be understood without legal or actuarial counsel.
(c) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a A claimant whose claim for benefits has been deniedwholly or partially denied by the Administrator may request, within 60 days following the date of such denial, in whole or in parta writing addressed to the Administrator, a Claimant (review of such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant’s duly authorized representative) claimant shall consider relevant to a determination of the claim, and the claimant may file with the Company include a written request for a hearing in person before the Administrator. Prior to submitting the request, the claimant shall be entitled to review of the denial of such documents as are pertinent to the claim. The Claimant or his duly authorized representative claimant may, but need notat all stages of review, review the pertinent documents and submit issues and comments in writing for consideration be represented by the Company. If the Claimant does not request a review counsel, legal or otherwise, of the initial determination within such sixty (60) days period, the Claimant will claimant’s choice. All requests for review shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionpromptly resolved. The manner and content of the final Administrator’s decision will include the same information described above in Section 13(b) with respect to any such review shall be set forth in writing and shall be mailed to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no claimant not later than one hundred twenty (120) 10 days following receipt by the Administrator of the claimant’s request unless special circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case the Administrator’s decision shall be so mailed not later than 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this Section, but who has not obtained full relief on the claim for benefits, may, within 60 days following the claimant’s receipt of the Administrator’s written decision on review, apply in writing to the Administrator for binding arbitration of the claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Plymouth, Michigan, in accordance with the arbitration rules of the American Arbitration Association, Commercial Disputes Resolution Procedures, as then in effect. If the parties are unable to mutually agree upon an arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of which shall be designated by the Company, one of which shall be designated by the claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the arbitration rules referenced above. The notice will explain what special circumstances make an extension necessary arbitrator(s) sole authority shall be to interpret and indicate apply the date a final decision is expected provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of the Agreement’s provisions. The arbitrator(s) shall have the power to be madecompel attendance of witnesses at the hearing. Any decision on appeal will be final, conclusive and binding court having jurisdiction may enter a judgment based upon all parties.such
Appears in 1 contract
Claims Procedure. To initiate a claim with respect (a) Any person entitled to benefits under the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) Agreement (the “"Claimant”") must file a written claim request with the Company. Upon receipt person authorized by the Board to fulfill the responsibilities of such claimthe Corporation as Plan Administrator, on a form provided by the Company Plan Administrator.
(b) A claim for benefits will advise be denied if the Corporation determines that the Claimant within ninety (90) days of receipt of is not entitled to receive benefits under the claim whether the claim is deniedAgreement. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified The Plan Administrator shall provide adequate notice in writing within ninety (90) days of filing to any Claimant whose claim for benefits under the claims than Agreement has been denied, and the Company requires up notice to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth claimant shall set forth:
(i) the The specific reason(s) reason for the denial of the claim, or any part of it, ;
(ii) specific reference(s) Specific references to pertinent provisions of the Plan or this award upon Agreement on which such the denial was is based, ;
(iii) a A description of any additional material or and information necessary needed for the Claimant to perfect the claim, his claim and an explanation of why such the material or information is necessary, needed; and
(iv) an explanation A statement that the claimant may; - Request a review of his claim upon written application to the Corporation, which is the Named Fiduciary under the Agreement; - Review pertinent documents affecting his claim; and - Submit issues and comments in writing.
(c) Any appeal the Claimant wishes to make of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within must be made by the Claimant in writing to the Plan Administrator within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review receipt of the written notice of denial of the claim. The failure of the Claimant or his duly authorized representative may, but need not, review to appeal the pertinent documents and submit issues and comments denial to the Plan Administrator in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the Plan Administrator's determination final, binding, and conclusive.
(d) If the Claimant should appeal to the Plan Administrator, he, or his duly authorized representative, may submit, in writing, whatever issues and comments he, or his duly authorized representative, feels are pertinent. The Plan Administrator shall re-examine all facts related to the appeal and make a final determination as to whether the denial of benefits is justified under the circumstances. The Plan Administrator shall advise the Claimant of its decision within sixty (60) days of the Claimant's written request for review, unless special circumstances (such as soon as possiblea hearing) would make a rendering of a decision within the sixty (60) day period infeasible, but in no event shall the Plan Administrator render a decision with respect to a denial for a claim for benefits later than one hundred twenty (120) days after receipt of the a request for review. The notice will explain what special circumstances make an extension necessary A written statement stating the decision on review, the specific reasons for the decision, and indicate the date a final specific provisions of the Agreement on which the decision is expected based shall be mailed or delivered to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthe Claimant within such sixty (60) (or one hundred twenty (120)) day period.
Appears in 1 contract
Samples: Deferred Compensation Agreement (BGF Industries Inc)
Claims Procedure. To initiate a claim with respect to (a) In the settlement event the Executive or her beneficiary in the case of Restricted Stock Units deferred in accordance with Section 5(b), Grantee the Executive's death or their authorized representative (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claimhereinafter, the Company will advise the Claimant within ninety (90"Claimant") days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processingasserts a right to a benefit under this Agreement which has not been received, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be must file with the Bank a claim for such benefit on forms provided a written opinion, in language calculated to be understood by the ClaimantBank. The Bank shall render its decision on the claim within ninety (90) days after receipt of the claim. If special circumstances apply, setting forth the ninety (90) day period may be extended by an additional ninety (90) days, provided written notice of the extension is given to the Claimant during the initial ninety (90) day period and such notice indicates the special circumstances requiring an extension of time and the date by which the Bank expects to render its decision on the claim. If the Bank wholly or partially denies the claim, the Bank shall provide written notice to the Claimant within the time limitations of this Section. Such notice shall set forth:
(i) the specific reason(s) reasons for the denial of the claim, or any part of it, ;
(ii) specific reference(s) reference to pertinent provisions of the Plan or this award upon Agreement on which such the denial was is based, ;
(iii) a description of any additional material or information necessary for the Claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ;
(iv) an explanation a description of the claim appeal procedure set forth in Section 13(c)Agreement's claims procedures, belowand the time limitations applicable to such procedures; and and
(v) a statement of the Claimant’s 's right to bring a civil action under section Section 502(a) of ERISA following an adverse determination upon appeal. Within the Employee Retirement Income Security Act of 1974, as amended, ("ERISA") if the claim denial is appealed to the Bank and the Bank fully or partially denies the claim pursuant to Section 7(c).
(b) A Claimant whose application for benefits is denied in whole or in part may request a full and fair review of the decision denying the claim by filing, in accordance with such procedures as the Bank may reasonably establish, a written appeal which sets forth the documents, records and other information relating to the claim within sixty (60) days after receiving a receipt of the notice from of the Company that a claim has been denied, in whole or in partdenial by the Bank. In connection with such appeal and upon request by the Claimant, a Claimant may review (or receive free copies of) all documents, records or other information relevant to the Claimant’s duly authorized representative) 's claim for benefit, all in accordance with such procedures as the Bank may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Companyreasonably establish. If the a Claimant does not request a review of the initial determination fails to file an appeal within such sixty (60) days day period, she shall have no further right to appeal.
(c) A decision on the appeal by the Bank shall include a review by the Bank that takes into account all comments, documents, records and other information submitted by the Claimant will be barred and estopped from challenging relating to the claim, without regard to whether such information was submitted or considered in the initial claim determination. Within The Bank shall render its decision on the appeal no later than sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content Bank of the final decision will include the same information described above in Section 13(b) with respect to the initial determinationappeal. If special circumstances require that apply, the sixty (60) day period may be extended by an additional sixty (60) days, provided written notice of the extension is given to the Claimant during the initial sixty (60) day period and such notice indicates the special circumstances requiring an extension of time period be extendedand the date by which the 77 Bank expects to render its decision on the claim on appeal. If the Bank wholly or partly denies the claim on appeal, the Company will so notify Bank shall provide written notice to the Claimant and will render within the decision as soon as possible, but no later than one hundred twenty time limitations of this Section. Such notice shall set forth:
(120i) days after receipt the specific reasons for the denial of the claim;
(ii) specific reference to pertinent provisions of the Agreement on which the denial is based;
(iii) a statement of the Claimant's right to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Claimant's claim for reviewbenefits; and
(iv) a Statement of the Claimant's right to bring a civil action under Section 502(a) of ERISA,
(d) The Bank shall be the Plan Administrator with respect to this Agreement.
(e) As Plan Administrator, the Bank shall have complete authority, in its sole and absolute discretion, to interpret the provisions of this Agreement and make determinations regarding eligibility. The notice will explain what special circumstances make an extension necessary Without limiting the foregoing, it is the Bank's intent that the Agreement be administered in a manner compliant with the provisions of Section 409A of the Code, and indicate regulations and rulings issued thereunder so as not to subject the date a final decision is expected benefits accruing hereunder to be made. Any decision on appeal will be final, conclusive and binding upon all partiestaxation pursuant to said Section 409A(a)(1).
Appears in 1 contract
Samples: Supplemental Executive Retirement Agreement (First Litchfield Financial Corp)
Claims Procedure. To initiate Claim forms or claim information as to the subject Policy(ies) can be obtained by contacting: Xxx XxXxx Xxxxxx & Xxxxxxx, Inc. 00 X. Xxxx Xxxxxx Xxxxxxxx, XX 00000 When the Named Fiduciary has a claim with respect to which may be covered under the settlement of Restricted Stock Units deferred provisions described in accordance with Section 5(b)an insurance Policy, Grantee he (or she) should contact the office or the person named above who will either complete a claim form and forward it to whom ownership rights may have passed by will an authorized representative of the Insurer(s) or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant Named Fiduciary what further requirements are necessary. The Insurer(s) will evaluate the claim and make a decision as to payment within ninety (90) 90 days of receipt of the claim whether date the claim is denied. If special circumstances require more than ninety (90) days for processing, received by the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madeInsurer(s). If the claim is denied in whole payable, a benefit check will be issued to the Named Fiduciary and forwarded through the office or in partperson named above. In the event that a claim is not eligible under a Policy(ies), the Claimant Insurer(s) will notify the Named Fiduciary of the denial. Such notification will be provided made in writing within 90 days of the date the claim is received and will be transmitted through the office or person named above. The notification will include the specific reasons for the denial as well as specific reference to the policy provisions upon which the denial is based. The Named Fiduciary will also be informed as to the steps which may be taken to have the claim denial reviewed. A decision as to the validity of a written opinionclaim will ordinarily be made within 10 working days of the date the claim is received by the Insurer(s). Occasionally, however, certain questions may prevent the Insurer(s) from rendering a decision on the validity of the claim within the specific 90-day period. If this occurs, the Named Fiduciary will be notified of the reasons for the delay as well as the anticipated length of the delay, in language calculated to writing and through the office or person named above. If further information or other material is required, the Named Fiduciary will be understood by so informed. If the Claimant, setting forth (i) the specific reason(s) for Named Fiduciary is dissatisfied with the denial of the claimclaim or the amount paid, he or she has 60 days from the date he (or she) receives notice of a claim denial to file his (or her) objections to the action taken by the Insurer(s). If the Named Fiduciary wishes to contest a claim denial, he (or she) should notify the person or office named above who will assist in making inquiry to the Insurer(s). All objections to the Insurer(s)'s actions should be in writing and submitted to the person or office named above for transmittal to the Insurer(s). The Insurer(s) will review the claim denial and render a decision on such objections. The Named Fiduciary will be informed in writing of the decision of the Insurer(s) within 60 days of the date the claim request is received by the Insurer(s). This decision will be final. Once a decision has been rendered as to the distribution of Policy(ies) proceeds under the claim procedure described above, claims for any part of it, (ii) specific reference(s) to pertinent provisions of benefits due under the Plan or this award the surrender of a Policy(ies) may be made in writing by the Bank or the Bank's designated representative and Director or his designated beneficiary(ies), as the case may be, to the Named Fiduciary. In the event a claim for benefits is wholly or partly denied or disputed, the Named Fiduciary shall, within a reasonable period of time after receipt of the claim, notify the Bank or the Bank's designated representative and Insured or his (or her) designated beneficiary(ies), as the case may be, of such total or partial denial or dispute listing:
A. The specific reason or reasons for the denial or dispute;
B. Specific reference to pertinent plan provisions upon which such the denial was or dispute is based, (iii) a ;
C. A description of any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of why such material or information is necessary, (iv) an ; and,
D. An explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appealPlan's review procedure. Within sixty (60) 60 days after receiving a of denial or notice from of claim under the Company that a claim has been denied, in whole or in partPlan, a Claimant (or claimant may request that the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration claim be reviewed by the CompanyNamed Fiduciary in a full and fair hearing. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will A final decision shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented rendered by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) Named Fiduciary within 60 days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 1 contract
Claims Procedure. To initiate (i) An Indemnified Person shall give prompt written notice (a “Claim Notice”) to the Indemnifying Person (which if the Sellers are the Indemnifying Persons pursuant to Section 7.2, the Indemnified Person shall provide such Claim Notice to the Sellers’ Representative for all purposes of this Article VII) after the Indemnified Person first becomes aware of any event or other facts that has resulted or that would reasonably be expected to result in any Loss for which the Indemnified Person is entitled to any indemnification under this Agreement, and such notice shall contain (A) a description and, if known, the estimated amount of any Loss incurred or reasonably expected to be incurred by the Indemnified Person, (B) a reasonable explanation of the basis for the Claim Notice to the extent of the facts then known by the Indemnified Person and (C) a demand for payment of such Loss; provided that failure to give such notification shall not affect the indemnification provided hereunder except to the extent, and only to the extent that, the Indemnifying Person shall have been actually and materially prejudiced as a result of such failure.
(ii) The Sellers’ Representative (if the Indemnifying Persons are the Sellers pursuant to Section 7.2) or the Purchaser (if the Indemnifying Persons are the Purchaser pursuant to Section 7.3) may in good faith, at any time on or before the tenth Business Day following its receipt of a Claim Notice (the “Objection Period”), object to the claim made in such Claim Notice by delivering written notice to the Indemnified Person and the Escrow Agent (a “Claim Objection”). The Claim Objection shall set forth in reasonable detail the good faith reasons for the objection to such claim for indemnification, and the amount of any claimed Loss which is disputed. If the Sellers’ Representative (if the Indemnifying Persons are the Sellers pursuant to Section 7.2) or the Purchaser (if the Indemnifying Persons are the Purchaser pursuant to Section 7.3), as applicable, does not timely deliver a Claim Objection, or delivers a Claim Objection that does not object to all of the Losses set forth in the Claim Notice, the Indemnifying Persons shall be deemed to have accepted and agreed with all or such portion of the claim and shall be conclusively deemed to have consented to the recovery by the Indemnified Person of all or such portion of the Losses specified in the Claim Notice. If the Sellers’ Representative (if the Indemnifying Persons are the Sellers pursuant to Section 7.2) or Purchaser (if the Indemnifying Persons are the Purchaser pursuant to Section 7.3) timely delivers a Claim Objection, the Purchaser and the Sellers’ Representative, as applicable, shall attempt in good faith to agree upon the rights of the respective parties with respect to the settlement disputed items of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or Losses and if the person parties are not able to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of fully resolve all such claim, the Company will advise the Claimant differences within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Companyapplicable party’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial reviewClaim Objection, the Company will render a written opinion. The manner and content of Purchaser or the final decision will include Sellers’ Representative, as applicable, shall have the same information described above in right to pursue legal recourse pursuant to Section 13(b7.5(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbelow.
Appears in 1 contract
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred Benefits shall be paid in accordance with Section 5(b)the provisions of this Agreement. The Executive, Grantee (or a designated recipient or any other person claiming through the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file Executive shall make a written request with for benefits under this Agreement, This written claim shall be mailed or delivered to the CompanyFiduciary. Upon receipt of such claimSuch claim shall be reviewed by the Fiduciary. If the claim is denied, in full or in part, the Company will advise the Claimant Fiduciary shall provide a written notice within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) reasons for denial, specific reference to the provisions of this Agreement upon which the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was is based, (iii) a description of and any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an and appropriate information and explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) steps to be taken if a statement review of the Claimant’s right to bring denial is desired. If the claim is denied and a civil action under section 502(areview is desired, the Executive (or beneficiary) of ERISA following an adverse determination upon appeal. Within shall notify the Fiduciary in writing within sixty (60) days after receiving a notice from the Company that [a claim has been denied, in whole or in part, a Claimant shall be deemed denied if the Fiduciary does not take any action within the aforesaid ninety (or the Claimant’s duly authorized representative90) may file with the Company a written request for a review day period] after receipt of the denial written notice of denial. In requesting a review, the claim. The Claimant Executive or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not beneficiary may request a review of the initial determination Plan Document or other pertinent documents with regard to the employee benefit plan created under this Agreement, may submit any written issues and comments, may request an extension of time for such written submission of issues and comments, and may request that a hearing be held, but the decision to hold a hearing shall be within such sixty (60) days period, the Claimant will sole discretion of the Fiduciary. The decision on the review of the denial claim shall be barred and estopped from challenging rendered by the determination. Within Fiduciary within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for reviewreview (if a hearing is held) or within sixty (60) days after the hearing if one is held. The notice will explain what special circumstances make an extension necessary decision shall be written stating the specific reasons for the decision and indicate shall include reference to specific provisions of this Agreement on which the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 1 contract
Samples: Executive Salary Continuation Agreement (Pacific Community Banking Group)
Claims Procedure. To initiate (a) The administrator for purposes of this Agreement shall be ProAssurance ("Administrator"), whose address is 000 Xxxxxxxxx Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000; Telephone: (000) 000-0000. The "Named Fiduciary" as defined in Section 402(a)(2) or ERISA, also shall be ProAssurance. ProAssurance shall have the right to designate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. ProAssurance shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim with respect for benefits by the Executive ("the claimant") shall be stated in writing by the Administrator and delivered or mailed to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee claimant within ten (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (9010) days of after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 10-day period. In no event shall such extension exceed a period often (ii10) days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the claim appeal procedure set forth in Section 13(c), below; and (v) a statement best of the Claimant’s right to bring Administrator's ability in a civil action under section 502(amanner that may be understood without legal or actuarial counsel.
(c) of ERISA following an adverse determination upon appeal. Within sixty A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (6010) days after receiving a notice from following the Company that a claim has been deniedreceipt of such denial, in whole or in parta writing addressed to the Administrator, a Claimant (review of such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant’s duly authorized representative) claimant shall consider relevant to a determination of the claim, and the claimant may file with the Company include a written request for a hearing in person before the Administrator. Prior to submitting the request, the claimant shall be entitled to review of such documents as the denial of Administrator shall agree are pertinent to the claim. The Claimant or his duly authorized representative claimant may, but need notat all stages of review, review the pertinent documents and submit issues and comments in writing for consideration be represented by the Company. If the Claimant does not request a review counsel, legal or otherwise, of the initial determination within such sixty (60) days period, the Claimant will claimant's choice. All requests for review shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionpromptly resolved. The manner and content of the final Administrator's decision will include the same information described above in Section 13(b) with respect to any such review shall be set forth in writing and shall be mailed to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no claimant not later than one hundred ten (10) days following receipt by the Administrator of the claimant's request unless special circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case the Administrator's decision shall be so mailed not later than twenty (12020) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiessuch request.
Appears in 1 contract
Samples: Release and Severance Compensation Agreement (Proassurance Corp)
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distributiona) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, by the Company will advise Escrow Agent on or before the Claimant within ninety (90) days of receipt last day of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days Escrow Period of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood certificate signed by the Claimant, setting forth any executive officer of Parent: (i) stating that an Indemnified Party has paid, sustained or incurred Losses and (ii) specifying in reasonable detail the specific reason(s) for individual items of Losses included in the denial amount so stated, the date each such item was paid, sustained or incurred, and the nature of the claimmisrepresentation, breach of representation, warranty, agreement or any part covenant to which such item is related (an “Officer’s Certificate”), the Escrow Agent shall set aside a portion of itthe Indemnity Escrow Amount equal to such alleged Losses. Upon the earliest of: (i) receipt of written authorization from the Representative or from the Representative jointly with Parent to make such delivery, (ii) specific reference(s) to pertinent provisions receipt of written notice of a final decision of the Plan claim pursuant to Section 7.5, or this award upon which such denial was based, (iii) a description of any additional material or information necessary for in the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of event the claim appeal procedure set forth in Section 13(c), below; and (v) a statement the Officer’s Certificate is uncontested by the Representative as of the Claimantclose of business on the next Business Day following the forty-fifth (45th) day following receipt by the Escrow Agent of the Officer’s right Certificate, on the next Business Day the Escrow Agent shall deliver the portion of the Indemnity Escrow Amount to bring such Indemnified Party equal to the amount of Losses to be paid.
(b) At the time of delivery of any Officer’s Certificate to the Escrow Agent, a civil action under section 502(a) duplicate copy of ERISA following an adverse determination upon appeal. Within sixty such Officer’s Certificate shall be delivered to the Representative and for a period of forty-five (6045) days after receiving a notice such delivery to the Escrow Agent of such Officer’s Certificate, the Escrow Agent shall make no delivery of any portion of the Indemnity Escrow Amount unless the Escrow Agent shall have received written authorization from the Company that a claim has been denied, in whole or in part, a Claimant Representative to make such delivery. After the expiration of such forty-five (or the Claimant’s duly authorized representative45) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days day period, the Claimant will Escrow Agent shall make delivery of the applicable portion of the Indemnity Escrow Amount in accordance with this Section 7.4(b); provided that no such payment or delivery may be barred and estopped from challenging made if the determination. Within sixty (60) days after Representative shall object in a written statement to the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered claim made in the initial reviewOfficer’s Certificate, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect such statement shall have been delivered to the initial determination. If special circumstances require that Escrow Agent and to Parent prior to the sixty expiration of such forty-five (6045) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesperiod.
Appears in 1 contract
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (a) A Participant or the person to whom ownership rights may have passed by will or the laws of descent and distribution) Beneficiary (the “Claimantclaimant”) must file shall have the right to request any benefit under the Plan by filing a written request claim for any such benefit with the CompanyAdministrator on a form provided or approved by the Administrator for such purpose. Upon receipt of The Administrator (or a claims fiduciary appointed by the Administrator) shall give such claimclaim due consideration and shall either approve or deny it in whole or in part. The following procedure shall apply:
(i) The Administrator (or a claims fiduciary appointed by the Administrator) may schedule and hold a hearing.
(ii) If the claim is not a Disability Benefit Claim, the Company will advise the Claimant within ninety (90) days of following receipt of such claim by the Administrator, notice of any approval or denial thereof, in whole or in part, shall be delivered to the claimant or his duly authorized representative or such notice of denial shall be sent by mail (postage prepaid) to the claimant or his duly authorized representative at the address shown on the claim whether the claim is deniedform or such individual’s last known address. If special circumstances require more than The aforesaid ninety (90) day response period may be extended to one hundred eighty (180) days for processing, after receipt of the Claimant will claimant’s claim if special circumstances exist and if written notice of the extension to one hundred eighty (180) days indicating the special circumstances involved and the date by which a decision is expected to be notified in writing made is furnished to the claimant or his duly authorized representative within ninety (90) days after receipt of filing the claims than the Company requires up to an additional ninety claimant’s claim.
(90iii) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied a Disability Benefit Claim, within forty-five (45) days following receipt of such claim by the Administrator, notice of any approval or denial thereof, in whole or in part, shall be delivered to the Claimant will claimant or his duly authorized representative or such notice of denial shall be sent by mail to the claimant or his duly authorized representative at the address shown on the claim form or such individual’s last known address. The aforesaid forty-five (45) day response period may be extended to seventy-five (75) days after receipt of the claimant’s claim if it is determined that such an extension is necessary due to matters beyond the control of the Plan and if written notice of the extension to seventy-five (75) days indicating the circumstances involved and the date by which a decision is expected to be made is furnished to the claimant or his duly authorized representative within forty-five (45) days after receipt of the claimant’s claim. Thereafter, the aforesaid seventy-five (75) day response period may be extended to one hundred five (105) days after receipt of the claimant’s claim if it is determined that such an extension is necessary due to matters beyond the control of the Plan and if written notice of the extension to one hundred five (105) days indicating the circumstances involved and the date by which a decision is expected to be made is furnished to the claimant or his duly authorized representative within seventy-five (75) days after receipt of the claimant’s claim. In the event of any such extension, the notice of extension shall specifically explain, to the extent applicable, the standards on which entitlement to a benefit is based, the unresolved issues that prevent a decision on the claim, and the additional information needed to resolve those issues, and the claimant shall be afforded at least forty-five (45) days within which to provide any specified information which is to be provided by the claimant.
(iv) Any notice of denial shall be written in a written opinion, in language manner calculated to be understood by the Claimant, setting claimant and shall:
(A) Set forth a specific reason or reasons for the denial,
(iB) Make reference to the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan document or this award upon other relevant documents, records or information on which such the denial was is based, ,
(iiiC) a description of Describe any additional material or information necessary for the Claimant claimant to perfect the claim, claim and an explanation of explain why such material or information is necessary,
(D) Explain the Plan’s claim review procedures, including the time limits applicable to such procedures (iv) an explanation which are generally contained in of the claim appeal procedure set forth in Section 13(csubparagraph 8.10(b)), below; and (v) provide a statement of the Claimantclaimant’s right to bring a civil action in state or federal court under section Section 502(a) of ERISA the Act following an adverse determination on review of the claim denial,
(E) In the case of a Disability Benefit Claim, if an internal rule, guideline, protocol, or other similar criterion was relied upon appeal. Within sixty (60) days after receiving in making the adverse determination, either provide the specific rule, guideline, protocol or other similar criterion, or provide a notice from statement that such a rule, guideline, protocol or other similar criterion was relied upon in making the Company adverse determination and that a copy of such rule, guideline, protocol or other criterion will be provided free of charge to the claimant or his duly authorized representative upon request in writing, and
(F) In the case of a Disability Benefit Claim, if the adverse benefit determination is based on a medical necessity or experimental treatment or similar exclusion or limit, either provide an explanation of the scientific or clinical judgment for the determination, applying the terms of the Plan to the claimant’s medical circumstances, or provide a statement that such explanation will be provided free of charge upon request in writing.
(b) A Participant or Beneficiary whose claim filed pursuant to subparagraph 8.10
(a) has been denied, in whole or in part, a Claimant may, within sixty (60) days (or one hundred eighty (180) days in the Claimant’s duly authorized representativecase of a Disability Benefit Claim) may file with following receipt of notice of such denial, make written application to the Company a written request Administrator for a review of such claim, which application shall be filed with the denial Administrator. For purposes of such review, the claim. following procedure shall apply:
(i) The Claimant Administrator (or a claims fiduciary appointed by the Administrator) may schedule and hold a hearing.
(ii) The claimant or his duly authorized representative mayshall be provided the opportunity to submit written comments, but need notdocuments, review records, and other information relating to the pertinent documents and submit issues and comments claim for benefits.
(iii) The claimant or his duly authorized representative shall be provided, upon request in writing for consideration and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to such claim and may submit to the Administrator written comments, documents, records, and other information relating to such claim.
(iv) The Administrator (or a claims fiduciary appointed by the Company. If Administrator) shall make a full and fair review of any denial of a claim for benefits, which shall include:
(A) Taking into account all comments, documents, records, and other information submitted by the Claimant claimant or his duly authorized representative relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination, and
(B) In the case of a Disability Benefit Claim:
(I) Providing for a review that does not request afford deference to the initial claim denial and that is conducted by an appropriate named fiduciary of the Plan who is neither the individual who made the claim denial that is the subject of the review, nor the subordinate of such individual,
(II) In making its decision on a review of any claim denial that is based in whole or in part on a medical judgment, including determinations with regard to whether a particular treatment, drug, or other item is experimental, investigational, or not medically necessary or appropriate, consulting with a health care professional who has appropriate training and experience in the initial determination within such sixty field of medicine involved in the medical judgment,
(60III) days periodProviding to the claimant or his authorized representative, either upon request in writing and free of charge or automatically, the Claimant will identification of medical or vocational experts whose advice was obtained on behalf of the Plan in connection with the claim denial that is the subject of the review, without regard to whether the advice was relied upon in making the benefit determination, and
(IV) Ensuring that the health care professional engaged for purposes of a consultation under clause (iii)(B)(II) of this subparagraph shall be barred and estopped from challenging an individual who is neither an individual who was consulted in connection with the determination. Within claim denial that is the subject of the review, nor the subordinate of any such individual.
(v) If the claim is not a Disability Benefit Claim, the decision on review shall be issued promptly, but no later than sixty (60) days after receipt by the CompanyAdministrator of the claimant’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after such receipt if a hearing is to be held or if other special circumstances exist and if written notice of the request for review. The notice will explain what extension to one hundred twenty (120) days indicating the special circumstances make an extension necessary involved and indicate the date by which a final decision is expected to be made. Any made on review is furnished to the claimant or his duly authorized representative within sixty (60) days after the receipt of the claimant’s request for a review.
(vi) If the claim is a Disability Benefit Claim, the decision on appeal will review shall be finalissued promptly, conclusive but no later than forty-five (45) days after receipt by the Administrator of the claimant’s request for review, or ninety (90) days after such receipt if a hearing is to be held or if other special circumstances exist and binding upon all partiesif written notice of the extension to ninety (90) days indicating the special circumstances involved and the date by which a decision is expected to be made on review is furnished to the claimant or his duly authorized representative within forty-five (45) days after the receipt of the claimant’s request for a review.
Appears in 1 contract
Samples: Profit Sharing Plan Adoption Agreement (Southern National Bancorp of Virginia Inc)
Claims Procedure. To initiate a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(sIf any communication or notice is received by a Purchaser Indemnified Person from a Tax Authority (“Tax Notice”) for the denial in respect of the claima Tax Claim arising out of Clause 6.2(a) and such Purchaser Indemnified Person intends to make an indemnity claim pursuant to this Clause 6.2, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claimit shall promptly, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but any event no later than one hundred twenty the earlier of (120A) days 3 (three) Business Days after receipt of the request for reviewTax Notice, and (B) if the Tax Notice is received sufficiently in advance, 3 (three) Business Days prior to the deadline given by the Tax Authority to submit the response, provide a copy of the Tax Notice (along with relevant information and documents) to the concerned Seller (a “Tax Notice Intimation”). Any failure to deliver the Tax Notice Intimation within the period mentioned in the preceding sentence shall not relieve the concerned Seller of its indemnification obligations under this Agreement unless (and only to the extent that) the Seller’s ability to contest the claim is materially prejudiced by such delay or failure to notify.
(ii) The notice concerned Seller shall promptly and in any event no later than 5 (five) Business Days after receipt of the Tax Notice Intimation or the Due Date if the Tax Notice is received sufficiently in advance, whichever is earlier, inform the Purchaser in writing, whether it will explain what special circumstances make an extension necessary payment of all amounts claimed under the Tax Notice including tax, interest, penalties, and indicate all additional Tax Losses incurred after the date of the Tax Notice (“Tax Claim Amounts”) or contest the Tax Notice before the relevant Tax Authority.
(iii) Subject to 6.2(b)(i) and 6.3, the concerned Seller, shall, at least 3 (three) Business Days prior to expiry of the time period for payment of the Tax Claim Amount (such prior date, the “Due Date”), pay the entire Tax Claim Amounts: (A) directly to the Tax Authorities on its own account and simultaneously with such payment, provide the Purchaser Indemnified Persons evidence of such payment provided such payment by the concerned Seller unequivocally discharges the Purchaser Indemnified Persons for the liability towards such Tax Claim Amount; or (B) if permitted by the Applicable Law, directly to the relevant Tax Authority (on behalf of the Purchaser Indemnified Persons) in the manner as stipulated in the Tax Notice and simultaneously with such payment, provide the Purchaser Indemnified Persons evidence of such payment; or (C) to the Purchaser Indemnified Persons, if the concerned Seller is not permitted by Applicable Law to make payment of the Tax Claim Amounts to the Tax Authorities directly on behalf of the Purchaser Indemnified Persons; provided the Purchaser Indemnified Person shall forthwith make the payment to the relevant Tax Authority and shall notify the concerned Seller in writing, as soon as practicable, and in any case no later than 5 (five) Business Days from the date of the payment along with evidence of such payment. Further, in such a final decision case, any Losses arising on account of any delay by the Purchaser Indemnified Persons to make such payment to the Tax Authority within the prescribed Due Date shall be on account of the Purchaser Indemnified Persons. It is expected clarified that the concerned Seller shall be entitled to exercise all legal remedies available including to seek a stay, injunction or deferral of the payment (“Tax Injunctive Order”) of any amounts that are claimed to be made. Any decision on appeal will paid by the Purchaser Indemnified Parties to the Tax Authority, if permitted by Applicable Law, and for as long as the Tax Injunctive Order suspends the obligation to make such payments, the concerned Seller shall not be final, conclusive and binding upon all partiesobligated to make payment to the Purchaser Indemnified Parties.
Appears in 1 contract
Samples: Share Purchase Agreement
Claims Procedure. To initiate (a) All claims for benefits or for determination of the qualified status of a claim domestic relations order under this Plan shall be filed in writing with respect to the settlement of Restricted Stock Units deferred Plan Administrator in accordance with Section 5(b)such procedures as the Plan Administrator shall reasonably establish.
(b) The Plan Administrator shall, Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt submission of the a claim, provide adequate notice in writing to any claimant whose claim whether the claim is has been denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The Such notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) shall contain the specific reason(s) reason or reasons for the denial of and references to specific Plan provisions on which the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of denial is based. The Plan Administrator will also provide the Plan or this award upon which such denial was based, (iii) claimant with a description of any additional material or information which is necessary in order for the Claimant claimant to perfect the claim, his claim and an explanation of why such material or information is necessary. If special circumstances require an extension of time for processing the claim, (iv) an explanation the Plan Administrator shall furnish the claimant a written notice of such extension prior to the expiration of the claim appeal procedure set forth in Section 13(c)ninety (90) day period. The extension notice shall indicate the reasons for the extension and the expected date for a final decision, below; which date shall not be more than one hundred and eighty (v180) days from the initial claim.
(c) The Plan Administrator shall, upon written request by a statement of claimant submitted to the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within Plan Administrator within sixty (60) days after receiving a of the claimant's receipt of the notice from the Company that a his claim has had been denied, in whole or in partafford a reasonable opportunity to such claimant, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a full and fair review by the Plan Administrator of the denial of decision denying the claim. The Claimant or his duly authorized representative may, but need not, Plan Administrator will afford the claimant the opportunity to review the pertinent documents and to submit issues and comments in writing for consideration by writing. The claimant shall have the Company. If the Claimant does not request a review of the initial determination right to be represented.
(d) The Plan Administrator shall, within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s of receipt of a request for a review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of decision on the final decision will include the same information described above in Section 13(b) with respect to the initial determinationreview. If special circumstances require that extra time for the sixty (60) day time period be extendedPlan Administrator to review the decision, the Company Plan Administrator will so notify attempt to complete the Claimant and will render the decision review as soon as possiblepracticable, but and in no later event will the Plan Administrator take more than one hundred and twenty (120) days after receipt to send the claimant a written notice of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesreview.
Appears in 1 contract
Claims Procedure. To initiate a Any claim with respect for benefits under the Fund shall be made in writing and submitted to the settlement Plan Administrator, who shall reach a decision as soon as reasonable under the circumstances and notify the claimant, or his duly authorized representative, thereof promptly (and, except as provided herein, within 90 days of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of the claim) in writing by mail addressed to the last known address of the claimant or such representative, as the case may be, appearing on the records of the Plan Administrator. If the Plan Administrator determines that special circumstances require an extension of time for processing the claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires Plan Administrator shall have up to an additional ninety (90) 90 days to reply. The respond provided he gives notice will explain what special circumstances make an extension necessary of the extension, the reasons therefor, and indicate the expected date a final decision is expected of response to be madethe claimant prior to the end of the initial 90-day period. If the claim is denied shall be denied, in whole or in part, the Claimant will notice thereof shall be provided a written opinionby certified mail, return receipt requested, and shall set forth, in language a manner reasonably calculated to be understood by the Claimant, setting forth understood,
(i1) the specific reason(s) reason or reasons for the denial of the claim, or any part of it, denial;
(ii2) specific reference(s) reference to pertinent Fund provisions of on which the Plan or this award upon which such denial was is based, ;
(iii3) a description of any additional material or information necessary for to be submitted by the Claimant claimant in order to perfect the his claim, and an explanation of why such material or information is necessary, ; and
(iv4) an explanation of the Fund’s claim appeal review procedure set forth in Section 13(c)and time limits, below; and (v) a statement of the Claimantclaimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeallawsuit. Within sixty (60) days after receiving a notice from the Company that a claim has been deniedUpon denial, in whole or in part, of a Claimant (or claim by the Claimant’s duly authorized representative) may file with Plan Administrator, the Company a written request for a review of the denial of the claim. The Claimant claimant, or his duly authorized representative representative, as the case may be, may, but need notwithin the period ending ninety (90) days from the date of receipt of the denial as aforesaid,
(5) request review thereof, by filing a written application with the Trustees or a committee thereof;
(6) upon request, review pertinent documents, records, and other information and obtain copies free of charge; and
(7) submit comments, documents, records, and other information relating to the pertinent documents claim in writing. Documents, records, and submit issues other information are “pertinent” if they were relied upon in making the determination on the claim or if they were submitted, considered, or generated in the course of making the benefit determination. The Trustees or a committee thereof shall constitute the review board, which shall fully review such request, review all comments, documents, records, and comments other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination, hold any hearing deemed appropriate by such review board, and notify the claimant or his duly authorized representative, as the case may be, of the decision in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days periodas soon as practicable, the Claimant will be barred and estopped from challenging the determination. Within but in no event later than sixty (60) days after the Company’s receipt of a the written request for review; provided, it will review however, if a hearing is requested or if the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial reviewTrustees determine that special circumstances exist, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect Trustees shall have up to the initial determination. If special circumstances require that the an additional sixty (60) day time period be extendeddays to respond provided they give notice of the extension, the Company will so notify reasons therefor, and the Claimant and will render expected date of response to the decision as soon as possibleclaimant prior to the end of the initial 60-day period; provided further, but no later than one hundred twenty if the Trustees have regularly scheduled quarterly meetings, their response date shall be up to five (1205) days after the next regularly scheduled meeting which comes at least thirty (30) days after their receipt of the request for review. The In no event, however, shall the Trustees respond later than five (5) days following the third regularly scheduled meeting after the receipt of the request for review. Such notice will explain what special circumstances make an extension necessary and indicate of the date a final decision is expected to be made. Any decision on appeal will shall be finalwritten in a manner reasonably calculated to be understood, conclusive shall include the specific reasons for the decision, and binding upon all partiesshall set forth specific references to the Fund provisions on which the decision rests. The use of the claims procedure of this Article is mandatory in pursuing claims for benefits. Except as otherwise provided, failure to file a claim by the end of the Plan Year following the Plan Year in which the individual knew or should have known of the claim shall constitute an irrevocable waiver of the claim unless it shall be shown not to have been reasonably possible to furnish proof within the specified time period, and that proof was furnished as soon as was reasonably possible, in which case failure to furnish proof within the time provided shall not invalidate nor reduce the claim. Failure to raise issues or present evidence at any stage in the claims procedure shall preclude those issues or evidence from being presented in a judicial review of the claim. If any time limitation of the Plan with respect to furnishing proof of loss or bringing of an action at law or in equity is less than that permitted by ERISA, such limitation is hereby extended to agree with the minimum period permitted by such law. In the event the Plan Administrator or the Trustees extend the time for response due to the claimant’s failure to provide information necessary to decide the claim, the period for the benefit determination shall be tolled from the date notice of the extension is sent to the claimant until the claimant responds to the request for additional information.
Appears in 1 contract
Claims Procedure. To initiate Any person claiming a claim with respect to benefit under the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee Plan (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the a “Claimant”) must file a written request with shall present the Company. Upon receipt of such claim, in writing, to the Company will advise Plan Sponsor, and the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified Plan Sponsor shall respond in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madewriting. If the claim is denied in whole or in partdenied, the Claimant will be provided a written opinionnotice of denial shall state, in language a manner calculated to be understood by the Claimant, setting forth :
(ia) the The specific reason(s) reason or reasons for the denial of the claimdenial, or any part of it, (ii) with specific reference(s) references to pertinent provisions of the Plan or this award upon provisions on which such the denial was is based, ;
(iiib) a A description of any additional material or information necessary for the Claimant to perfect the claim, his or her claim and an explanation of why such material or information is necessary, ; and
(ivc) an An explanation of the claim appeal Plan’s claims review procedure set forth in Section 13(c)and the time limits applicable to such procedures, below; and (v) including a statement of the Claimant’s right to bring a civil action under section Section 502(a) of ERISA following an adverse benefit determination upon appealon review and exhaustion of all administrative remedies under the Plan. Within sixty (60) The written notice denying or granting the Claimant’s claim shall be provided to the Claimant within 60 days after receiving the Employer’s receipt of the claim, unless special circumstances require an extension of time for processing the claim. If such an extension is required, written notice of the extension shall be furnished by the Plan Sponsor to the Claimant within the initial 60 day period and in no event shall such an extension exceed a notice period of 60 days from the Company that end of the initial 60 day period. Any extension notice shall indicate the special circumstances requiring the extension and the date on which the Employer expects to render a claim has been denied, in whole or in part, a decision on the claim. Any Claimant (or such Claimant’s authorized representative) whose claim is denied may, within 60 days after the Claimant’s duly authorized representative) may file with receipt of notice of the Company a written denial request for a review of the denial of by notice given, in writing, to the claimEmployer. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within Upon such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented claim shall be reviewed by the ClaimantPlan Sponsor (or its designated representative) which may, without regard to whether such materials were submitted or considered in but shall not be required to, grant the initial Claimant a hearing. In connection with the review, the Company will render a written opinionClaimant may have representation, may examine pertinent documents, and may submit in writing comments, documents, records and other information relating to the claim. A Claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to his or her claim. The manner and content decision on review normally shall be made within 30 days of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after Employer’s receipt of the request for review. The If an extension of time is required due to special circumstances, the Claimant shall be notified, in writing, by the Plan Sponsor, within the initial 30 day period, and the time limit for the decision on review shall be extended to 90 days. Any extension notice will explain what shall indicate the special circumstances make requiring an extension necessary of time and indicate the date by which the Employer expects to render the decision on review. The decision on review shall be in writing and shall state, in a final manner calculated to be understood by the Claimant, the specific reasons for the decision and shall include references to the relevant Plan provisions on which the decision is expected to be madebased. Any The written decision on appeal will review shall also state that the Claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim, and shall include a statement of the Claimant’s right to bring a civil action under Section 502(a) of ERISA. The written decision on review shall be finalgiven to the Claimant within the 30 day (or, conclusive if applicable, the 90 day) time limit discussed above. All decisions on review shall be final and binding upon with respect to all concerned parties.
Appears in 1 contract
Samples: Adoption Agreement (Cumberland Pharmaceuticals Inc)
Claims Procedure. To initiate The Committee shall notify a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified Participant in writing within ninety (90) 90 days of filing the Participant's written application for benefits of the Participant's eligibility or non-eligibility for benefits under the Plan; provided, however, benefit distribution shall not be contingent upon a Participant's application for benefits. If the Committee determines a Participant is not eligible for benefits or full benefits, the notice shall set forth: (a) the specific reasons for such denial; (b) a specific reference to the provision of the Plan on which the denial is based; (c) a description of any additional information or material necessary for the Participant to perfect the claim, and a description of why it is needed; and (d) an explanation of the Plan's claims than review procedure and other appropriate information as to the Company requires up steps to an additional ninety (90) days be taken if the Participant wishes to replyhave the claim reviewed. The notice will explain what If the Committee determines there are special circumstances requiring additional time to make an extension necessary a decision, the Committee shall notify the Participant of the special circumstances and indicate the date by which a final decision is expected to be mademade and may extend the time for up to an additional 90-day period. If a Participant is determined by the Committee to be not eligible for benefits, or if a Participant believes he or she is entitled to greater or different benefits, the Participant shall have the opportunity to have the Participant's claim reviewed by the Committee by filing a petition for review with the Committee within 60 days after receipt by the Participant of the notice issued by the Committee. The petition shall state the specific reasons the Participant believes the Participant is denied in whole entitled to benefits or greater or different benefits. Within 60 days after receipt by the Committee of the petition, the Committee shall afford the Participant (and the Participant's counsel, if any) an opportunity to present the Participant's position to the Committee orally or in partwriting, and the Claimant will be provided Participant (or counsel) shall have the right to review the pertinent documents, and the Committee shall notify the Participant of its decision in writing within the 60-day period, stating specifically the basis of the decision written in a written opinion, in language manner calculated to be understood by the Claimant, setting forth (i) Participant and the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon on which such denial was the decision is based. If, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation because of the claim appeal procedure set forth in Section 13(c)need for a hearing, below; and (v) a statement the 60-day period is not sufficient, the decision may be deferred for up to another 60-day period at the election of the Claimant’s right Committee, but notice of this deferral shall be given to bring the Participant. If a civil action under section 502(a) Participant does not appeal on time, the Participant will have failed to exhaust the Plan's internal administrative appeal process, which is generally a prerequisite to bringing suit. In the event an appeal of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that denial of a claim has been for benefits is denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of any lawsuit to challenge the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review such claim must be brought within one year of the initial determination within such sixty (60) days period, date the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date Committee has rendered a final decision is expected on the appeal. In the case of a Participant's death, the same procedures shall apply to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthe Beneficiary.
Appears in 1 contract
Claims Procedure. To initiate (a) If, prior to the Escrow Termination Date, Acquiror determines to assert a claim Claim, then Acquiror shall give Escrow Agent and Stockholders’ Agent written notice of the Claim (a “Claim Notice”), specifying the basis therefor and, if known or estimable, the amount and calculation thereof and if not known or estimable, a specific amount determined in good faith (“Claim Amount”). If Stockholders’ Agent does not deliver to Acquiror and Escrow Agent written notice of an objection to Acquiror’s Claim prior to the 31st calendar day after receipt of the Claim Notice by Escrow Agent relating thereto, then the Escrow Agent shall, out of the Indemnification Escrow Fund, promptly pay the Claim Amount to Acquiror, and Stockholders’ Agent shall be deemed to have waived any further rights to object thereto. If Stockholders’ Agent shall timely (prior to the 31st calendar day after receipt of the Claim Notice by Escrow Agent) deliver to Acquiror and Escrow Agent such written notice of objection, then Escrow Agent shall not make any payment to Acquiror with respect to such Claim (or the settlement disputed portion thereof, as specified in Stockholders’ Agent’s written notice of Restricted Stock Units deferred objection) until: (i) it has received joint written instructions signed by an Authorized Representative of the Acquiror and Stockholders’ Agent which refer to such Claim; or (ii) it has received a copy of a judgment, decree or order of a court, or copy of an arbitration award, adjudicating the dispute with respect to such Claim, in accordance with the terms of the Merger Agreement (such order, award or determination must be accompanied by a written certification from counsel for the instructing Party attesting that such order, award or determination is final and not subject to further proceedings or appeal along with a written instruction from an Authorized Representative of the instructing Party given to effectuate such order, award or determination, and the Escrow Agent shall be entitled conclusively to rely upon any such certification and instruction and shall have no responsibility to review the order, award or determination to which such certification and instruction refers or to make any determination as to whether such order, award or determination is final), whereupon Escrow Agent shall distribute from the Indemnification Escrow Fund such amount as provided therein.
(b) If there is a dispute between Acquiror and Stockholders’ Agent with regard to the payment of a Claim from the Indemnification Escrow Fund, the reasonable legal fees, expenses and other costs incurred by Escrow Agent in connection with the adjudication of such dispute shall be paid by the party which is not the prevailing party in such dispute (as determined in accordance with the Merger Agreement).
(c) Any amounts held in the Indemnification Escrow Fund after the Escrow Termination Date in excess of the aggregate Claim Amounts under all Claims pending as of the Escrow Termination Date, if any, shall be paid promptly to the Agent for further distribution to the Stockholders in accordance with Section 5(b4.
(d) Any instructions setting forth, claiming, containing, objecting to, or in any way related to the transfer or distribution of the Escrow Property, must be in writing or set forth in a Portable Document Format (“PDF”), Grantee (executed by the appropriate Party or Parties as evidenced by the signatures of the person or persons signing this Agreement or one of their designated persons as set forth in Schedule 1 (each an “Authorized Representative”), and delivered to whom ownership rights may have passed Escrow Agent only by will confirmed facsimile or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up attached to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate email on a Business Day only at the date a final decision is expected to be made. If the claim is denied in whole fax number or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure email address set forth in Section 13(c10 below. No instruction for or related to the transfer or distribution of the Escrow Property shall be deemed delivered and effective unless Escrow Agent actually shall have received it on a Business Day by facsimile or as a PDF attached to an email only at the fax number or email address set forth in Section 10 and as evidenced by a confirmed transmittal to the Party’s or Parties’ transmitting fax number or email address and Escrow Agent has been able to satisfy any applicable security procedures as may be required hereunder. Escrow Agent shall not be liable to any Party or other person for refraining from acting upon any instruction for or related to the transfer or distribution of the Escrow Property if delivered to any other fax number or email address, including but not limited to a valid email address of any employee of Escrow Agent. Acquiror acknowledges that Escrow Agent is authorized to use the following funds transfer instructions to disburse any funds due to Acquiror without a verifying call-back as set forth in Section 5(d) below: Acquiror: Bank Name: Bank Address: ABA number: Account name: Account number:
(e) Additionally, Acquiror agrees that repetitive funds transfer instructions may be given to Escrow Agent for one or more beneficiaries where only the date of the requested transfer, the amount of funds to be transferred, and/or the description of the payment shall change within the repetitive instructions (“Standing Settlement Instructions”). Any such Standing Settlement Instructions shall be set up in writing in advance of any actual transfer request and shall contain complete funds transfer information (as set forth above) for the beneficiary. Any such set-up of Standing Settlement Instructions (other than those established concurrently with the execution of this Agreement), and any changes in existing set-up, shall be confirmed by means of a verifying callback to an Authorized Representative. Standing Settlement Instructions will continue to be followed until cancelled by Acquiror in a writing signed by an Authorized Representative and delivered to Escrow Agent in accordance with this Section 5(e). Once set up as provided herein, Escrow Agent may rely solely upon such Standing Settlement Instructions and all identifying information set forth therein for each beneficiary. Acquiror agrees that any Standing Settlement Instructions shall be effective as the funds transfer instructions of Acquiror, without requiring a verifying callback, as set forth in Section 5(f) below; and , if such Standing Settlement Instructions are consistent with previously authenticated Standing Settlement Instructions for that beneficiary.
(vf) In the event any other funds transfer instructions are set forth in a statement permitted instruction from a Party or the Parties in accordance with Section 5(d), Escrow Agent is authorized to seek confirmation of such funds transfer instructions by a single telephone call-back to one of the ClaimantAuthorized Representatives, and Escrow Agent may rely upon the confirmation of anyone purporting to be that Authorized Representative. The persons and telephone numbers designated for call-backs may be changed only in a writing executed by Authorized Representatives of the applicable Party and actually received by Escrow Agent via facsimile or as a PDF attached to an email. Except as set forth in Section 5(d) above, no funds will be disbursed until an Authorized Representative is able to confirm such instructions by telephone call-back. Escrow Agent, any intermediary bank and the beneficiary’s right to bring bank in any funds transfer may rely upon the identifying number of the beneficiary’s bank or any intermediary bank included in a civil action under section 502(a) funds transfer instruction provided by a Party or the Parties and confirmed by an Authorized Representative. Further, the beneficiary’s bank in the funds transfer instructions may make payment on the basis of ERISA following the account number provided in such Party’s or the Parties’ instruction and confirmed by an adverse determination upon appeal. Within sixty (60) days after receiving Authorized Representative even though it identifies a notice person different from the Company named beneficiary.
(g) The Parties acknowledge that a claim has been deniedthere are certain security, in whole or in partcorruption, a Claimant (or transmission error and access availability risks associated with using open networks such as the Claimant’s duly authorized representative) may file with Internet, and the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require Parties hereby agree that the sixty Escrow Agent is not liable for such risks absent the Escrow Agent’s gross negligence or willful misconduct.
(60h) day time period be extended, The Parties acknowledge that the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiessecurity procedures set forth in this Section 5 are commercially reasonable.
Appears in 1 contract
Claims Procedure. To initiate In the event that benefits under this Agreement are not paid to the Executive (or his beneficiary in the case of the Executive's death), and such person feels entitled to receive them, a claim with respect shall be made in writing to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant Plan Administrator within ninety (90) days of receipt of from the date payments are not made. Such claim whether shall be reviewed by the Plan Administrator and the Bank. If the claim is denied. If special circumstances require more than , in full or in part, the Plan Administrator shall provide a written notice within ninety (90) days setting forth the specific reasons for processingdenial, specific reference to the provisions of this Agreement upon which the denial is based, and any additional material or information necessary to perfect the claim, If any. Also, such written notice shall indicate the steps to be taken if a review of the denial is desired. If a claim is denied and a review is desired, the Claimant will be notified Executive (or his beneficiary in the case of the Executive’s death), shall notify the Plan Administrator in writing within ninety (90) days of filing receiving notice of said denial [and a claim shall be deemed denied if the claims than Plan Administrator does not take any action within the Company requires up to an additional aforesaid ninety (90) days day period]. In requesting a review, the Executive or his beneficiary may review this Agreement or any documents relating to replyit and submit any written issues and comments he or she may feel appropriate. The notice will explain what special circumstances make an extension necessary and indicate In its sole discretion the date a final decision is expected to be made. If Plan Administrator shall then review the claim is denied in whole or in part, the Claimant will be provided and provide a written opinion, in language calculated to be understood by the Claimant, setting forth decision within ninety (i90) days. This decision likewise shall state the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan Agreement on which the decision is based. If claimants continue to dispute the benefit denial based upon completed performance of this Agreement or this award upon which such denial was basedthe meaning and effect of the terms and conditions thereof, (iii) then claimants may submit the dispute to a description Board of any additional material or information necessary Arbitration for final arbitration. Said Board shall consist of one member selected by the Claimant to perfect claimant, one member selected by the claimBank, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of third member selected by the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claimfirst two members. The Claimant or his duly authorized representative mayBoard shall operate under any generally recognized set of arbitration rules. The parties hereto agree that they and their heirs, but need notpersonal representatives, review the pertinent documents successors and submit issues and comments in writing for consideration assigns shall be bound by the Company. If the Claimant does not request a review decision of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) Board with respect to the initial any controversy properly submitted to it for determination. If special circumstances require that Where a dispute arises as to the sixty (60) day time period Bank's discharge of the Executive “for cause”, such dispute shall likewise be extended, submitted to arbitration as above described and the Company will so notify the Claimant and will render parties hereto agree to be bound by the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthereunder.
Appears in 1 contract
Samples: Executive Salary Continuation Agreement (Lyons Bancorp Inc)
Claims Procedure. To initiate a Any claim with respect for benefits under Article 5 of this Agreement by Employee shall be made in writing and sent to the settlement of Restricted Stock Units deferred Employer at its principal offices in accordance with Section 5(b)Mechanicsburg, Grantee Pennsylvania, or such other place as Employer shall hereafter designate in writing. If Employee, or any beneficiary following Employee’s death (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (collectively, the “Claimant”) must file a written request with ), believes he has been denied any benefits or payments under Article 5 of this Agreement, either in total or in an amount less than the Company. Upon receipt of such claimfull benefit or payment to which the Claimant would normally be entitled, the Company will Employer shall advise the Claimant in writing of the amount of the benefit, or payment, if any, and the specific reasons for the denial within ninety thirty (9030) days of the receipt of the claim whether the claim is deniedClaimant’s claim. If special circumstances require more than ninety (90) days for processing, Employer shall also furnish the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided at that time with a written opinion, in language calculated to be understood by the Claimant, setting forth notice containing:
(ia) the A specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) reference to pertinent provisions of the Plan or this award upon which such denial was based, Agreement;
(iiib) a A description of any additional material or information necessary for the Claimant to perfect the claimclaim if possible, and an explanation of why such material or information is necessary, needed; and
(ivc) an An explanation of the claim appeal review procedure set forth in this Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal5.03. Within sixty (60) days after receiving of receipt of the information described above, the Claimant shall, if further review is desired, file a notice written request of reconsideration of Employer’s decision with the Appeal Committee. The Appeal Committee shall consist of those individuals who were serving as the Compensation Committee of the Board of Directors of Employer immediately prior to the Change of Control. The Appeal Committee shall select from its membership a chairperson and a secretary and may adopt such rules and procedures as it deems necessary to carry out its functions. In the Company that event any individual is unable to serve on the Appeal Committee, then the chairperson of the Appeal Committee shall appoint a claim has successor provided such successor must have been denied, in whole or in part, a Claimant member of the Board of Directors of Employer prior to the Change of Control (or “Prior Board Member”). So long as the Claimant’s duly authorized representative) may file request for review is pending with the Company a written request for a review of Appeal Committee (including such 60-day period), the denial of the claim. The Claimant Claimant, or his duly authorized representative mayrepresentative, but need not, may review the pertinent documents and may submit issues and comments in writing for consideration to the Appeal Committee. A final and binding decision shall be made by the Company. If Appeal Committee within thirty (30) days of the filing by the Claimant does not request a review of the initial determination within such sixty (60) days period, request for reconsideration. The Appeal Committee’s decision shall be conveyed to the Claimant will be barred in writing and estopped from challenging shall include specific reasons for the determination. Within sixty (60) days after decision and specific references to the Company’s receipt pertinent provisions of a request for review, it will review this Agreement on which the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opiniondecision is based. The manner Appeal Committee shall discharge its duties under this claims procedure in accordance with the fiduciary standards of Employee Retirement Income Security Act of 1974, as amended (“ERISA”), and content in doing so, to the extent permitted by law, shall be indemnified and held harmless by Employer (to the extent not indemnified or saved harmless under any liability insurance or other indemnification arrangement with Employer) for or against all liability to which the Appeal Committee may be subjected by reason of the final decision will include the same information described above any act done in Section 13(b) good faith with respect to the initial determinationadjudication of any claim under Article 5 of this Agreement, including reasonable expenses. If special circumstances require that Notwithstanding anything to the sixty (60) day time period be extendedcontrary herein contained, the Company will so notify Claimant shall be entitled to submit his claim for determination to any court having competent jurisdiction regardless of whether he has first exercised his right to have Employer’s decision reconsidered by the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesAppeal Committee.
Appears in 1 contract
Claims Procedure. To initiate (a) If a Participant does not receive the timely payment of the benefits which the Participant believes are due under the Plan, the Participant may make a claim with respect for benefits in the manner hereinafter provided. All claims for benefits under the Plan shall be made in writing and shall be signed by the Participant. Claims shall be submitted to the settlement of Restricted Stock Units deferred in accordance with Section 5(b)Committee, Grantee (or to a representative designated by the person to whom ownership rights may have passed by will or Committee. If the laws of descent and distribution) (the “Claimant”) must file a written request Participant does not furnish sufficient information with the Company. Upon receipt of such claim, claim for the Company will advise Committee to determine the Claimant within ninety (90) days of receipt validity of the claim whether the Committee shall indicate to the Participant any additional information which is necessary for the Committee to determine the validity of the claim. Each claim is deniedhereunder shall be acted on and approved or disapproved by the Committee within 90 days following the receipt by the Committee of the information necessary to process the claim. If special circumstances require more than ninety (90) days In the event the Committee denies a claim for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied benefits in whole or in part, the Claimant will be provided Committee shall notify the Participant in writing of the denial of the claim and notify the Participant of his or her right to a written opinionreview of the Committee’s decision. Such notice by the Committee shall also set forth, in language a manner calculated to be understood by the ClaimantParticipant, setting forth (i) the specific reason(s) reason for such denial, the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon on which such the denial was based, (iii) is based and a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) claim with an explanation of the claim appeal Plan’s appeals procedure as set forth in Section 13(c)this Section. If no action is taken by the Committee on a Participant’s claim within 90 days after receipt by the Committee, below; and (v) a statement such claim shall be deemed to be denied for purposes of the Claimantfollowing appeals procedure.
(b) Any Participant whose claim for benefits is denied in whole or in part may appeal for a review of the decision by the full Committee. Such appeal must be made within three months after the Participant has received actual or constructive notice of the denial as provided above. An appeal must be submitted in writing within such period and must:
(i) request a review by the full Committee of the claim for benefits under the Plan;
(ii) set forth all of the grounds upon which the Participant’s right request for review is based and any facts in support thereof; and
(iii) set forth any issues or comments which the Participant deems pertinent to bring a civil action under section 502(a) of ERISA following an adverse determination upon the appeal. Within sixty (60) The Committee shall regularly review appeals by Participants. The Committee shall act upon each appeal within 60 days after receiving receipt thereof unless special circumstances require an extension of the time for processing, in which case a notice from decision shall be rendered by the Company that Committee as soon as possible but not later than 120 days after the appeal is received by the Committee. The Committee shall make a full and fair review of each appeal and any written materials submitted by the Participant in connection therewith. The Committee may require the Participant to submit such additional facts, documents or other evidence as the Committee in its discretion deems necessary or advisable in making its review. The Participant shall be given the opportunity to review pertinent documents or materials upon submission of a written request to the Committee, provided the Committee finds the requested documents or materials are pertinent to the appeal. On the basis of its review, the Committee shall make an independent determination of the Participant’s eligibility for benefits under the Plan. The decision of the Committee on any claim has been denied, for benefits shall be final and conclusive upon all parties thereto. In the event the Committee denies an appeal in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a Committee shall give written request for a review notice of the decision to the Participant, which notice shall set forth, in a manner calculated to be understood by the Participant, the specific reasons for such denial and which shall make specific reference to the pertinent provisions of the claim. The Claimant or his duly authorized representative may, but need not, review Plan on which the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the CompanyCommittee’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesbased.
Appears in 1 contract
Claims Procedure. To initiate a) A person who believes that he or she is being denied a claim with respect benefit to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee which he or she is entitled under this Agreement (or the person hereinafter referred to whom ownership rights as a "Claimant") may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request for such benefit with the CompanyCorporation, setting forth his or her claim. The request must be addressed to the Chairman of the Board of Directors (the "Chairman") of the Corporation at its then principal place of business.
b) Upon receipt of such a claim, the Company will Chairman shall advise the Claimant that a reply will be forthcoming within ninety (90) days of receipt of and shall, in fact, deliver such reply within such period. The Chairman may, however, extend the claim whether the claim is denied. If special circumstances require more than ninety (90) days reply period for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. for reasonable cause.
c) If the claim is denied in whole or in part, the Claimant will be provided Chairman shall adopt a written opinion, in using language calculated to be understood by the Claimant, setting forth forth: (i1) the specific reason(sreason or reasons for such denial; (2) for the denial of the claim, or any part of it, (ii) specific reference(s) reference to pertinent provisions of the Plan or this award upon Agreement on which such denial was is based, ; (iii3) a description of any additional material or information necessary for the Claimant to perfect the claim, his or her claim and an explanation of why such material or such information is necessary, ; (iv4) an explanation of appropriate information as to the steps to be taken if the Claimant wishes to submit the claim appeal procedure set forth in Section 13(c), belowfor review; and (v5) the time limits for requesting a statement of the Claimant’s right to bring a civil action review under section 502(asubsection (d) of ERISA following an adverse determination upon appeal. and for review under subsection (e) hereof.
d) Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a receipt by the Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial written opinion described above, the Claimant may request in writing that the Board of Directors of the claimCorporation (the "Board") review the determination of the Chairman. Such request must be addressed to the Board at the Corporation's then principal place of business. The Claimant or his or her duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the CompanyBoard. If the Claimant does not request a review of the initial Chairman's determination by the Board within such sixty (60) days day period, the Claimant will he or she shall be barred and estopped from challenging the Chairman's determination. .
e) Within sixty (60) days after the Company’s Board's receipt of a request for review, it will review the initial Chairman's determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company Board will render a written opinion. The , written in a manner calculated to be understood by the Claimant, setting forth the specific reasons for the decision and content of the final decision will include the same information described above in Section 13(b) with respect containing specific references to the initial determinationpertinent provisions of this Agreement on which the decision is based. If special circumstances require that the sixty (60) day time period be extended, the Company Board will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all parties.
Appears in 1 contract
Claims Procedure. To initiate a claim with respect Subject to the settlement provisions of Restricted Stock Units deferred Subsection 9.5 and 9.6, any claim for indemnification, compensation or reimbursement (collectively, “Indemnification”) pursuant to this Section 9 shall be made as follows:
9.4.1 If any Indemnified Party has or claims in good faith to have incurred or suffered Losses for which it is or may be entitled to Indemnification under this Section 9, such Indemnified Party may deliver a Claim Notice to Seller and the Escrow Agent (if such Claim Notice is made during the Escrow Period). Each Claim Notice shall:
(i) state that the Indemnified Party believes in good faith that the Indemnified Party is entitled to Indemnification under this Section 9; (ii) contain a brief description of the facts and circumstances supporting the Indemnified Party’s claim; and (iii) if practicable, contain a non-binding, preliminary, good faith estimate of the amount to which the Indemnified Party claims to be entitled (the aggregate amount of such estimate, as it may be modified by the Indemnified Party in good faith from time to time, being referred to as the “Claimed Amount”).
9.4.2 During the thirty (30) Business Days period commencing upon receipt by Seller of a Claim Notice from an Indemnified Party (the “Dispute Period”), Seller may deliver to the Indemnified Party, with a copy to the Escrow Agent if the Claim Notice was also sent to the Escrow Agent, a written response (the “Response Notice”) in which Seller: (i) agrees that the full Claimed Amount is owed to the Indemnified Party; (ii) agrees that part, but not all, of the Claimed Amount is owed to the Indemnified Party; or (iii) indicates that no part of the Claimed Amount is owed to the Indemnified Party. If the Response Notice is delivered in accordance with Section 5(bclause (ii) or (iii) of the preceding sentence, the Response Notice shall also contain a brief description of the facts and circumstances supporting Seller’s claim that only a portion or no part of the Claimed Amount is owed to the Indemnified Party, as the case may be (any part of the Claimed Amount that is not agreed to be owed to the Indemnified Party pursuant to the Indemnified Party’s Claim Notice being referred to as the “Contested Amount”). If a Response Notice is not received by the Indemnified Party, Grantee or by the Escrow Agent if the Claim Notice was also sent to the Escrow Agent, from Seller prior to the expiration of the Dispute Period and after a further period of five (5) days following Buyer’s written notice to the Seller on the Seller’s failure to submit a Response Notice, then Seller shall be conclusively deemed to have agreed that an amount equal to the full Claimed Amount is owed to the Indemnified Party.
9.4.3 If Seller in its Response Notice agrees that the full Claimed Amount is owed to the Indemnified Party, or if no Response Notice is received by the person Indemnified Party from Seller prior to whom ownership rights may have passed by the expiration of the Dispute Period, then Buyer will or instruct the laws Escrow Agent to release the Claimed Amount to the Indemnified Party.
9.4.4 If Seller in the Response Notice agrees that part, but not all, of descent and distribution) the Claimed Amount is owed to the Indemnified Party (the “ClaimantAgreed Amount”), then the Parties will jointly instruct the Escrow Agent to release the Agreed Amount to the Indemnified Party.
9.4.5 If any Response Notice expressly indicates that there is a Contested Amount, Seller and the Indemnified Party shall attempt in good faith to resolve the dispute related to the Contested Amount. If Seller and the Indemnified Party resolve such dispute, such resolution shall be binding on Seller and such Indemnified Party and a settlement agreement stipulating the amount owed to such Indemnified Party (the “Stipulated Amount”) must file shall be signed by such Indemnified Party and Seller. The Parties will jointly instruct the Escrow Agent to release the Stipulated Amount to the Indemnified Party.
9.4.6 In the event that there is a written request dispute relating to any Claim Notice or Contested Amount (whether it is a matter between the Indemnified Party, on the one hand, and Seller on the other hand, or it is a matter that is subject to an Action asserted or commenced by a third party brought against the Indemnified Party in a litigation or arbitration), an action to resolve such dispute may be brought in accordance with Subsection 12.6.
9.4.7 Upon final resolution of the Company. Upon receipt action to resolve the dispute relating to the Claim Notice, Buyer will instruct the Escrow Agent (with a copy to Seller) to release the amount of the award specified in the court’s decision to the Indemnified Party (a copy of such claimfinal resolution shall be provided by Buyer to the Escrow Agent together with such instruction).
9.4.8 If the Parties fail to jointly instruct the Escrow Agent in any of the situations referred to in this Section 9.4, the Company will advise Parties agree to irrevocably accept any ruling by any arbitral tribunal under the Claimant within ninety (90) days arbitration clause of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesAgreement.
Appears in 1 contract
Claims Procedure. To initiate (a) The administrator for purposes of this Agreement shall be ProAssurance ("Administrator"), whose address is 000 Xxxxxxxxx Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000; Telephone: (000) 000-0000. The "Named Fiduciary" as defined in Section 402(a)(2) or ERISA, also shall be ProAssurance. ProAssurance shall have the right to designate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. ProAssurance shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim with respect for benefits by the Executive ("the claimant") shall be stated in writing by the Administrator and delivered or mailed to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee claimant within ten (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (9010) days of after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 10-day period. In no event shall such extension exceed a period of ten (ii10) days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the claim appeal procedure set forth in Section 13(c), below; and (v) a statement best of the Claimant’s right to bring Administrator's ability in a civil action under section 502(amanner that may be understood without legal or actuarial counsel.
(c) of ERISA following an adverse determination upon appeal. Within sixty A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (6010) days after receiving a notice from following the Company that a claim has been deniedreceipt of such denial, in whole or in parta writing addressed to the Administrator, a Claimant (review of such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant’s duly authorized representative) claimant shall consider relevant to a determination of the claim, and the claimant may file with the Company include a written request for a hearing in person before the Administrator. Prior to submitting the request, the claimant shall be entitled to review of such documents as the denial of Administrator shall agree are pertinent to the claim. The Claimant or his duly authorized representative claimant may, but need notat all stages of review, review the pertinent documents and submit issues and comments in writing for consideration be represented by the Company. If the Claimant does not request a review counsel, legal or otherwise, of the initial determination within such sixty (60) days period, the Claimant will claimant's choice. All requests for review shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionpromptly resolved. The manner and content of the final Administrator's decision will include the same information described above in Section 13(b) with respect to any such review shall be set forth in writing and shall be mailed to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no claimant not later than one hundred ten (10) days following receipt by the Administrator of the claimant's request unless special circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case the Administrator's decision shall be so mailed not later than twenty (12020) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiessuch request.
Appears in 1 contract
Samples: Release and Severance Compensation Agreement (Proassurance Corp)
Claims Procedure. To initiate 7.1 Upon the Purchaser or any Target Company becoming aware of a claim Claim for Taxation which may result in a Tax Claim the Purchaser shall:
(a) as soon as reasonably practicable, and in any event in a case involving an assessment with respect a time limit for appeal at least ten Business Days before the expiry of that time limit, and, in any other case, within 30 days of becoming aware of the Claim for Taxation (but not as a condition precedent to the settlement making of Restricted Stock Units deferred a Tax Claim) give written notice of that Claim for Taxation to the Vendor or, as the case may be, shall procure that the Target Company forthwith give written notice of that Claim for Taxation to the Vendor;
(b) subject always to the terms of this paragraph 7 and the Vendor agreeing to indemnify the Purchaser and/or the relevant Target Company to its reasonable satisfaction against all losses, costs, damages and expenses, including interest on overdue Tax, which may be incurred, further procure that the Target Company take such action and give such information and assistance in connection with the affairs of the relevant Target Company as the Vendor may reasonably and within a reasonable period (having regard to any statutory deadline) by written notice request to avoid, resist, appeal or compromise the Claim for Taxation;
(c) procure that the Vendor is promptly provided with copies of any correspondence with the Tax Authority;
(d) not submit any correspondence to the relevant Tax Authority in connection with the Claim for Taxation in question without first submitting the correspondence to the Vendor for its approval (such approval not to be unreasonably withheld or delayed) and the Purchaser shall take into account any reasonable comments of the Vendor.
7.2 The Purchaser shall not be obliged to procure that the Target Company appeals against any tax assessment if, the Vendor having been given written notice of the receipt of that Claim for Taxation in accordance with Section 5(b)paragraph 7.1 above, Grantee the Target Company has not within 21 days (or, if there is a statutory time limit of not more than 30 days, within 14 days) thereafter received instructions in writing from the Vendor, in accordance with the preceding provisions of this paragraph 7, to make that appeal.
7.3 The Purchaser shall not be obliged to procure that any Target Company take any action under paragraph 7.1 above which involves contesting any matter with any Tax Authority (excluding the authority or body demanding the Tax in question) or any court or tribunal unless the Vendor furnishes the Target Company with the written opinion of leading tax counsel to the effect that the appeal in question will, on the balance of probabilities, succeed. Such tax counsel shall be instructed by the Vendor and at the Vendor’s expense but the Vendor shall promptly provide the Purchaser with a copy of such instructions and give the Purchaser or its representative a reasonable opportunity to attend any conference with Counsel.
7.4 The Purchaser shall not be required to take any action or procure that any Target Company take any action under this paragraph 7 if it reasonably determines that such action would have an adverse effect on the amount of Tax payable by the Purchaser or any Target Company in respect of a period after Completion.
7.5 The action which the Vendor may request under paragraph 7.1 (b) above shall include the Purchaser or a Target Company applying to postpone (so far as legally possible) the payment of any Tax and allowing the Vendor or the person Vendor’s professional advisors to whom ownership rights may have passed by will or conduct the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claim, the Company will advise the Claimant within ninety (90) days of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days Claim for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part of it, (ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claim, and an explanation of why such material or information is necessary, (iv) an explanation of the claim appeal procedure set forth in Section 13(c), below; and (v) a statement of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesTaxation.
Appears in 1 contract
Samples: Share Purchase Agreement (Powerwave Technologies Inc)
Claims Procedure. To initiate (a) The administrator for purposes of this Agreement shall be the Company or, following a claim with respect to Change in Control, the settlement of Restricted Stock Units deferred in accordance with Section 5(bSurvivor ("Administrator"), Grantee whose current address is 5555 Xxxx Xxxx, Xxxxxx Xxxxxxx, Xxxxx 00000, xxd whose telephone number is (or the person to whom ownership rights may have passed by will or the laws 512) 000-0000. Xxe "Named Fiduciary" as defined in Section 402(a)(2) of descent and distribution) (the “Claimant”) must file a written request with ERISA, also shall be the Company. Upon receipt The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of such claimthe same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the Company will advise address or telephone number of the Claimant same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits by the Executive ("the claimant") shall be stated in writing by the Administrator and delivered or mailed to the claimant within ninety ten (9010) days of after receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processing, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinion, in language calculated to be understood by the Claimant, setting forth (i) the specific reason(s) for the denial of the claim, or any part unless special circumstances require an extension of ittime for processing the claim. If such an extension is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 10-day period. In no event shall such extension exceed a period of ten (ii10) days from the end of the initial period. Any notice of denial shall set forth the specific reference(s) reasons for the denial, specific reference to pertinent provisions of the Plan or this award Agreement upon which such the denial was is based, (iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and with an explanation of why such material or information is necessary, (iv) an and any explanation of claim review procedures, written to the claim appeal procedure set forth in Section 13(c), below; and (v) a statement best of the Claimant’s right Administrator's ability in a manner that is intended to bring a civil action under section 502(abe understood without legal or actuarial counsel.
(c) of ERISA following an adverse determination upon appeal. Within sixty A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (6010) days after receiving a notice from following the Company that a claim has been denieddate of such denial, in whole or in parta writing addressed to the Administrator, a Claimant (review of such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant’s duly authorized representative) claimant shall consider relevant to a determination of the claim, and the claimant may file with the Company include a written request for a hearing in person before the Administrator. Prior to submitting the request, the claimant shall be entitled to review of such documents as the denial of Administrator shall agree are pertinent to the claim. The Claimant or his duly authorized representative claimant may, but need notat all stages of review, review the pertinent documents and submit issues and comments in writing for consideration be represented by the Company. If the Claimant does not request a review counsel, legal or otherwise, of the initial determination within such sixty (60) days period, the Claimant will claimant's choice. All requests for review shall be barred and estopped from challenging the determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial review, the Company will render a written opinionpromptly resolved. The manner and content of the final Administrator's decision will include the same information described above in Section 13(b) with respect to any such review shall be set forth in writing and shall be mailed to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no claimant not later than one hundred ten (10) days following receipt by the Administrator of the claimant's request unless special circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case the Administrator's decision shall be so mailed not later than twenty (12020) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiessuch request.
Appears in 1 contract
Samples: Executive Change in Control Bonus and Severance Agreement (American Dental Technologies Inc)
Claims Procedure. To initiate A claim for benefits must be filed before payment of retirement or death benefits will commence. A claim shall be deemed filed when an Employee or his beneficiary or representative requests, in writing, payment of benefits due under the Plan. The claim may be filed with the Plan Administrator or any officer of Employer. In the event that a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must file a written request with the Company. Upon receipt of such claimfor benefits is filed, the Company will advise the Claimant Plan Administrator, within ninety three (903) days of receipt of the claim whether months after the claim is denied. If filed, shall give notice of the decision on the claim; and if notice on the denial of a claim is not furnished, and the claim has not been granted within the three (3) month claim processing period, the claim shall be deemed denied for all purpose of processing to the review stage as hereinafter described.
(a) The three (3) month time period mentioned above may be extended by the Plan Administrator for an additional three (3) months if special circumstances require more than ninety (90) days an extension of time for processingprocessing the claim. If an extension is required, the Claimant will be notified in writing within ninety Plan Administrator shall furnish written notice of the three (903) days month extension to the claimant prior to the termination of filing the claims than the Company requires up to an additional ninety initial three (903) days to replymonth period. The extension notice will explain what shall indicate the special circumstances make requiring an extension necessary of time and indicate the date a by which the Plan Administrator expects to render the final decision is expected decision.
(b) The Plan Administrator shall provide to be made. If the claim every claimant who is denied in whole or in part, the Claimant will be provided a claim for benefits written opinion, in language calculated to be understood by the Claimant, notice setting forth forth:
(i) the specific reason(s) reason or reasons for the denial of the claim, or any part of it, denial,
(ii) the specific reference(s) reference to the pertinent Plan provisions of on which the Plan or this award upon which such denial was is based, ,
(iii) a description of any additional material or information necessary for the Claimant claimant to perfect the claim, and claim arid an explanation of why such material or information is necessary, and
(iv) an explanation of the Plan's claim appeal procedure set forth in Section 13(c), below; and review procedure.
(vc) a statement In the event that the claim of the Claimant’s right to bring a civil action under section 502(a) of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been Employee or his beneficiary or representative is denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review of the denial of the claim. The Claimant claimant or his duly authorized representative maymay request a review of the denied claim by means of a written application for review delivered to the Plan Administrator. Pursuant to this right of Review, but need not, the claimant Or his duly authorized representative may review the pertinent documents and submit issues and comments in writing writing.
(d) Any request for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days period, the Claimant will a denied claim must be barred and estopped from challenging the determination. Within filed no later than sixty (60) days after the Company’s earlier of receipt by the claimant of written notification of the three (3) month claim processing period including any extension thereof.
(e) In the event a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted or considered in the initial reviewhas been made as herein provided, the Company will render Plan Administrator shall make a written opinion. The manner and content of decision On the final decision will include the same information described above in Section 13(b) with respect to the initial determination. If special circumstances require that the request for review within sixty (60) day days after the receipt by the Plan Administrator of the request for the review, unless special circumstances require an extension of time period be extendedfor processing the review, in which case the Company will so notify the Claimant and will Plan Administrator shall render the a decision as soon as possible, but in no event later than one hundred and twenty (120) days after receipt of the Plan Administrator has received the request for review. The notice will explain what special circumstances make If an extension necessary is required, the Plan Administrator shall furnish written notice of the extension to the claimant prior to the commencement of the extension. The decision on review shall he furnished to the claimant in writing within the time for review and indicate shall include specific reasons for the date a final decision, as well as specific references to the pertinent Plan provisions on which the decision is expected based.
(f) If the Plan Administrator is unable after diligent search to locate an employee or former employee participant or beneficiary to whom a benefit is due under the provisions of this Plan, such benefit shall be made. Any decision forfeited on appeal will the last day of the Plan Year in which such search is concluded, If a claim is made subsequently by such participant or beneficiary for the benefit so forfeited, such benefit shall be final, conclusive and binding upon all partiesrestored in full.
Appears in 1 contract
Claims Procedure. To initiate (a) Any Eligible Executive or former Eligible Executive who believes that he or she is entitled to benefits hereunder in an amount greater than he or she has received (for purposes of this Section 5.6, a claim with respect to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (the “Claimant”) must may file a written request with claim for such benefits by writing directly to the Plan Administrator at the Company’s office within ninety (90) days after the date as of which the Claimant’s employment is terminated. Upon receipt Any such claim shall be filed in writing stating the nature of such the claim, the Company will advise facts supporting the Claimant claim, the amount claimed, and the name and address of the claimant. No legal action to recover benefits or enforce or clarify rights under this Plan can be commenced until the claims and review procedures provided under this Plan have first been exhausted. Failure to submit a claim within ninety (90) days after the date as of which the Claimant’s employment was terminated shall bar the Claimant’s claim for benefits.
(b) The Plan Administrator shall consider any claim and answer it in writing stating whether the claim is granted or denied. Such written response shall be provided to the claimant within ninety (90) days of the claim’s receipt by the Plan Administrator, unless an extension 93011281.6 of time is needed to process the claim whether in which case the claim is denied. If special circumstances require more than ninety (90) days for processingPlan Administrator shall give the claimant written notice of such need, the Claimant will be notified in writing within ninety (90) days reason therefore and the length of filing the claims than the Company requires up to such extension, which shall not exceed an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be madedays. If the claim is denied denied, in whole or in part, the Claimant will be provided a such written opinion, in language calculated to be understood by the Claimant, setting forth notice shall include (i) the specific reason(s) for the denial of the claim, or any part of itdenial, (ii) a specific reference(sreference to Plan provision(s) to pertinent provisions of on which the Plan or this award upon which such denial was is based, (iii) a description of any additional material or information necessary for the Claimant to perfect the claiman appeal, and an explanation of why such material or information is necessary, and (iv) an explanation a description of the claim this Plan’s appeal procedure as set forth in Section 13(c)subsection (c) of this Section, below; and (v) including the time limits applicable to such procedure, as well as a statement notifying the claimant of the Claimant’s right to bring a civil action under section Section 502(a) of ERISA following an adverse determination upon denial of a final appeal. If a Claimant has not received notification within ninety (90) days (or such extended period as may be applicable) that his claim has not been allowed, the Claimant will be considered to have exhausted this Plan’s internal claims procedures and will be entitled to pursue any remedies available to him under ERISA.
(c) Within sixty (60) days after receiving a of notice from the Company that a claim has been is denied, the claimant may file a written appeal with the Plan Administrator. The Claimant shall have the right to be represented at such review, to review all documents relevant to the denial, and to submit written comments, documents, records and other information relating to the claim for benefits. The Claimant shall be provided upon request and free of charge reasonable access to and copies of all documents, records and other information relevant to the Claimant’s claim for benefits. Any review requested by the Claimant of a determination by the Plan Administrator shall take into account all comments, documents, records and other information submitted by the Claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. Any such appeal should contain (i) a statement of the ground(s) for the appeal, (ii) a specific reference to this Plan’s provision(s) on which the appeal is based, (iii) a statement of the argument(s) and authority (if any) supporting each of the ground(s) for appeal and (iv) any other pertinent documents or comments that the appellant wishes to submit in support of the appeal. The Plan Administrator shall comply with any reasonable request from a claimant for documents or information relevant to his claim prior to the filing of an appeal. The Plan Administrator shall consider the appeal and provide the appellant with a written decision regarding the appeal no later than sixty (60) days after such appeal is received, unless an extension of time is needed to process the claim in which case the Plan Administrator shall give the claimant written notice of such need, the reason therefore and the length of such extension, which shall not exceed an additional sixty (60) days. In the event the appeal is denied, in whole or in part, the Plan Administrator’s written decision shall set forth the reason(s) for the denial and this Plan’s provision(s) on which the denial is based. The notification of the benefit determination must provide the same information that is required for an initial claim denial, be written in a manner calculated to be understood by the Claimant and with specific references to the relevant Plan provisions on which the decision is based, and must include a statement of the right to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claim for benefits and to bring a civil action. In no event shall a Claimant be entitled to challenge a decision of the Plan Administrator, in court or in any other administrative proceeding until the claims procedures provided herein are exhausted. The decision upon appeal, or the initial decision if no appeal is taken, shall be final, conclusive and binding on all parties, subject, however, to the provisions of the Code and ERISA. 93011281.6
(d) Any person submitting a claim in accordance with this section may withdraw the claim at any time or, with the consent of the Employer, defer the date on which such claim shall be deemed filed for purposes of this Section.
(e) For purposes of this section, a document, record or other information is considered “relevant” to the Claimant’s duly authorized representativeclaim if such document, record or other information (1) may file with the Company a written request for a review of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration was relied upon by the Company. If Plan Administrator in making the Claimant does not request a review benefit determination; (2) was submitted, considered or generated in the course of making the initial determination within such sixty (60) days period, the Claimant will be barred and estopped from challenging the benefit determination. Within sixty (60) days after the Company’s receipt of a request for review, it will review the initial determination. After considering all materials presented by the Claimant, without regard to whether such materials were submitted document, record or considered other information was relied upon in making the initial reviewbenefit determination; or (3) demonstrates compliance with the administrative processes and safeguards designed to ensure and to verify that that benefit claim determinations are made in accordance with governing Plan documents and that, the Company will render a written opinion. The manner and content of the final decision will include the same information described above in Section 13(b) where appropriate, this Plan’s provisions have been applied consistently with respect to similarly situated Claimants. A document, record, or other information that constitutes privileged attorney-client material or attorney work-product, or that is otherwise protected from disclosure on the initial determination. If special circumstances require that basis of privilege or immunity, shall not be considered “relevant” to the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesClaimant's claim.
Appears in 1 contract
Samples: Executive Severance Plan (Rayonier Advanced Materials Inc.)
Claims Procedure. To initiate (i) Benefits will be provided to each Designated Employee as specified in this Plan. If a claim Designated Employee believes that he has not been provided with respect benefits due under the Plan, then the Designated Employee may elect the arbitration procedure in Section 6(b) of this Plan, or alternatively, the Designated Employee (who is hereafter referred to the settlement of Restricted Stock Units deferred in accordance with Section 5(b), Grantee (or the person to whom ownership rights may have passed by will or the laws of descent and distribution) (as the “Claimant”) must file has the right to make a written request with claim for benefits under the CompanyPlan. Upon receipt Written claims for severance pay benefits shall be governed by the following procedures; any written claims for health or welfare benefits shall be governed by the claims procedures of the applicable health or welfare plan. If such a written claim is made, and the Administrator wholly or partially denies the claim, the Company will advise Administrator shall provide the Claimant within ninety (90) days with written notice of receipt of the claim whether the claim is denied. If special circumstances require more than ninety (90) days for processingsuch denial, the Claimant will be notified in writing within ninety (90) days of filing the claims than the Company requires up to an additional ninety (90) days to reply. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. If the claim is denied in whole or in part, the Claimant will be provided a written opinionsetting forth, in language a manner calculated to be understood by the Claimant, setting forth :
(iA) the specific reason(sreason or reasons for such denial;
(B) for specific reference to pertinent Plan provisions on which the denial of the claim, or any part of it, is based;
(ii) specific reference(s) to pertinent provisions of the Plan or this award upon which such denial was based, (iiiC) a description of any additional material or information necessary for the Claimant to perfect the claim, claim and an explanation of why such material or information is necessary, ; and
(ivD) an explanation of the Plan’s claims review procedure and time limits applicable to those procedures, including a statement of the Claimant’s right to bring a civil action under ERISA Section 502(a) if the claim appeal procedure set forth is denied on appeal.
(ii) The written notice of any claim denial pursuant to Section 6(a)(i) shall be given not later than thirty (30) days after receipt of the claim by the Administrator, unless the Administrator determines that special circumstances require an extension of time for processing the claim, in Section 13(c), belowwhich event:
(A) written notice of the extension shall be given by the Administrator to the Claimant prior to thirty (30) days after receipt of the claim;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day period for giving notice of a claim denial; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Administrator expects to render the benefit determination.
(iii) The decision of the Administrator shall be final unless the Claimant, within sixty (60) days after receipt of notice of the claims denial from the Administrator, submits a written request to the Board of Directors of DXC, or its delegate, for an appeal of the denial. During that sixty (60) day period, the Claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claim for benefits. The Claimant shall be provided the opportunity to submit written comments, documents, records, and other information relating to the claim for benefits as part of the Claimant’s appeal. The Claimant may act in these matters individually, or through his or her authorized representative.
(iv) After receiving the written appeal, if the Board of Directors of DXC, or its delegate, shall issue a written decision notifying the Claimant of its decision on review, not later than thirty (30) days after receipt of the written appeal, unless the Board of Directors of DXC or its delegate determines that special circumstances require an extension of time for reviewing the appeal, in which event:
(A) written notice of the extension shall be given by the Board of Directors of DXC or its delegate prior to thirty (30) days after receipt of the written appeal;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day review period; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Board of Directors of DXC or its delegate expects to render the appeal decision. The period of time within which a benefit determination on review is required to be made shall begin at the time an appeal is received by the Board of Directors of DXC or its delegate, without regard to whether all the information necessary to make a benefit determination on review accompanies the filing of the appeal. If the period of time for reviewing the appeal is extended as permitted above, due to a claimant’s failure to submit information necessary to decide the claim on appeal, then the period for making the benefit determination on review shall be tolled from the date on which the notification of the extension is sent to the claimant until the date on which the claimant responds to the request for additional information.
(v) In conducting the review on appeal, the Board of Directors of DXC or its delegate shall take into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. If the Board of Directors of DXC or its delegate upholds the denial, the written notice of decision from the Board of Directors of DXC or its delegate shall set forth, in a manner calculated to be understood by the Claimant:
(A) the specific reason or reasons for the denial;
(B) specific reference to pertinent Plan provisions on which the denial is based;
(C) a statement that the Claimant is entitled to be receive, upon request and free of charge, reasonable access to , and copies of, all documents, records and other information relevant to the claim for benefits; and
(D) a statement of the Claimant’s right to bring a civil action under section XXXXX 502(a).
(vi) If the Plan or any of ERISA following an adverse determination upon appeal. Within sixty (60) days after receiving a notice from the Company that a claim has been denied, in whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Company a written request for a review its representatives fail to follow any of the denial of the claim. The Claimant or his duly authorized representative may, but need not, review the pertinent documents and submit issues and comments in writing for consideration by the Company. If the Claimant does not request a review of the initial determination within such sixty (60) days periodabove claims procedures, the Claimant will shall be barred deemed to have duly exhausted the administrative remedies available under the plan and estopped from challenging shall be entitled to pursue any available remedies under ERISA Section 502(a), including but not limited to the determination. Within sixty filing of an action for immediate declaratory relief regarding benefits due under the Plan.
(60vii) days after If the Company’s receipt Board of Directors of DXC or its delegate upholds the denial on review of a request for reviewseverance pay claim, it will or if a health or welfare benefit claim is denied on review under the initial determination. After considering all materials presented by applicable health or welfare plan and/or the Claimantadministrative remedies thereunder have been exhausted, without regard then the Claimant shall have the right to whether such materials were submitted or considered in the initial reviewbring a civil action under ERISA Section 502(a) or, alternatively, the Company will render a written opinion. The manner and content Claimant may invoke the arbitration provisions of the final decision will include the same information described above in Section 13(b6(b) with respect to the initial determination. If special circumstances require that the sixty (60) day time period be extended, the Company will so notify the Claimant and will render the decision as soon as possible, but no later than one hundred twenty (120) days after receipt of the request for review. The notice will explain what special circumstances make an extension necessary and indicate the date a final decision is expected to be made. Any decision on appeal will be final, conclusive and binding upon all partiesthis Plan.
Appears in 1 contract
Samples: Severance Plan (DXC Technology Co)
