Claims Procedures. (a) For purposes of these claims procedures, the Administrator shall serve as the “Claims Administrator.” (b) Any claim for benefits hereunder shall be filed by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunder. (c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision. (d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review. (e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure. (f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA. (g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 7 contracts
Samples: Split Dollar Agreement (National Commerce Corp), Split Dollar Agreement (National Commerce Corp), Split Dollar Agreement (National Commerce Corp)
Claims Procedures. Any claim by the Executive or Beneficiary ("Claimant") with respect to participation, contributions, benefits or other aspects of the operation of the Agreement shall be made in writing to the Secretary of the Company or such other person designated by the Committee from time to time for such purpose. If the designated person receiving a claim believes, following consultation with the Chairman of the Committee, that the claim should be denied, he or she shall notify the Claimant in writing of the denial of the claim within 90 days after his or her receipt thereof (this period may be extended an additional 90 days in special circumstances and, in such event, the Claimant shall be notified in writing of the extension). Such notice shall (a) For purposes of these claims procedures, set forth the Administrator shall serve as specific reason or reasons for the “Claims Administrator.”
(b) Any claim for benefits hereunder shall be filed by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification denial making reference to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunder.
(c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt pertinent provisions of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; , (iiib) describe any additional material or information necessary to perfect the additional claim, and explain why such material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (ivc) inform the Claimant of his or her right pursuant to this section to request review of the right to bring a civil action under the provisions of ERISAdecision.
(g) After exhausting A Claimant may appeal the claims procedure described hereindenial of a claim by submitting a written request for review to the Committee, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) within 60 days after the date on which such denial is received. Such period may be extended by the Committee for good cause shown. The claim will then be reviewed by the Committee. A Claimant has exhausted or his or her duly authorized representative may discuss any issues relevant to the procedures claim, may review pertinent documents and remedies set forth may submit issues and comments in writing. If the Committee deems it appropriate, it may hold a hearing as to a claim. If a hearing is held, the Claimant shall be entitled to be represented by counsel. The Committee shall decide whether or not to grant the claim within 60 days after receipt of the request for review, but this Section 11period may be extended by the Committee for up to an additional 60 days in special circumstances. Written notice of any such special circumstances shall be sent to the Claimant. Any claim not decided upon in the required time period shall be deemed denied. All interpretations, determinations and decisions of the Committee with respect to any claim shall be made in its sole discretion based on the Agreement and other relevant documents and shall be final, conclusive and binding on all persons.
Appears in 4 contracts
Samples: Severance Agreement (Venator Group Inc), Executive Employment Agreement (Venator Group Inc), Executive Employment Agreement (Venator Group Inc)
Claims Procedures. (a) a. For purposes of these claims procedures, the Administrator Board shall serve as the “Claims Administrator.”
(b) Any b. If the Insured or any beneficiary of the Insured should have a claim for benefits hereunder he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder. Benefit claims shall be made by the Insured, his beneficiary or beneficiaries or a duly authorized representative thereof (the “claimant”).
(c) c. If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension shall not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any d. The notice of a denial of a claim for benefits hereunder adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), ERISA in the event of an adverse determination on review.
(e) e. If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and .
f. The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, records and other information relevant “relevant” to the Claimantclaimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA.
g. For purposes hereof, documents, records and information shall be considered “relevant” to the claimant’s claim if it (gi) was relied upon in making the benefit determination, (ii) was submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
h. After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors Board, any member of the Bank (or any member thereof) Board or the Claims Administrator more than ninety (90) days after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
Appears in 4 contracts
Samples: Supplemental Split Dollar Agreement (Red River Bancshares Inc), Supplemental Split Dollar Agreement (Red River Bancshares Inc), Supplemental Split Dollar Agreement (Red River Bancshares Inc)
Claims Procedures. (a) For purposes Promptly after receipt by any indemnified Person of these claims proceduresnotice of the commencement or assertion of any Claim or Proceeding by a third party or circumstances which, with the Administrator lapse of time, such indemnified Person believes is likely to give rise to a Claim or Proceeding by a third party or of facts causing any indemnified Person to believe it has a Claim for breach hereunder (an “Asserted Liability”), such indemnified Person shall serve as give prompt written notice thereof (the “Claims AdministratorNotice”) to the relevant indemnifying Person, provided that in any event, such indemnified Person shall give the Claims Notice to the indemnifying Person no later than 30 days after becoming aware of such Asserted Liability. So long as the Claims Notice is given within the applicable survival period set forth in Section 7.1, the failure to so notify the indemnifying Person shall not relieve the indemnifying Person of its obligations or liability hereunder, except to the extent such failure shall have actually prejudiced the indemnifying Person. The Claims Notice shall describe the Asserted Liability in reasonable detail, and shall indicate the amount (estimated, if necessary) of the Loss that has been or may be suffered. The indemnified Person and the indemnifying Person agree to keep each other reasonably appraised of any additional information concerning any Asserted Liability.”
(b) Any claim As to an Asserted Liability arising from a third party action, the indemnifying Person shall be, subject to the limitations set forth in this Section 7.5, entitled to assume control of and appoint lead counsel for benefits hereunder such defense only for so long as it conducts such defense with reasonable diligence. The indemnifying Person shall keep the indemnified Persons advised of the status of such third party action and the defense thereof on a reasonably current basis and shall consider in good faith the recommendations made by the indemnified Persons with respect thereto. If the indemnifying Person assumes the control of the defense of any third party action in accordance with the provisions of this Section 7.5, the indemnified Person shall be filed by entitled to participate in the Insureddefense of any such third party action and to employ, his beneficiary or at its expense, separate counsel of its choice for such purpose, it being understood, however, that the indemnifying Person shall continue to control such defense; provided that notwithstanding the foregoing, the indemnifying Person shall pay the reasonable costs and expenses of such defense (including reasonable attorneys’ fees and expenses) of the indemnified Persons if (x) the indemnified Person’s outside counsel shall have reasonably concluded and advised in writing (with a duly authorized representative thereof (a “Claimant”) through the provision of a written notification copy to the Claims Administrator. The Claims Administrator shall make all determinations as indemnifying Person) that there are defenses available to such indemnified Person that are different from or additional to those available to the right indemnifying Person, or (y) the indemnified Person’s outside counsel shall have advised in writing (with a copy to the indemnifying Person) the indemnified Person that there is a conflict of interest that would make it inappropriate under applicable standards of professional conduct to have common counsel for the indemnifying Person and the indemnified Person. Notwithstanding the foregoing, (i) the indemnifying Person shall obtain the prior written consent of the indemnified Person before entering into any Claimant settlement, compromise, admission or acknowledgement of the validity of such Asserted Liability if the settlement requires an admission of guilt or wrongdoing on the party of the indemnified Person, subjects the indemnified Person to a benefit hereundercriminal liability or does not unconditionally release the indemnified Person from all liabilities and obligations with respect to such Asserted Liability or the settlement imposes injunctive or other equitable relief against, or any continuing obligation or payment requirement on, the indemnified Person and (ii) the indemnified Person shall be entitled to participate, at its own cost and expense, in the defense of such Asserted Liability and to employ separate counsel of its choice for such purpose.
(c) If Each Party shall cooperate in the claim is wholly defense or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice prosecution of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim Asserted Liability arising from a third party action and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material furnish or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps cause to be taken by the Claimant if a review of the denial is desiredfurnished such records, including the time limits information and testimony (subject to any applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”confidentiality agreement), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desiredattend such conferences, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a reviewdiscovery proceedings, the Claimant may submit any written commentshearings, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record trials or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action appeals as may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth reasonably requested in this Section 11connection therewith.
Appears in 3 contracts
Samples: Purchase and Sale Agreement (Summit Midstream Partners, LP), Contribution Agreement (Summit Midstream Partners, LP), Contribution Agreement
Claims Procedures. (a) For purposes of these claims procedures, the Administrator shall Board (or such other entity, committee, or persons as designated by the Board) will serve as the “Claims Administrator.”
(b) Any If any Insured or beneficiary of the Insured should have a claim for benefits hereunder he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
. Benefit claims may be filed by the Insured, his beneficiary or beneficiaries or a duly authorized representative thereof (c) the “Claimant). If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension will not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall will be sent delivered or mailed to the Claimant within ninety (90) days after receipt of the claim and shall will include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any . The notice of a denial of a claim for benefits hereunder shall adverse benefit determination will (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits perfect the claim and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), Section 502(a) ERISA in the event of an adverse determination on review.
(ec) If a claim is denied and a review is desired, the Claimant shall must notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records records, and other information relating to the claim that the Claimant feels are appropriateclaim. The Claimant shall will, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall will (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, do records and other information relevant to the Claimant’s claim for benefits; and (iv) inform the Claimant of the right to bring a civil action under the provisions Section 502(a) of ERISA.
(gd) After exhausting the The foregoing claims procedure described hereinprocedures will be administered in accordance with Department of Labor Regulation Section 2560.503-1, nothing shall prevent as amended from time to time, and will not be construed to provide, and will not provide, the Claimant from pursuing any other legal or equitable remedy otherwise available, including with rights greater than those provided for under the right to bring a civil action under Section 502(a) of ERISA, if applicableregulation. Notwithstanding the foregoing, no No legal action may be commenced or maintained against the Bank, the Board of Directors Board, any member of the Bank (or any member thereof) Board or the Claims Administrator more than ninety (90) days after until the Claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
Appears in 3 contracts
Samples: Endorsement Split Dollar Agreement (ServisFirst Bancshares, Inc.), Endorsement Split Dollar Agreement (ServisFirst Bancshares, Inc.), Endorsement Split Dollar Agreement (ServisFirst Bancshares, Inc.)
Claims Procedures. Any claim by the Executive or Beneficiary ("Claimant") with respect to participation, contributions, benefits or other aspects of the operation of the Agreement shall be made in writing to the Secretary of the Company or such other person designated by the Committee from time to time for such purpose. If the designated person receiving a claim believes, following consultation with the Chairman of the Committee, that the claim should be denied, he or she shall notify the Claimant in writing of the denial of the claim within 90 days after his or her receipt thereof (this period may be extended an additional 90 days in special circumstances and, in such event, the Claimant shall be notified in writing of the extension). Such notice shall (a) For purposes of these claims procedures, set forth the Administrator shall serve as specific reason or reasons for the “Claims Administrator.”
(b) Any claim for benefits hereunder shall be filed by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification denial making reference to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunder.
(c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt pertinent provisions of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; , (iiib) describe 7 any additional material or information necessary to perfect the additional claim, and explain why such material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (ivc) inform the Claimant of his or her right pursuant to this section to request review of the right to bring a civil action under the provisions of ERISAdecision.
(g) After exhausting A Claimant may appeal the claims procedure described hereindenial of a claim by submitting a written request for review to the Committee, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) within 60 days after the date on which such denial is received. Such period may be extended by the Committee for good cause shown. The claim will then be reviewed by the Committee. A Claimant has exhausted or his or her duly authorized representative may discuss any issues relevant to the procedures claim, may review pertinent documents and remedies set forth may submit issues and comments in writing. If the Committee deems it appropriate, it may hold a hearing as to a claim. If a hearing is held, the Claimant shall be entitled to be represented by counsel. The Committee shall decide whether or not to grant the claim within 60 days after receipt of the request for review, but this Section 11period may be extended by the Committee for up to an additional 60 days in special circumstances. Written notice of any such special circumstances shall be sent to the Claimant. Any claim not decided upon in the required time period shall be deemed denied. All interpretations, determinations and decisions of the Committee with respect to any claim shall be made in its sole discretion based on the Agreement and other relevant documents and shall be final, conclusive and binding on all persons.
Appears in 2 contracts
Samples: Executive Employment Agreement (Woolworth Corporation), Executive Employment Agreement (Woolworth Corporation)
Claims Procedures. (ai) For purposes of these claims proceduresprocedure purposes, the Administrator shall serve as the “"Claims Administrator.”
(b) Any claim for benefits hereunder Manager" shall be filed by Xxxx Xxxxxxxx or his designee. At any time, the InsuredCompany may remove the Claims Manager with or without cause. Within ten (10) days of the removal of the Claims Manager, his beneficiary or the Company shall appoint a duly authorized representative thereof successor Claims Manager. The Company shall provide written notice of such appointment to all of the parties hereto within ten (a “Claimant”10) through days of the provision appointment of a written notification to the successor Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunderManager.
(cii) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of reason a claim for benefits hereunder under this Agreement is denied by the Company, the Claims Manager shall (i) specify deliver to the reason claimant a written explanation setting forth the specific reasons for the denial; (ii) reference , pertinent references to the provisions section of this the Agreement on which the denial is based; (iii) describe the , a description of any additional material or informationinformation necessary to perfect the claim, if any, necessary for the Claimant to receive benefits and explain an explanation of why such material or information is necessary; , such other data as may be pertinent, and information on the procedures to be followed by the claimant in obtaining a review of his or her claim, all written in a manner calculated to be understood by the claimant. For this purpose, the claimant's claim shall be deemed filed when presented orally or in writing to the Claims Manager. The Claims Manager's explanation shall be in writing and shall be delivered to the claimant within thirty (30) days of the date on which the claim is filed.
(iii) The claimant (or his or her duly authorized representative) shall have thirty (30) days following the claimant's receipt of the denial of the claim to file with the Claims Manager a written request for review of the denial. For such review, the claimant (or his or her duly authorized representative) may submit pertinent documents and written issues and comments.
(iv) indicate The Claims Manager shall decide the steps to be taken by issue on review and furnish the Claimant if claimant with a copy of his or her decision within thirty (30) days of the receipt of the claimant's request for review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination his or her claim. The decision on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator be in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or include specific reasons for the adverse determination; (ii) reference decision, written in a manner calculated to be understood by the claimant, as well as specific references to the pertinent provisions of this the Agreement on which the benefit determination decision is based; (iii) contain . If a statement that copy of the Claimant decision is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant not so furnished to the Claimant’s claim for benefits; and claimant within thirty (iv30) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bankdays, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11claim shall be deemed denied on review.
Appears in 2 contracts
Samples: Split Dollar Insurance Agreement (Sanfilippo John B & Son Inc), Split Dollar Insurance Agreement (Sanfilippo John B & Son Inc)
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Committee shall serve as the “Claims Administrator.”
(b) Any If Insured or any beneficiary of Insured should have a claim for benefits hereunder hereunder, he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
. Benefit claims shall be made by Insured, Insured’s beneficiary(ies) or a duly authorized representative thereof (c) the “claimant”). If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) 90 days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim for benefits is allowable if special circumstances require an extension, but such an extension shall not extend beyond 180 days from the date the claim for benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) 90 days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any notice . Notice of a denial of a claim for benefits hereunder an adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review. If notice of an adverse benefit determination is not furnished in accordance with the preceding provisions of this Section 11, the claim shall be deemed denied and the claimant shall be permitted to exercise the claimant’s right to review as set forth below.
(ec) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) 60 days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, records and other information relevant “relevant” to the Claimantclaimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA. For purposes hereof, documents, records and information shall be considered “relevant” to the claimant’s claim if they (i) were relied upon in making the benefit determination; (ii) were submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrate compliance with the administrative processes and safeguards of this claims procedure.
(gd) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (Committee, whether in its capacity as Claims Administrator or otherwise, or any member thereof) or of the Claims Administrator Committee more than ninety one (901) days year after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
Appears in 2 contracts
Samples: Split Dollar Agreement (Park National Corp /Oh/), Split Dollar Agreement (Park National Corp /Oh/)
Claims Procedures. Other than in respect of claims to be made under the R&W Insurance Policy as set forth in this Article X, any claim for indemnification pursuant to this Article X (and, at the option of any Buyer Indemnified Party, any claim pursuant to Section 10.2(a)(iv)) shall be brought and resolved as follows:
(a) For purposes of these If any Buyer Indemnified Party has or claims proceduresin good faith to have incurred or suffered, or believes in good faith that it may incur or suffer, Loss for which it is or may be entitled to indemnification under this Article X or for which it is or may otherwise be entitled to a monetary remedy relating to this Agreement, the Administrator Transactions or any of the Transactions or thereby, such Buyer Indemnified Party may deliver a claim certificate (a “Claim Certificate”) to the Members’ Representative. Each Claim Certificate shall: (i) contain a brief description of the facts and circumstances supporting the Buyer Indemnified Party’s claim; and (ii) if practicable, contain a non-binding, preliminary, good faith estimate of the amount to which the Buyer Indemnified Party might be entitled. Such Buyer Indemnified Party may update a Claim Certificate from time to time to reflect any change in circumstances following the date thereof. If a claim under this Article X may be brought under different or multiple sections, clauses or sub-clauses of Article X (or with respect to different or multiple representations, warrants or covenants), then, subject to the conditions, qualifications and limitations and other provisions of this Article X, the Buyer Indemnified Party shall serve as have the right to bring such claim under any or each such section, clause, subclauses, representation, warranty or covenant (each a “Claims AdministratorSubject Provision”) that it chooses, and the Buyer Indemnified Party will not be precluded from seeking indemnification under any Subject Provision by virtue of the Buyer Indemnified Party not being entitled to seek indemnification under any other Subject Provision.”
(b) Any claim for benefits hereunder shall be filed by Notwithstanding the Insuredforegoing, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims Administratorextent permitted under this Article X, any Buyer Indemnified Party may make a claim directly against the Members by delivering a Claim Certificate to such Member. The Claims Administrator shall make all determinations as Such Buyer Indemnified Party may update a Claim Certificate from time to time to reflect any change in circumstances following the right of any Claimant to a benefit hereunderdate thereof.
(c) If After the claim is wholly or partially deniedgiving of any Claim Certificate pursuant hereto, the Claims Administrator amount of indemnification to which a Buyer Indemnified Party shall provide be entitled under this Article X shall be determined (i) by the written agreement between the Buyer Indemnified Party and the Members’ Representative, (ii) by a final judgment or electronic notice thereof decree of any court of competent jurisdiction or (iii) by any other means to which the Claimant within Buyer Indemnified Party and the Members’ Representative shall agree. For purposes of this Agreement, the judgment or decree of a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend court shall be deemed final when the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim appeal, if special circumstances require an extension. Written notice of any extension of time any, shall be sent to the Claimant within ninety (90) days after receipt of the claim have expired and no appeal shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decisionhave been taken or when all appeals taken shall have been finally determined.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify Subject to Section 10.7 and the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”)limitations set forth in Section 10.3, in the event that any Losses are determined to be owed to any Buyer Indemnified Party, each Member shall promptly, and in no event later than five (5) Business Days after the determination of Losses hereunder, wire transfer to Buyer an adverse determination on reviewamount equal to the product of (x) such Member’s Pro Rata Portion, multiplied by (y) the aggregate amount of such Losses (other than Losses arising out of, related to or incurred or accrued in connection with any breach of or inaccuracies in any representation or warranties made by a Member in Article II or any fraud, intentional misrepresentation or willful breach by a Member, for which the applicable Member responsible for such breach or act shall wire transfer to Buyer an amount equal to the entire aggregate amount of such Loss).
(e) If a claim is denied and a review is desiredNotwithstanding anything to the contrary in this Agreement, the Claimant shall notify the Claims Administrator parties hereby acknowledge and agree, that in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a reviewaddition to any other right hereunder, the Claimant may submit if any written commentsLosses are determined to be owed to any Buyer Indemnified Party, documentsthen, records and other information relating subject to the claim limitations contained in Section 10.3, Buyer may, in its sole discretion, from time to time elect to set-off the amount of such Losses from any amount that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant is payable pursuant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification Annex I of the benefit determination upon review. In the event of an adverse benefit determination on reviewOperating Agreement, the notice thereof shall (i) specify the reason or reasons including for the adverse determination; (ii) reference avoidance of doubt, if such amount becomes payable following the specific provisions expiration of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant any of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies survival periods set forth in this Section 1110.1 hereof.
Appears in 2 contracts
Samples: Membership Interest Purchase Agreement (CarGurus, Inc.), Membership Interest Purchase Agreement (CarGurus, Inc.)
Claims Procedures. (a) For purposes Benefits under the Plan are paid to the Employee or Beneficiary without the necessity of these a formal claim. However, if an Employee or Beneficiary disagrees with the Administrator’s determination of the amount of benefits under the Plan or with respect to any other decision the Administrator may make regarding the Employee’s or Beneficiary’s interest in the Plan, the Employee or Beneficiary may file a claim with the Administrator. All claims proceduresfor benefits under the Plan must be made in writing. If the Administrator believes that a claim should be denied, the Administrator shall serve as will notify the “Claims Administrator.”
(b) Any claim for benefits hereunder shall be filed by the Insured, his beneficiary Employee or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunder.
(c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant Beneficiary in writing within a reasonable period of time, but not later than ninety (90) 90 days after receipt of the claim; provided. This 90-day period may be extended for an additional 90 days, however, that provided the Claims Administrator may extend notifies the time for processing a claim to a date not more than one hundred eighty (180) days after receipt Employee or Beneficiary before the expiration of the claim if special circumstances require an extensionoriginal 90-days. Written Such notice of any extension of time shall be sent to set forth the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason specific reasons for the denial; (ii) reference , the Plan provisions of this Agreement on which the denial is based; (iii) describe the , a description of any additional material or information, if any, information necessary for the Claimant Employee or Beneficiary to receive benefits perfect his claim and explain an explanation of why such material or information is necessary; (iv) indicate , and information as to the steps to be taken by if the Claimant if a review of the denial is desiredEmployee or Beneficiary wishes to submit his claim for review, including the time limits applicable thereto; and (v) contain a statement of the ClaimantEmployee’s or Beneficiary’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of ERISA § 502(a) following an adverse benefit determination on review.. If the Employee or Beneficiary wishes to appeal the Administrator’s decision, the appeal must be filed in writing with the Administrator no later than 60 days after the Employee or Beneficiary receives notice of the denial. Upon appeal:
(ea) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant The Employee or Beneficiary may submit any written comments, documents, records records, and other information relating to the claim that the Claimant feels are appropriate. for benefits.
(b) The Claimant shall Employee or Beneficiary will be provided provided, upon request and free of charge, reasonable access to, to and copies of, of all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(fc) The Claims Administrator shall review the claim, taking into account all All comments, documents, records and other information that are submitted by relating to the Claimantclaim will be taken into account, without regard to regardless of whether such the information was submitted or considered in the initial benefit determination. The Administrator shall notify the Employee or Beneficiary of the Plan’s determination not later than 60 days after receipt of the request for review, and shall unless the Administrator determines that special circumstances require an extension of time for processing the claim. The extension may not be for a period longer than 60 days from the end of the initial review period. The Administrator will provide the Claimant Employee or Beneficiary with a written or electronic notification notice of the benefit determination upon Plan’s decision on review. In If the event of an adverse benefit determination on reviewclaim for benefits is denied or ignored, in whole or in part, and the notice thereof shall (i) specify the reason Employee or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement Beneficiary still believes that the Claimant he or she is entitled to receivethe benefit, upon request the Employee or Beneficiary may file a lawsuit. However, the Employee or Beneficiary may not file a lawsuit until he or she has completed the claim 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) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims appeal procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11above.
Appears in 2 contracts
Samples: Senior Management Retirement Savings Plan (NCL CORP Ltd.), Supplemental Executive Retirement Plan (NCL CORP Ltd.)
Claims Procedures. (a) For purposes The Company agrees that by establishment of these claims procedures, this Trust it hereby forgoes any review (judicial or otherwise) of certifications by the Administrator shall serve Recordkeeper as to the “Claims Administratorbenefit payable to any persons hereunder.”
(b) Any claim for benefits hereunder shall be filed by the Insured, his beneficiary or If a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims Administrator. The Claims Administrator shall make all determinations dispute arises as to the right amounts or timing of any Claimant to benefits or the persons entitled thereto under this Trust, such dispute shall be resolved under a benefit hereunderclaims review procedure established and maintained by the Recordkeeper that includes the following:
(1) The manner in which a claim is made.
(c2) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof Provisions to the Claimant within a reasonable period of timeeffect that, but not later than ninety (90) days after receipt of in the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice event of a denial of a claim for benefits hereunder shall (i) specify as to the amount of any distribution and/or the method of payment under any Plan by the Recordkeeper, a claimant will be given notice in writing of such detail within 90 days, which notice will set forth the reason for the denial; (ii) reference , the provisions of this Agreement pertinent Plan provision on which the denial is based; (iii) describe , a description of the additional material or information, if any, information necessary for to perfect the Claimant to receive benefits claim and explain an explanation of why such material or information is necessary; (iv) indicate the , and appropriate steps to be taken by the Claimant if a review of claimant to submit the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on claim for review.
(e3) If a claim is denied and Provisions to the effect that the claimant may request a review is desired, the Claimant shall notify the Claims Administrator of such denial by filing notice in writing with the Recordkeeper, within sixty (60) 60 days after receipt of written notice such denial, may review pertinent documents and may submit issues and comments in writing.
(4) Provisions for the Recordkeeper, in its discretion, to request a meeting to clarify an immediate matters it deems appropriate.
(5) Provisions to the effect that all interpretations, determinations, and decisions of the Recordkeeper in respect to any matter will be final, conclusive, and binding upon the claimant.
(c) By making a denial of a claim. In requesting a reviewPlan subject to the Trust, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free claims review procedures of charge. For purposes paragraph (b) of this Section 11, a document, record or other item of information shall be considered “relevant” 8 supersede any claims review procedures in the Plan to the Claimant’s claim if it (i) was relied upon in making extent of any benefits payable from the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedureTrust.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 2 contracts
Samples: Trust Agreement (Sun Co Inc), Trust Agreement (Sun Co Inc)
Claims Procedures. (a) For purposes of these claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for benefits hereunder shall be filed by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunder.
(c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review9.2.1. In the event that any claim is asserted against the Assets, Purchaser shall prepare a proposed statement of an adverse benefit determination on review, adjustment ("Statement of Adjustment") and deliver the notice thereof Statement of Adjustment to Seller who shall have twenty (i20) specify days to review and verify the reason or reasons for Statement of Adjustment (the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 "Review Period"). If Seller does not object in writing to the Claimant’s claim for benefits; Statement of Adjustment within the Review Period, then the Statement of Adjustment shall be final and (iv) inform binding on the Claimant Seller. If Seller does so object within the Review Period, then the parties shall meet as soon as practicable to attempt to resolve any such objection of Seller. If the parties agree in writing on a Statement of Adjustment, then the Seller and shall immediately pay their pro rata share of the right to bring a civil action under amount set forth in the provisions Statement of ERISAAdjustment.
9.2.2. If the parties cannot agree on a Statement of Adjustment within twenty (g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (9020) days after the Claimant has exhausted Review Period, then the procedures claim shall be settled by arbitration in accordance with the Commercial Rules of the American Arbitration Association then in effect. The decision of a sole arbitrator shall, except for mistakes of law, be final and binding upon the parties hereto, and judgment upon the award rendered by the arbitrator, may be entered in any court having jurisdiction thereof. The arbitrator shall be an existing or former judge of a court of record within the United States or an attorney in good standing admitted to practice for a period of at least ten (10) years within the United States. No arbitration shall involve parties other than the parties hereto and their respective successors and assigns or be in any respect binding with respect to any such other parties. The situs of the arbitration will be in the County of Orange, State of California. The parties to any arbitration arising hereunder shall have the right to take depositions and to obtain discovery regarding the subject matter of the arbitration and to use and exercise all of the same rights, remedies set forth and procedures, and be subject to all of the same duties, liabilities, and obligations in this the arbitration with respect to the subject matter thereof, as if the subject matter of the arbitration were pending in a civil action before a court of highest jurisdiction in the state where the arbitration is held. The arbitrator shall have the power to enforce said discovery by imposition of same terms, conditions, consequences, liabilities, sanctions and penalties as can be or maybe imposed in like circumstances in a civil action by a court of highest jurisdiction of the state in which the arbitration is held, except the power to order the arrest or imprisonment of a person.
9.2.3. In the event that any claim is asserted against Purchaser or the Assets are made a party defendant in any action or proceeding, and such claim, action or proceeding involves a matter which is the subject of indemnification under Section 119.1.2., then the Seller shall be notified as promptly as possible. Seller shall have the right to join in the defense of said claim, action or proceeding at the Seller's sole cost and expense. Unless the parties otherwise agree in writing as to the manner in which the Seller shall defend, compromise or settle (exercising reasonable business judgment) such claim, Purchaser shall be entitled to defend, compromise or settle such claim, for the account, and at the risk, of the Seller.
Appears in 2 contracts
Samples: Asset Purchase Agreement (Troy Group Inc), Asset Purchase Agreement (Extended Systems Inc)
Claims Procedures. (a) For purposes Promptly after receipt by a Person seeking indemnification (the “Indemnified Person”) of these claims proceduresnotice (i) of the commencement or assertion of any claim or Legal Proceeding by a third party or (ii) of facts causing any Indemnified Person to believe it has a claim for indemnification hereunder (an “Indemnity Claim”), such Indemnified Person will give prompt written notice thereof (the “Claim Notice”) to Holdings LP or to AMID, as applicable (Holdings LP or AMID, as applicable, the Administrator shall serve “Indemnifying Person”). Notwithstanding the foregoing, as long as the “Claims AdministratorClaim Notice is given within the applicable survival period set forth in Section 8.1, the failure to so notify the Indemnifying Person will not relieve the Indemnifying Person of its obligations or liability hereunder, except to the extent such failure materially prejudices the Indemnifying Person. The Claim Notice will describe the Indemnity Claim in reasonable detail, and will indicate the amount (estimated, if necessary) of the Damages that has been or may be suffered and the provisions under this Agreement on which such claim is based. The Indemnified Person and the Indemnifying Person agree to keep each other reasonably appraised of any additional information concerning any Indemnity Claim.”
(b) Any As to the defense of an Indemnity Claim arising from a third party action, the Indemnifying Person will be, subject to the limitations set forth in this Section 8.5 and subject to the Indemnifying Person’s prior confirmation in writing to the Indemnified Person(s) that the Indemnity Claim is covered as an indemnified claim under this Agreement within 30 days of receipt of a Claim Notice from the Indemnified Person, entitled to assume control of and appoint lead counsel reasonably satisfactory to the Indemnified Person for benefits hereunder such defense, at the cost of the Indemnifying Person. The Indemnifying Person will keep the Indemnified Person(s) advised of the status of such third party action and the defense thereof on a reasonably current basis and will consider in good faith the recommendations made by the Indemnified Person(s) with respect thereto. The Indemnifying Person shall be filed liable for the fees and expenses of counsel employed by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”Indemnified Person(s) through for any period during which the provision Indemnifying Person has failed to assume the defense thereof. If the Indemnifying Person assumes the control of a written notification to the Claims Administrator. The Claims Administrator shall make all determinations as to the right defense of any Claimant third party action in accordance with the provisions of this Section 8.5, the Indemnified Person(s) will be entitled to participate in the defense of any such third party action and to engage, at its expense, separate counsel of its choice for such purpose, it being understood, however, that the Indemnifying Person will continue to control such defense. Notwithstanding the foregoing, the Indemnifying Person will not be able to control the defense of any claim arising from a benefit hereunderthird party action if the third party action is (A) for equitable or injunctive relief or any claim that would impose criminal liability or criminal damages, (B) in the reasonable opinion of the Indemnified Person(s), the third party action could have a material adverse effect on its business, assets, liabilities, condition (financial or otherwise) or results of operations of the Indemnified Persons, or (C) the claim alleges Damages in excess of the Indemnifying Person’s maximum indemnification obligations under this Agreement.
(c) If Subject to Section 8.5(d), if the claim Indemnifying Person does not expressly elect to assume the defense of such third party action within the time period and otherwise in accordance with the first sentence of this Section 8.5(b), is wholly not otherwise entitled to assume the defense of such third party action under the last sentence of Section 8.5(b) or partially deniedafter assuming the defense of a third party action, fails to take commercially reasonable steps necessary to diligently defend such third party action, the Claims Administrator Indemnified Person(s) shall provide written or electronic notice thereof have the sole right to assume the Claimant within a reasonable period defense of timeand to settle such third party action, but not later than ninety (90) days after receipt at the cost and expense of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decisionIndemnifying Person.
(d) Any notice If the Indemnified Person has assumed the defense of a denial of a claim for benefits hereunder shall third party action pursuant to this Section 8.5, (i) specify the reason for the denial; it shall use commercially reasonable efforts to diligently defend such third party action, (ii) reference it will keep the provisions Indemnifying Person advised of this Agreement the status of such third party action and the defense thereof on which the denial is based; a reasonably current basis, (iii) describe it will reasonably consult with the additional material or informationIndemnifying Person with respect to the defense and settlement thereof, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate it will consider in good faith the steps to be taken recommendations made by the Claimant if a review of the denial is desired, including the time limits applicable thereto; Indemnifying Person with respect thereto and (v) contain a statement it will not agree to any settlement thereof without the written consent of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974Indemnifying Person (which consent shall not be unreasonably withheld, as amended (“ERISA”delayed or conditioned), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desiredNotwithstanding the foregoing, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; Indemnifying Person will obtain the prior written consent of the Indemnified Person(s) before entering into any settlement, compromise, admission or acknowledgement of the validity of such Indemnity Claim if the settlement requires an admission of guilt or wrongdoing on the part of the Indemnified Person(s), subjects the Indemnified Person(s) to criminal liability or does not unconditionally release the Indemnified Person(s) from all liabilities and obligations with respect to such Indemnity Claim or the settlement imposes injunctive or other equitable relief against, or any continuing obligation or payment requirement on, the Indemnified Person(s) and (ii) was submitted, considered or generated the Indemnified Person(s) will be entitled to participate in the course defense of making such Indemnity Claim and to engage separate counsel of its choice for such purpose at its own cost and expense unless (A) the benefit determination, whether engagement of such counsel or not actually relied upon incurrence of such expenses shall have been specifically authorized in making writing by the determination; Indemnifying Person or (iii) demonstrates compliance the named parties to the third party action include both an Indemnified Person(s) and an Indemnifying Person, and the Indemnified Person(s) reasonably determines after consultation with outside legal counsel that representation by counsel to the administrative processes Indemnifying Person of both the Indemnifying Person, and safeguards the Indemnified Person(s) would present such counsel with a conflict of this claims procedureinterest.
(f) Each party will cooperate in the defense or prosecution of any Indemnity Claim arising from a third party action and will furnish or cause to be furnished such records, information and testimony (subject to any applicable confidentiality agreement), and attend such conferences, discovery proceedings, hearings, trials or appeals as may be reasonably requested in connection therewith. The Claims Administrator shall review Indemnifying Person will reimburse the claim, taking into account Indemnified Person(s) for all comments, documents, records costs and other information submitted expenses incurred by the Claimant, without regard to whether such information was submitted or considered Indemnified Person(s) in connection with the initial benefit determination, investigation and shall provide the Claimant with written or electronic notification defense of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 third party action prior to the Claimant’s claim for benefits; date the Indemnifying Person validly exercised its right to assume the investigation and (iv) inform the Claimant defense of the right to bring a civil action under the provisions of ERISAthird party action.
(g) After exhausting In the claims procedure described hereincase of an Indemnity Claim not based upon a third party action (“Direct Claim”), nothing the Indemnifying Person shall prevent have 20 days from its receipt of the Claimant from pursuing any other legal Claim Notice to either (i) admit its obligation to provide indemnification, (ii) agree that the Indemnified Person(s) is entitled to receive part, but not all of the indemnification obligation or equitable remedy otherwise available(ii) dispute the Claim for indemnification, and provide a written explanation for its position and supporting documentation. If the Indemnifying Person does not notify the Indemnified Person(s) within 30 days following its receipt of a Claim Notice in respect of a Direct Claim that the Indemnifying Person disputes its liability to the Indemnified Person(s) hereunder, such Direct Claim specified by the Indemnified Person(s) in such Claim Notice shall be conclusively deemed a liability of the Indemnifying Person hereunder and the Indemnifying Person shall pay the amount of such liability to the Indemnified Person(s) on demand. In the event that the Indemnifying Person disputes a Claim Notice for a Direct Claim, the parties, including appropriate management representatives, shall promptly seek to negotiate a resolution in good faith. If the right parties are unable to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding resolve the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) dispute within 120 days after the Claimant has exhausted Indemnifying Person first receives the procedures and remedies set forth in Claim Notice for a Direct Claim, then the Indemnified Person(s) may seek any remedy available to it under this Section 11Agreement.
Appears in 2 contracts
Samples: Contribution Agreement (Southcross Energy Partners, L.P.), Contribution Agreement (American Midstream Partners, LP)
Claims Procedures. (a) For purposes of these The broker shall
15.1 receive all valid, legitimate and payable claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for benefits hereunder shall be filed by the Insured, his beneficiary or a and submit such claims to A-SURE within 24 hours after receipt thereof in order to have such claims duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims Administratorprocessed. The Claims Administrator shall make all determinations as broker has no mandate to acknowledge or accept any responsibility on behalf of the right of any Claimant insurer. Mandated Broker, to a benefit hereunderregister claim on system, immediately on receipt.
(c) If 15.2 non mandated Brokers to supply to A-SURE all the claim is wholly or partially denieddetails relevant to all claims within 24 hours from receipt of notification thereof, as well as confirmation of cover on the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt date of the claim; provided, however, and that the Claims Administrator may extend premium owed for the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of period in which the claim if special circumstances require an extensionoccurred, has been paid by the insured. Written notice of any extension of time shall be sent Mandated Brokers to the Claimant within ninety (90) days after receipt of the claim ensure that cover is in place and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decisionall premiums paid.
(d) Any notice of 15.3 in all cases insist on a denial of a completed claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or informationform, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken signed by the Claimant if a review of insured, or voice logged unless otherwise instructed by the denial is desired, including the time limits applicable thereto; Insurer or A-SURE in writing and (v) contain a statement of the Claimant’s right duly provided to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on reviewOmnium.
(e) If a claim is denied 15.4 display the utmost good faith in dealings with clients, A-SURE and a review is desired, Insurers during the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determinationclaims process; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates non compliance with the administrative processes and safeguards above-mentioned is grounds for dismissal of this claims procedureagreement.
(f) The Claims Administrator shall review 15.5 if required, provide assistance and supply any documentation which may be required with regards to the claimhandling, taking into account all commentsprocessing and investigating of claims as well as the prosecuting of alleged deceiving claims;
15.6 notify A-SURE within 24 hours after receiving any summons or legal action against the insurer or A-SURE as well as to provide any required judicial information. If it appears that the insurer must file affidavits within 24 hours, documentsimmediate notice is required.
15.7 Where the broker completes any claim forms or supporting documentation, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification he acts as representative of the benefit determination upon review. In client and not of the event insurer;
15.8 not trade or negotiate with any motor or other vehicle salvages in terms of an adverse benefit determination on reviewclaims under the motor section, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant is entitled but to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant provide to the Claimant’s claim for benefits; and (iv) inform the Claimant disposal of the right insurer for further handling;
15.9 with regards to bring a civil action under third party claims, supply all claims documentation and proof of settling to the provisions Legal department of ERISA.A-SURE and support the insurer by provision of testimony and by obtaining required documentation to ensure effective recovery and payments;
(g) After exhausting the claims procedure described herein15.10 where any direct payments are received from any third party, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise availableif claim payments are made to insured’s by cheque or bank transfers, including the right these amounts must be refunded to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors A-SURE without delay in respect of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11insurer.
Appears in 2 contracts
Samples: Intermediary Contract, Intermediary Contract
Claims Procedures. (a) For purposes Promptly after receipt by any indemnified Person of these claims proceduresnotice of the commencement or assertion of any Claim or Proceeding by a non-Affiliate third party or circumstances which, with the Administrator lapse of time, such indemnified Person believes is likely to give rise to a Claim or Proceeding by a non-Affiliate third party or of facts causing any indemnified Person to believe it has a Claim for indemnification hereunder (an “Asserted Liability”), such indemnified Person shall serve as give written notice thereof (the “Claims AdministratorNotice”) to the relevant indemnifying Person as promptly as reasonably practicable under the circumstances, provided that in any event, such indemnified Person shall give the Claims Notice to the indemnifying Person no later than 20 days after becoming aware of such Asserted Liability. So long as the Claims Notice is given within the applicable survival period set forth in Section 10.1, the failure to so notify the indemnifying Person shall not relieve the indemnifying Person of its obligations or liability hereunder, except to the extent such failure shall have actually prejudiced the indemnifying Person. The Claims Notice shall describe the Asserted Liability in reasonable detail, shall indicate the amount (estimated, if necessary) of the Loss that has been or may be suffered, shall include a copy of all papers (if any) served with respect to the Claim or Proceeding and shall identify the specific basis under this Agreement for the Asserted Liability. The indemnified Person and the indemnifying Person agree to keep each other reasonably appraised of any additional information obtained by such Person concerning any Asserted Liability.”
(b) Any claim As to an Asserted Liability arising from a non-Affiliate third party action, the indemnifying Person shall be, subject to the limitations set forth in this Section 10.5, entitled to assume control of and appoint lead counsel for benefits hereunder such defense only for so long as it conducts such defense with reasonable diligence. The indemnifying Person shall keep the indemnified Persons advised of the status of such non-Affiliate third party action and the defense thereof on a reasonably current basis and shall consider in good faith the recommendations made by the indemnified Persons with respect thereto. If the indemnifying Person assumes the control of the defense of any non-Affiliate third party action in accordance with the provisions of this Section 10.5, the indemnified Person shall be filed by entitled to participate in the Insureddefense of any such non-Affiliate third party action and any applicable settlement thereof and to employ, his beneficiary at its expense, separate counsel of its choice for such purpose, it being understood, however, that the indemnifying Person shall continue to control such defense or such settlement; provided that notwithstanding the foregoing, the indemnifying Person shall pay the reasonable costs and expenses of such defense (including reasonable attorneys’ fees and expenses) of the indemnified Persons if (x) the indemnified Person’s outside counsel shall have reasonably concluded and advised in writing (with a duly authorized representative thereof (a “Claimant”) through the provision of a written notification copy to the Claims Administratorindemnifying Person) that there are defenses available to such indemnified Person that are different from or additional to those available to the indemnifying Person, or (y) the indemnified Person’s outside counsel shall have advised in writing (with a copy to the indemnifying Person) the indemnified Person that there is a conflict of interest that would make it inappropriate under applicable standards of professional conduct to have common counsel for the indemnifying Person and the indemnified Person. The Claims Administrator Notwithstanding the foregoing, the indemnifying Person shall make obtain the prior written consent of the indemnified Person before entering into any settlement, compromise, admission or acknowledgement of the validity of such Asserted Liability if the settlement requires an admission of guilt or wrongdoing on the party of the indemnified Person, subjects the indemnified Person to criminal liability or does not unconditionally release the indemnified Person from all determinations as liabilities and obligations with respect to such Asserted Liability or the settlement imposes injunctive or other equitable relief against, or any continuing obligation or payment requirement on, the indemnified Person. If the indemnifying Person does not elect to assume control of the defense of such non-Affiliate third party action, then the indemnified Person shall have the right to defend against such non-Affiliate third party action at the sole cost and expense of the indemnifying Person, with counsel of the indemnifying Person’s choosing (subject to the right of the indemnifying Person to elect to control the defense of such non-Affiliate third party action at any Claimant time prior to settlement or final determination thereof). Any settlement of such non-Affiliate third party action by the indemnified Person shall require the consent of the indemnifying Person (which shall not be unreasonably withheld, conditioned or delayed), unless the settlement is solely for money damages and results in a benefit hereunderfinal resolution.
(c) If Each Party shall cooperate in the claim is wholly defense or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice prosecution of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim Asserted Liability arising from a non-Affiliate third party action and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material furnish or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps cause to be taken by the Claimant if a review of the denial is desiredfurnished such records, including the time limits information and testimony (subject to any applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”confidentiality agreement), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desiredattend such conferences, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a reviewdiscovery proceedings, the Claimant may submit any written commentshearings, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record trials or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action appeals as may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth reasonably requested in this Section 11connection therewith.
Appears in 2 contracts
Samples: Purchase and Sale Agreement (Summit Midstream Partners, LP), Purchase and Sale Agreement (Summit Midstream Partners, LP)
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Committee shall serve as the “Claims Administrator.”
(b) Any If the Insured or any beneficiary of the Insured should have a claim for benefits hereunder hereunder, he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
. Benefit claims shall be made by Insured, Insured’s beneficiary(ies) or a duly authorized representative thereof (c) the “claimant”). If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) 90 days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim for benefits is allowable if special circumstances require an extension, but such an extension shall not extend beyond 180 days from the date the claim for benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) 90 days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any notice . Notice of a denial of a claim for benefits hereunder an adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review. If notice of an adverse benefit determination is not furnished in accordance with the preceding provisions of this Section 11, the claim shall be deemed denied and the claimant shall be permitted to exercise the claimant’s right to review as set forth below.
(ec) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) 60 days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, records and other information relevant “relevant” to the Claimantclaimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA. For purposes hereof, documents, records and information shall be considered “relevant” to the claimant’s claim if they (i) were relied upon in making the benefit determination; (ii) were submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrate compliance with the administrative processes and safeguards of this claims procedure.
(gd) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, Park, the Board of Directors of the Bank (Committee, whether in its capacity as Claims Administrator or otherwise, or any member thereof) or of the Claims Administrator Committee more than ninety one (901) days year after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Board shall serve as the “Claims Administrator.”
(b) Any If the Insured or any beneficiary of the Insured should have a claim for benefits hereunder he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
. Benefit claims shall be made by the Insured, his beneficiary or beneficiaries or a duly authorized representative thereof (c) the “claimant). If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension shall not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any . The notice of a denial of a claim for benefits hereunder adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s claimant's right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), ERISA in the event of an adverse determination on review. If notice of the adverse benefit determination is not furnished in accordance with the preceding provisions of this Section, the claim shall be deemed denied and the claimant shall be permitted to exercise his right to review as set forth below.
(ec) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claimant's claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, do records and other information relevant “relevant” to the Claimant’s claimant's claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA. For purposes hereof, documents, records and information shall be considered “relevant” to the claimant's claim if it (i) was relied upon in making the benefit determination, (ii) was submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(gd) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors Board, any member of the Bank (or any member thereof) Board or the Claims Administrator more than ninety one (901) days year after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Committee shall serve as the “Claims Administrator.”
(b) Any If the Insured or any beneficiary of the Insured should have a claim for benefits hereunder he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
, and the amount of such benefit, in its full and sole discretion. Benefit claims shall be made by the Insured, his beneficiary or beneficiaries or a duly authorized representative thereof (c) the “claimant”). All determinations of the Claims Administrator shall be binding upon the Insured, any claimant, and any person claiming through them. If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension shall not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any . The notice of a denial of a claim for benefits hereunder adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review. If notice of the adverse benefit determination is not furnished in accordance with the preceding provisions of this Section, the claim shall be deemed denied and the claimant shall be permitted to exercise his right to review as set forth below.
(ec) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, records and other information relevant to in the Claimantfile and regarding claimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA.
(gd) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors Board, the Compensation Committee of the Bank (or Board, and any member thereof) of the Board or the Claims Administrator more than ninety (90) days after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
(e) In the event a claim above is a claim for disability benefits, then the applicable time periods for notifying claimants regarding benefit determinations shall be reduced as required by 29 CFR 2560.503-1. Thus, the plan administrator shall provide notice to the claimant within a reasonable period of time, but not later than forty-five (45) days after receipt of the claim. This period may be extended by up to thirty (30) days, provided that the plan administrator both determines that such an extension is necessary due to matters beyond the control of the plan and notifies the claimant, prior to the expiration of the initial forty-five (45) day period, of the circumstances requiring the extension of time and the date by which the plan expects to render a decision. If, prior to the end of the first thirty (30) day extension period, the administrator determines that, due to matters beyond the control of the plan, a decision cannot be rendered within that extension period, the period for making the determination may be extended for up to an additional thirty (30) days, provided that the plan administrator notifies the claimant, prior to the expiration of the first thirty (30) day extension period, of the circumstances requiring the extension and the date as of which the plan expects to render a decision. In the case of any extension under this paragraph, the notice of extension shall specifically explain 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 the specified information. In addition to complying with such timing rules, a claim under this paragraph shall comply with all procedural requirements under ERISA, including but not limited to providing a detailed explanation for the denial in a language calculated to be understood by the Claimant, considering all submitted information regardless of whether submitted in the initial claim, avoiding conflicts of interest when making a determination, and advising of any statutory filing deadlines.
Appears in 1 contract
Claims Procedures. (a) For purposes Any controversy or claim arising out of these claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for benefits hereunder or relating to this Plan shall be filed by with the InsuredPlan Administrator, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims AdministratorLear, Corporation, 21557 Telegraph Road, P.O. Box 0000, Southfield, MX 00000-0000, Xxxxxxxxx: Xecretary. The Claims Plan Administrator (or its designee) shall make all determinations concerning such claim. Any decision by the Plan Administrator (or its designee) denying such claim shall be in writing and shall be delivered to all parties in interest in accordance with the notice provisions of Section 10.02 hereof. Such decision shall set forth the reasons for denial in plain language. Pertinent provisions of the Plan shall be cited and, where appropriate, an explanation as to how the right of any Claimant to a benefit hereunder.
(c) If claimant can perfect the claim is wholly or partially denied, will be provided. This notice of denial of benefits will be provided within 90 days of the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after Plan Administrator's receipt of the claimant's claim for benefits. If the Plan Administrator fails to notify the claimant of its decision regarding the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension considered denied, and the date by which claimant then shall be permitted to proceed with the Claims Administrator expects appeal as provided in this Section. A claimant who has been completely or partially denied a benefit shall be entitled to render a final decision.
(d) Any notice of a appeal this denial of his/her claim by filing a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a written statement of his/her position with the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Plan Administrator in writing within no later than sixty (60) days after receipt of the written notice notification of a denial such claim denial. Following the review of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other additional information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered the Plan Administrator shall render a decision on the review of the denied claim in the initial benefit determinationfollowing manner:
a. The Plan Administrator shall make its decision regarding the merits of the denied claim within 60 days following receipt of the request for review (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 Plan Administrator 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 extension shall be furnished to the claimant 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 shall provide cite specific references to the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific pertinent Plan provisions of this Agreement on which the benefit determination decision is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes Any controversy or claim arising out of these claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for benefits hereunder or relating to this Agreement shall be filed by with the InsuredAdministrator, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims AdministratorHoneywell International Inc., 000 Xxxxxxxx Xxxx, Xxxxxxxxxx, Xxx Xxxxxx 00000. The Claims Administrator shall make all determinations concerning such claim. Any decision by the Administrator denying such claim shall be in writing and shall be delivered to all parties in interest in accordance with the notice provisions of Section 7(b) hereof. The denial shall state a specific reason for it, shall cite to pertinent provisions of the Agreement and, where appropriate, provide an explanation as to how the right of any Claimant to claimant can perfect the claim. The denial shall include a benefit hereunder.
(c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof statement that an appeal must be in writing to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written the Administrator’s notice of the denial and of claimant’s right to bring a civil action under Section 502(a) of ERISA following a denial on appeal. This notice of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant denial of benefits shall be provided reasonable access to, and copies of, all documents, records and other information relevant to within ninety (90) days of the ClaimantAdministrator’s receipt of the claimant’s claim for benefits. If the Administrator fails to notify the claimant of its decision regarding the claim, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information the claim shall be considered “relevant” denied, and the claimant shall then be permitted to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance proceed with the administrative processes and safeguards appeal as provided in this Section. A claimant who has been completely or partially denied a benefit shall be entitled to appeal this denial of this claims procedure.
his/her claim by filing a written statement of his/her position with the Administrator no later than sixty (f60) days after receipt of the written notification of such claim denial. The Claims Administrator shall schedule and provide an opportunity for a full and fair review of the claimissue within thirty (30) days of receipt of the appeal. If the claimant appeals a denial of benefits, the Administrator shall reexamine all facts related to such claim and its denial, taking into account all comments, documents, records and other information submitted by the Claimantclaimant relating to the claim, without regard to regardless of whether such information was submitted or considered in the initial benefit determination, and shall provide make a final determination as to whether the Claimant with written denial of benefits is justified under the circumstances. Following the review of information submitted by the claimant, either through the hearing process or electronic notification otherwise, the Administrator shall render a decision on the review of the benefit determination upon reviewdenied claim in the following manner:
i. The Administrator shall make its decision regarding the merits of the denied claim within sixty (60) days following receipt of the request for review (or within 120 days after such receipt, in a case where there are special circumstances requiring extension of time for reviewing the appealed claim). In The Administrator shall deliver the event decision to the claimant in writing. If an extension of an adverse benefit determination time for reviewing the appealed claim is required because of special circumstances, written notice of the extension shall be furnished to the claimant prior to the commencement of the extension. If the decision on reviewreview is not furnished within the prescribed time, the notice thereof claim shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.deemed
Appears in 1 contract
Samples: Deferred Compensation Agreement (Honeywell International Inc)
Claims Procedures. (a) For purposes of these claims proceduresIf, prior to the Escrow Termination Date, the Administrator Purchaser determines to assert a Claim, then the Purchaser shall serve as give the “Claims AdministratorEscrow Agent written notice of the Claim, specifying in reasonable detail the basis therefor and the amount and calculation thereof in accordance with the provisions of the Purchase Agreement (a "Claim Notice"). The Escrow Agent shall deliver a copy of such Claim to the Seller within five days after its receipt thereof. If the Seller does not deliver to the Purchaser and the Escrow Agent written notice of its objection to the Claim within ten (10) business days after receipt of the Claim Notice relating thereto, the Escrow Agent shall, out of the Escrowed Shares, promptly pay such amount to the Purchaser. If the Seller shall timely deliver to the Purchaser and the Escrow Agent such written notice of objection, then the Escrow Agent shall not make any payment to the Purchaser with respect to such Claim until: (i) he has received written instructions signed by the Purchaser and the Seller which refer to such Claim and direct the payment to the Purchaser from the Escrowed Shares; 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, whereupon the Escrow Agent shall distribute from the Escrowed Shares to the Purchaser the amount of any award to the Purchaser (not to exceed the amount of the Claim) specified therein and, if the Escrow Termination Date shall have occurred prior to such date, shall distribute from the Escrowed Shares to the Seller the amount, if any, by which the amount of the Claim exceeds the amount of such award, if any.”
(b) Any claim for benefits hereunder For the purposes of this Agreement, the value per share of the Escrowed Shares shall be filed by equal the Insuredclosing bid price of the common stock of Aquis Communications Group, his beneficiary or a duly authorized representative thereof (a “Claimant”) through Inc. on the provision of a written notification to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunderdate hereof.
(c) If there is a dispute between the claim is wholly or partially deniedSeller and the Purchaser with regard to the payment of a Claim from the Escrowed Shares, the Claims Administrator shall provide written or electronic notice thereof to reasonable legal fees, expenses and other costs incurred by the Claimant within a reasonable period Escrow Agent in connection with the adjudication of timesuch dispute and such fees, but not later than ninety (90) days after receipt expenses and costs incurred by the party awarded the majority of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt disputed amount of the claim if special circumstances require an extension. Written notice of any extension of time Escrowed Shares shall be sent paid by the other party. If the Purchaser is the party entitled to have its legal fees, expenses and other costs paid by the Claimant within ninety (90) days after receipt Seller, it shall be entitled to have the amount of such legal fees, expenses and other costs distributed to it out of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decisionEscrowed Shares.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Samples: Indemnity Escrow Agreement (Aquis Communications Group Inc)
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Committee shall serve as the “Claims Administrator.”
(b) Any If the Insured or any beneficiary of the Insured should have a claim for benefits hereunder he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
, and the amount of such benefit, in its full and sole discretion. Bxxxxxx claims shall be made by the Insured, his beneficiary or beneficiaries or a duly authorized representative thereof (c) the “claimant”). All determinations of the Claims Administrator shall be binding upon the Insured, any claimant, and any person claiming through them. If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension shall not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any . The notice of a denial of a claim for benefits hereunder adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review. If notice of the adverse benefit determination is not furnished in accordance with the preceding provisions of this Section, the claim shall be deemed denied and the claimant shall be permitted to exercise his right to review as set forth below.
(ec) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, records and other information relevant to in the Claimantfile and regarding claimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA.
(gd) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors Board, the Committee, and any member of the Bank (or any member thereof) Board or the Claims Administrator more than ninety (90) days after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 1112.
(e) In the event a claim above is a claim for disability benefits, then the applicable time periods for notifying claimants regarding benefit determinations shall be reduced as required by 29 CFR 2560.503-1. Thus, the plan administrator shall provide notice to the claimant within a reasonable period of time, but not later than forty-five (45) days after receipt of the claim. This period may be extended by up to thirty (30) days, provided that the plan administrator both determines that such an extension is necessary due to matters beyond the control of the plan and notifies the claimant, prior to the expiration of the initial forty-five (45) day period, of the circumstances requiring the extension of time and the date by which the plan expects to render a decision. If, prior to the end of the first thirty (30) day extension period, the administrator determines that, due to matters beyond the control of the plan, a decision cannot be rendered within that extension period, the period for making the determination may be extended for up to an additional thirty (30) days, provided that the plan administrator notifies the claimant, prior to the expiration of the first thirty (30) day extension period, of the circumstances requiring the extension and the date as of which the plan expects to render a decision. In the case of any extension under this paragraph, the notice of extension shall specifically explain 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 the specified information. In addition to complying with such timing rules, a claim under this paragraph shall comply with all procedural requirements under ERISA, including but not limited to providing a detailed explanation for the denial in a language calculated to be understood by the Claimant, considering all submitted information regardless of whether submitted in the initial claim, avoiding conflicts of interest when making a determination, and advising of any statutory filing deadlines.
Appears in 1 contract
Claims Procedures. Any claim by the Executive or Beneficiary ("Claimant") with respect to participation, contributions, benefits or other aspects of the operation of the Agreement shall be made in writing to the Secretary of the Company or such other person designated by the Committee from time to time for such purpose. If the designated person receiving a claim believes, following consultation with the Chairman of the Committee, that the claim should be denied, he or she shall notify the Claimant in writing of the denial of the claim within 90 days after his or her receipt thereof (this period may be extended an additional 90 days in special circumstances and, in such event, the Claimant shall be notified in writing of the extension). Such notice shall (a) For purposes of these claims procedures, set forth the Administrator shall serve as specific reason or reasons for the “Claims Administrator.”
(b) Any claim for benefits hereunder shall be filed by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification denial making reference to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunder.
(c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt pertinent provisions of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; , (iiib) describe any additional material or information necessary to perfect the additional claim, and explain why such material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (ivc) inform the Claimant of his or her right pursuant to this section to request review of the right to bring a civil action under the provisions of ERISAdecision.
(g) After exhausting A Claimant may appeal the claims procedure described hereindenial of a claim by submitting a written request for review to the Committee, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) within 60 days after the date on which such denial is received. Such period may be extended by the Committee for good cause shown. The claim will then be reviewed by the Committee. A Claimant has exhausted or his or her duly authorized representative may discuss any issues relevant to the procedures claim, may review pertinent documents and remedies set forth may submit issues and comments in writing. If the Committee deems it appropriate, it may hold a hearing as to a claim. If a hearing is held, the Claimant shall be entitled to be represented by counsel. The Committee shall decide whether or not to grant the claim within 60 days after receipt of the request for review, but this Section 11period may be extended by the Committee for up to an additional 60 days in special circumstances. Written notice of any such special circumstances shall be sent to the Claimant. Any claim not decided upon in the required time period shall be deemed denied. All interpretations, determi nations and decisions of the Committee with respect to any claim shall be made in its sole discretion based on the Agreement and other relevant documents and shall be final, conclusive and binding on all persons.
Appears in 1 contract
Samples: Executive Employment Agreement (Woolworth Corporation)
Claims Procedures. (a) For purposes Any controversy or claim arising out of these claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for benefits hereunder or relating to this Plan shall be filed by with the InsuredPlan Administrator, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims AdministratorTRW Inc., 1000 Xxxxxxxx Xx., Xxxxxxxxx, XX. 00000, Attention: Secretary. The Claims Plan Administrator shall make all determinations concerning such claim. Any decision by the Plan Administrator denying such claim shall be in writing and shall be delivered to all parties in interest in accordance with the notice provisions of Section 10.02 hereof. Such decision shall set forth the reasons for denial in plain language. Pertinent provisions of the Plan shall be cited and, where appropriate, an explanation as to how the right of any Claimant to a benefit hereunder.
(c) If claimant can perfect the claim is wholly or partially denied, will be provided. This notice of denial of benefits will be provided within 90 days of the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after Plan Administrator’s receipt of the claimant’s claim for benefits. If the Plan Administrator fails to notify the claimant of its decision regarding the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension considered denied, and the date by which claimant shall then be permitted to proceed with the Claims Administrator expects appeal as provided in this Section. A claimant who has been completely or partially denied a benefit shall be entitled to render a final decision.
(d) Any notice of a appeal this denial of his/her claim by filing a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a written statement of his/her position with the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Plan Administrator in writing within no later than sixty (60) days after receipt of the written notice notification of such claim denial. The Plan Administrator shall schedule an opportunity for a denial full and fair review of a claimthe issue within thirty (30) days of receipt of the appeal. In requesting a reviewThe decision on review shall set forth specific reasons for the decision, the Claimant may submit any written comments, documents, records and other information relating shall cite specific references to the claim that pertinent Plan provisions on which the Claimant feels are appropriatedecision is based. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to Following the Claimant’s claim for benefits, upon request and free review of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other any additional information submitted by the Claimantclaimant, without regard to whether such information was submitted either through the hearing process or considered otherwise, the Plan Administrator shall render a decision on the review of the denied claim in the initial benefit determinationfollowing manner:
a. The Plan Administrator shall make its decision regarding the merits of the denied claim within 60 days following receipt of the request for review (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 Plan Administrator 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 extension shall be furnished to the claimant 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 shall provide cite specific references to the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific pertinent Plan provisions of this Agreement on which the benefit determination decision is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. To the extent the Committee permits deferral elections extending to the termination of employment or beyond, the following claims procedures shall apply:
(a) For purposes The Committee shall notify Participants and, where appropriate, the Beneficiary(ies) of their right to claim benefits under these claims procedures, shall make forms available for filing of such claims, and shall provide the Administrator shall serve as name of the “Claims Administratorperson or persons with whom such claims should be filed.”
(b) Any claim for benefits hereunder The Committee shall be filed by the Insured, his beneficiary or act upon claims as required and communicate a duly authorized representative thereof (a “Claimant”) through the provision of a written notification decision to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of claimant promptly and, in any Claimant to a benefit hereunder.
(c) If event, not later than 90 days after the claim is wholly or partially deniedreceived by the Committee, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if unless special circumstances require an extension. Written notice of any extension of time for processing the claim. If an extension is required, notice of the extension shall be sent furnished to the Claimant within ninety (90) days after receipt claimant prior to the end of the claim and initial 90-day period, which notice shall include an explanation of indicate the special circumstances requiring reasons for the extension and the date expected decision date. The extension shall not exceed 90 days. The claim may be deemed by which the Claims Administrator expects claimant to render have been denied for purposes of further review described below in the event a final decision.
(d) Any notice of a denial of a decision is not furnished to the claimant within the period described in the preceding three sentences. Every claim for benefits hereunder which is denied shall be denied by written notice setting forth in a manner calculated to be understood by the claimant (i) specify the specific reason or reasons for the denial; , (ii) specific reference the to any provisions of this Agreement Program on which the denial is based; , (iii) describe the description of any additional material or information, if any, information necessary for the Claimant claimant to receive benefits and explain perfect his claim with an explanation of why such material or information is necessary; , and (iv) indicate an explanation of the steps procedure for further review of the denial of the claim under this Program.
(c) The claimant or his or her duly authorized representative shall have 60 days after receipt of denial of his or her claim to be taken by request a review of such denial, the Claimant if right to review all pertinent documents and the right to submit issues and comments in writing. Upon receipt of a request for a review of the denial is desiredof a benefit claim, including the time limits applicable thereto; Committee shall undertake a full and (v) contain a statement fair review of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on reviewdenial.
(ed) If The Committee shall issue a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) decision not later than 60 days after receipt of written notice a request for review from a claimant unless special circumstances, such as the need to hold a hearing, require a longer period of time, in which case a denial decision shall be rendered as soon as possible but not later than 120 days after receipt of a claim. In requesting a the claimant’s request for review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant decision on review shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, writing and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or include specific reasons for the adverse determination; (ii) decision written in a manner calculated to be understood by the claimant with specific reference the specific to any provisions of this Agreement Program on which the benefit determination decision is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Samples: 2003 Cash Bonus/Restricted Stock and Stock Unit Award Program (Macerich Co)
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Board shall serve as the “Claims Administrator.”
(b) Any If the Executive or any beneficiary of the executive should have a claim for benefits hereunder hereunder, he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
. Benefit claims shall be made by the Executive, his beneficiary or beneficiaries or a duly authorized representative thereof (c) the “claimant”). If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension shall not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any . The notice of a denial of a claim for benefits hereunder adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), ERISA in the event of an adverse determination on review. If notice of the adverse benefit determination is not furnished in accordance with the preceding provisions of this Section, the claim shall be deemed denied and the claimant shall be permitted to exercise his right to review as set forth below.
(ec) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, do records and other information relevant “relevant” to the Claimantclaimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA. For purposes hereof, documents, records and information shall be considered “relevant” to the claimant’s claim if it (i) was relied upon in making the benefit determination, (ii) was submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(gd) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the BankEmployer, the Board of Directors Board, any member of the Bank (or any member thereof) Board or the Claims Administrator more than ninety (90) days after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
Appears in 1 contract
Samples: Split Dollar Agreement (Heartland Financial Usa Inc)
Claims Procedures. (a) For purposes Any controversy or claim arising out of these claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for benefits hereunder or relating to this Plan shall be filed by with the InsuredPlan Administrator, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims AdministratorTRW Inc., 0000 Xxxxxxxx Xx., Xxxxxxxxx, XX. 00000, Attention: Secretary. The Claims Plan Administrator shall make all determinations concerning such claim. Any decision by the Plan Administrator denying such claim shall be in writing and shall be delivered to all parties in interest in accordance with the notice provisions of Section 10.02 hereof. Such decision shall set forth the reasons for denial in plain language. Pertinent provisions of the Plan shall be cited and, where appropriate, an explanation as to how the right of any Claimant to a benefit hereunder.
(c) If claimant can perfect the claim is wholly or partially denied, will be provided. This notice of denial of benefits will be provided within 90 days of the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after Plan Administrator's receipt of the claimant's claim for benefits. If the Plan Administrator fails to notify the claimant of its decision regarding the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension considered denied, and the date by which claimant shall then be permitted to proceed with the Claims Administrator expects appeal as provided in this Section. A claimant who has been completely or partially denied a benefit shall be entitled to render a final decision.
(d) Any notice of a appeal this denial of his/her claim by filing a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a written statement of his/her position with the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Plan Administrator in writing within no later than sixty (60) days after receipt of the written notice notification of such claim denial. The Plan Administrator shall schedule an opportunity for a denial full and fair review of a claimthe issue within thirty (30) days of receipt of the appeal. In requesting a reviewThe decision on review shall set forth specific reasons for the decision, the Claimant may submit any written comments, documents, records and other information relating shall cite specific references to the claim that pertinent Plan provisions on which the Claimant feels are appropriatedecision is based. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to Following the Claimant’s claim for benefits, upon request and free review of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other any additional information submitted by the Claimantclaimant, without regard to whether such information was submitted either through the hearing process or considered otherwise, the Plan Administrator shall render a decision on the review of the denied claim in the initial benefit determinationfollowing manner:
a. The Plan Administrator shall make its decision regarding the merits of the denied claim within 60 days following receipt of the request for review (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 Plan Administrator 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 extension shall be furnished to the claimant 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 shall provide cite specific references to the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific pertinent Plan provisions of this Agreement on which the benefit determination decision is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes of these claims proceduresIn the event that a Covered Party has a good faith claim for Losses for which the Covered Party is seeking recovery from the Escrow Fund under this ARTICLE VIII, Parent shall deliver promptly, and in any event on or before the Escrow Termination Date, an Officer’s Certificate with respect to such claim to both the Escrow Agent and the Securityholders’ Representative. The Securityholders’ Representative may object in good faith to a claim for recovery set forth in an Officer’s Certificate by delivering to Parent within sixty (60) days from the date it receives the Officer’s Certificate (such date, the Administrator “Objection Deadline”), a written statement of objection to one or more of the claims made in the Officer’s Certificate (an “Objection Notice”). If the Securityholders’ Representative does not object in writing to all or any portion of the claims in the Officer’s Certificate by the Objection Deadline, such failure to so object shall serve as be an irrevocable acknowledgment by the “Claims AdministratorSecurityholders’ Representative and the Escrow Participants that the Covered Party is entitled to recover from the Escrow Fund the full amount of the Losses actually incurred or paid by the Covered Party to which the Securityholders’ Representative does not so object, subject to the limitations on recovery set forth in this ARTICLE VIII, and the Securityholders’ Representative and Parent shall use Reasonable Best Efforts to take all necessary actions to, to the extent that funds remain available in the Escrow Fund, cause the Escrow Agent to distribute the amount of such agreed upon Losses to Parent from the Escrow Fund in accordance with the terms of the Escrow Agreement.”
(b) Any claim If the Securityholders’ Representative delivers a timely Objection Notice, the Securityholders’ Representative and Parent shall attempt in good faith for benefits hereunder a period of not less than sixty (60) days to agree upon the rights of the respective parties with respect to the claims asserted in the Officer’s Certificate. If the Securityholders’ Representative and Parent should so agree, a memorandum setting forth such agreement shall be filed prepared and signed by the Insuredboth parties, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification who shall then, to the Claims Administratorextent that funds remain available in the Escrow Fund, furnish to the Escrow Agent a copy of such agreement and cause the Escrow Agent to distribute the amount of such agreed upon Losses to Parent from the Escrow Fund in accordance with the terms of the Escrow Agreement. The Claims Administrator Escrow Agent shall be entitled to rely on any such memorandum and make all determinations as to distributions from the right of any Claimant to a benefit hereunderEscrow Fund in accordance with the terms thereof.
(c) If no such agreement can be reached after good faith negotiation, either Parent or the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant Securityholders’ Representative may submit any written commentsthe disputed matter to arbitration, documents, records and other information relating to unless the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard question as to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant Covered Party is entitled to receiverecovery from the Escrow Fund or the amount of the Loss that is at issue is the subject of a pending litigation with a third party, upon request and free of charge, reasonable access toin which event arbitration shall not be commenced until such entitlement is determined or amount is ascertained or both parties agree to arbitration. Any such arbitration shall be conducted in accordance with Section 10.10. The Escrow Agent shall be entitled to rely on, and copies ofmake distributions from the Escrow Fund in accordance with, all documentsthe terms of any award, records and other information relevant to the Claimant’s claim for benefits; and (iv) inform the Claimant judgment, decree or order of the right to bring a civil action under arbitrator or arbitrators, as the provisions of ERISAcase may be.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes Promptly after receipt by any indemnified Person of these claims proceduresnotice of the commencement or assertion of any Claim or Proceeding by a third party or circumstances which, with the Administrator lapse of time, such indemnified Person believes is likely to give rise to a Claim or Proceeding by a third party or of facts causing any indemnified Person to believe it has a Claim for breach hereunder (an “Asserted Liability”), such indemnified Person shall serve as give prompt written notice thereof (the “Claims AdministratorNotice”) to the relevant indemnifying Person, provided that in any event, such indemnified Person shall give the Claims Notice to the indemnifying Person no later than 30 days after becoming aware of such Asserted Liability. So long as the Claims Notice is given within the applicable survival period set forth in Section 7.1, the failure to so notify the indemnifying Person shall not relieve the indemnifying Person of its obligations or liability hereunder, except to the extent such failure shall have actually prejudiced the indemnifying Person. The Claims Notice shall describe the Asserted Liability in reasonable detail, and shall indicate the amount (estimated, if necessary) of the Loss that has been or may be suffered. The indemnified Person and the indemnifying Person agree to keep each other reasonably appraised of any additional information concerning any Asserted Liability.”
(b) Any claim As to an Asserted Liability arising from a third party action, the indemnifying Person shall be, subject to the limitations set forth in this Section 7.5, entitled to assume control of and appoint lead counsel for benefits hereunder such defense only for so long as it conducts such defense with reasonable diligence. The indemnifying Person shall keep the indemnified Persons advised of the status of such third party action and the defense thereof on a reasonably current basis and shall consider in good faith the recommendations made by the indemnified Persons with respect thereto. If the indemnifying Person assumes the control of the defense of any third party action in accordance with the provisions of this Section 7.5, the indemnified Person shall be filed by entitled to participate in the Insureddefense of any such third party action and to employ, his beneficiary or at its expense, separate counsel of its choice for such purpose, it being understood, however, that the indemnifying Person shall continue to control such defense; provided that notwithstanding the foregoing, the indemnifying Person shall pay the reasonable costs and expenses of such defense (including reasonable attorneys’ fees and expenses) of the indemnified Persons if (x) the indemnified Person’s outside counsel shall have reasonably concluded and advised in writing (with a duly authorized representative thereof (a “Claimant”) through the provision of a written notification copy to the Claims Administrator. The Claims Administrator shall make all determinations as indemnifying Person) that there are defenses available to such indemnified Person that are different from or additional to those available to the right indemnifying Person, or (y) the indemnified Person’s outside counsel shall have advised in writing (with a copy to the indemnifying Person) the indemnified Person that there is a conflict of interest that would make it inappropriate under applicable standards of professional conduct to have common counsel for the indemnifying Person and the indemnified Person. Notwithstanding the foregoing, (i) the indemnifying Person shall obtain the prior written consent of the indemnified Person before entering into any Claimant settlement, compromise, admission or acknowledgement of the validity of such Asserted Liability if the settlement requires an admission of guilt or wrongdoing on the part of the indemnified Person, subjects the indemnified Person to a benefit hereundercriminal liability or does not unconditionally release the indemnified Person from all liabilities and obligations with respect to such Asserted Liability or the settlement imposes injunctive or other equitable relief against, or any continuing obligation or payment requirement on, the indemnified Person and (ii) the indemnified Person shall be entitled to participate, at its own cost and expense, in the defense of such Asserted Liability and to employ separate counsel of its choice for such purpose.
(c) If Each Party shall cooperate in the claim is wholly defense or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice prosecution of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim Asserted Liability arising from a third party action and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material furnish or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps cause to be taken by the Claimant if a review of the denial is desiredfurnished such records, including the time limits information and testimony (subject to any applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”confidentiality agreement), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desiredattend such conferences, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a reviewdiscovery proceedings, the Claimant may submit any written commentshearings, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record trials or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action appeals as may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth reasonably requested in this Section 11connection therewith.
Appears in 1 contract
Samples: Contribution Agreement (Summit Midstream Partners, LP)
Claims Procedures. a. If a Participant (ahereinafter referred to as the “Applicant”) For purposes does not receive the timely payment of these claims proceduresthe benefits which the Applicant believes are due under the Plan, the Administrator Applicant may make a claim for benefits in the manner hereinafter provided. All claims for benefits under the Plan shall serve be made in writing and shall be signed by the Applicant. Claims shall be submitted to a representative designated by the Administrative Committee and hereinafter referred to as the “Claims AdministratorCoordinator.”
(b) Any ” If the Applicant does not furnish sufficient information with the claim for the Claims Coordinator to determine the validity of the claim, the Claims Coordinator shall indicate to the Applicant any additional information which is necessary for the Claims Coordinator to determine the validity of the claim. Each claim hereunder shall be acted on and approved or disapproved by the Claims Coordinator within 30 days following the receipt by the Claims Coordinator of the information necessary to process the claim. In the event the Claims Coordinator denies a claim for benefits hereunder shall be filed by the Insured, his beneficiary in whole or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunder.
(c) If the claim is wholly or partially deniedin part, the Claims Administrator Coordinator shall provide written or electronic notice thereof to notify the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt Applicant in writing of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt denial of the claim and shall include an explanation notify the Applicant of his right to a review of the special circumstances requiring Claims Coordinator’s decision by the extension and the date Administrative Committee. Such notice by which the Claims Administrator expects Coordinator shall also set forth, in a manner calculated to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify be understood by the Applicant, the specific reason for such denial, the denial; (ii) reference the specific provisions of this Agreement the Plan on which the denial is based; (iii) describe the , a description of any additional material or information, if any, information necessary for to perfect the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review claim with an explanation of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the ClaimantPlan’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, appeals procedure as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 118.3. If no action is taken by the Claims Coordinator on an Applicant’s claim within 30 days after receipt by the Claims Coordinator, such claim shall be deemed to be denied for purposes of the following appeals procedure.
b. Any Applicant whose claim for benefits is denied in whole or in part may appeal for a review of the decision by the Administrative Committee. Such appeal must be made within three months after the Applicant 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 Administrative Committee of the claim for benefits under the Plan;
(ii) set forth all of the grounds upon which the Applicant’s request for review is based on any facts in support thereof; and
(iii) set forth any issues or comments which the Applicant deems pertinent to the appeal. The Administrative Committee shall regularly review appeals by Applicants. The Administrative Committee shall act upon each appeal within 30 days after receipt thereof unless special circumstances require an extension of the time for processing, in which case a decision shall be rendered by the Administrative Committee as soon as possible but not later than 60 days after the appeal is received by the Administrative Committee. The Administrative Committee shall make a full and fair review of each appeal and any written materials submitted by the Applicant in connection therewith. The Administrative Committee may require the Applicant to submit such additional facts, documents or other evidence as the Administrative Committee in its discretion deems necessary or advisable in making its review. The Applicant shall be given the opportunity to review pertinent documents or materials upon submission of a written request to the Administrative Committee, provided the Administrative Committee finds the requested documents or materials are pertinent to the appeal. On the basis of its review, the Administrative Committee shall make an independent determination of the Applicant’s eligibility for benefits under the Plan. In the event the Administrative Committee denies an appeal in whole or in part, the Administrative Committee shall give written notice of the decision to the Applicant, which notice shall set forth, in a manner calculated to be understood by the Applicant, the specific reasons for such denial and which shall make specific reference to the pertinent provisions of the Plan on which the Administrative Committee’s decision is based.
Appears in 1 contract
Samples: Restoration & Deferred Compensation Plan (MATERION Corp)
Claims Procedures. (a) For purposes Promptly after receipt by any indemnified Person of these claims proceduresnotice of the commencement or assertion of any Claim or Legal Proceeding by a third party or circumstances which, with the lapse of time, such indemnified Person believes is likely to give rise to a Claim or Legal Proceeding by a third party or of facts causing any indemnified Person to believe it has a Claim for indemnification hereunder (an “Asserted Liability”), such indemnified Person will give prompt written notice thereof (the “Claim Notice”) to the relevant indemnifying Person; provided that in any event, such indemnified Person will give the Claim Notice to the indemnifying Person no later than 30 days after becoming aware of such Asserted Liability. As long as the Claim Notice is given in accordance with Section 10.4(c), the Administrator shall serve as failure to so notify the “Claims Administrator.”indemnifying Person will not relieve the indemnifying Person of its obligations or liability hereunder, except to the extent such failure prejudices the indemnifying Person. The Claim Notice will describe the Asserted Liability in reasonable detail, and will indicate the amount (estimated, if necessary) of the Loss that has been or may be suffered. The indemnified Person and the indemnifying Person agree to keep each other reasonably appraised of any additional information concerning any Asserted Liability. 68
(b) Any claim As to an Asserted Liability arising from a third party action, the indemnifying Person will be, subject to the limitations set forth in this Section 10.5, entitled to assume control of and appoint lead counsel for benefits hereunder such defense only for as long as it conducts such defense with reasonable diligence; provided, that the indemnifying Person shall not be filed entitled to assume control of such defense and shall pay the fees and expenses of counsel retained by the Insuredindemnified Person if (A) such Asserted Liability may give rise to Losses which are more than 200% of the Indemnity Cap or Special Indemnification Cap, his beneficiary as applicable, at the time such claim is submitted by the indemnified Person; (B) such Asserted Liability for indemnification relates to or arises in connection with any criminal proceeding, action, indictment, allegation or investigation; (C) such Asserted Liability seeks an injunction or equitable relief against the indemnified Person; (D) the indemnified Person has been advised in writing by counsel that a duly authorized representative thereof (a “Claimant”) through the provision reasonable likelihood exists of a written notification conflict of interest between the indemnifying Person and the indemnified Person; or (E) upon petition by the indemnified Person, the appropriate court rules that the indemnifying Person failed or is failing to vigorously prosecute or defend such Asserted Liability; provided further, that if both Sellers are indemnifying Persons with respect to an Asserted Liability arising from a third party action, the Sellers must mutually agree with respect to assuming control of the defense of any third party action and appointing lead counsel for such defense. The indemnifying Person will keep the indemnified Persons advised of the status of such third party action and the defense thereof on a reasonably current basis and will consider in good faith the recommendations made by the indemnified Persons with respect thereto. If the indemnifying Person assumes the control of the defense of any third party action in accordance with the provisions of this Section 10.5, the indemnified Person will be entitled to participate in the defense of any such third party action and to engage, at its expense, separate counsel of its choice for such purpose, it being understood, however, that the indemnifying Person will continue to control such defense; provided that notwithstanding the foregoing, the indemnifying Person will pay the reasonable costs and expenses of such defense (including reasonable attorneys’ fees) of the indemnified Persons if (x) the indemnified Person’s outside counsel will have reasonably concluded and advised in writing (with a copy to the Claims Administrator. The Claims Administrator shall make all determinations as indemnifying Person) that there are defenses available to such indemnified Person that are different from or additional to those available to the right indemnifying Person, or (y) the indemnified Person’s outside counsel will have advised in writing (with a copy to the indemnifying Person) the indemnified Person that there is a conflict of interest that would make it inappropriate under applicable standards of professional conduct to have common counsel for the indemnifying Person and the indemnified Person. Notwithstanding the foregoing, the indemnifying Person will obtain the prior written consent of the indemnified Person before entering into any Claimant settlement, compromise, admission or acknowledgement of the validity of such Asserted Liability if the settlement requires an admission of guilt or wrongdoing on the part of the indemnified Person, subjects the indemnified Person to a benefit hereundercriminal liability or does not unconditionally release the indemnified Person from all liabilities and obligations with respect to such Asserted Liability or the settlement imposes injunctive or other equitable relief against, or any continuing obligation or payment requirement on, the indemnified Person.
(c) If Each Party will cooperate in the claim is wholly defense or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice prosecution of any extension of time shall Asserted Liability arising from a third party action and will furnish or cause to be sent furnished such records, information and testimony (subject to the Claimant within ninety (90) days after receipt of the claim any applicable confidentiality agreement), and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.attend such 69
(d) Any notice In the case of a denial Claim not based upon a third party action (“Direct Claim”), the indemnifying Person shall have 60 days from its receipt of a claim for benefits hereunder shall the Claim Notice to either (i) specify the reason for the denial; admit its obligation to provide indemnification or (ii) reference dispute the provisions of this Agreement on which Claim for indemnification, and provide a written explanation for its position and supporting documentation (it being understood that during such 60-day period such indemnifying Person shall have the denial is basedright to investigate such Direct Claim and seek to cure the underlying breach, fact, or circumstance giving rise thereto; (iii) describe except that such indemnifying Person may not and shall not hold itself out as the additional material agent or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review representative of the denial is desiredindemnified Person or otherwise bind or purport to bind the indemnified Person or any of its Affiliates in connection with such investigation or cure). In the event that the indemnifying Person disputes a Claim Notice for a Direct Claim, the Parties, including appropriate management representatives, shall promptly seek to negotiate a resolution in good faith. If the time limits applicable thereto; Parties are unable to resolve the dispute within 90 days after the indemnifying Person first receives the Claim Notice for a Direct Claim, then the indemnified Person may seek any remedy available to it under this Agreement. If the indemnifying Person fails to respond to the Claim Notice relating to a Direct Claim within such 60 day period, then the indemnifying Person shall be conclusively deemed obligated to provide indemnity for all reasonable costs and (v) contain a statement of expenses relating to the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), Direct Claim referenced in the event of an adverse determination on reviewClaim Notice.
(e) If a claim is denied and a review is desired, To the Claimant shall notify extent any of the Claims Administrator in writing within sixty (60) days after receipt provisions of written notice of a denial of a claim. In requesting a review, Section 6.8 conflict with the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes provisions of this Section 1110.5, a document, record or other item of information Section 6.8 shall be considered “relevant” control with respect to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedureany Tax Proceeding.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Company shall serve as the “Claims Administrator.”
(b) Any If the Insured or any beneficiary of the Insured should have a claim for benefits hereunder he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder. Benefit claims shall be made by the Insured, his beneficiary or beneficiaries or a duly authorized representative thereof (the “claimant).
(c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension shall not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any The notice of a denial of a claim for benefits hereunder adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), ERISA in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and .
(f) The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, do records and other information relevant “relevant” to the Claimantclaimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA.
(g) For purposes hereof, documents, records and information shall be considered “relevant” to the claimant’s claim if it (i) was relied upon in making the benefit determination, (ii) was submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(h) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) Company or the Claims Administrator more than ninety (90) days after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 1112.
Appears in 1 contract
Samples: Split Dollar Agreement (Imax Corp)
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Board shall serve as the “"Claims Administrator.”"
(b) Any If the Executive or any beneficiary of the executive should have a claim for benefits hereunder hereunder, he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall sha11 make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
. Benefit claims shall be made by the Executive, his beneficiary or beneficiaries or a duly authorized representative thereof (c) the '"claimant"). If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension shall not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any . The notice of a denial of a claim for benefits hereunder adverse benefit determination shall (i) specify the reason for fur the denial; (iidenial(ii) reference the provisions of this Agreement on which the denial is based; (iiibased;(iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (ivnecessary(iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s claimant's right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), ERISA in the event of an adverse determination on review. If notice of the adverse benefit determination is not furnished in accordance with the preceding provisions of this Section, the claim shall be deemed denied and the claimant shall be permitted to exercise his right to review as set forth below.
(ec) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are arc appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant "relevant" to the Claimant’s claimant's claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, do records and other information relevant "relevant" to the Claimant’s claimant's claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA. For purposes hereof, documents, records and information shall be considered "relevant" to the claimant's claim if it (i) was relied upon in making the benefit determination, (ii) was submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(gd) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors Board, any member of the Bank (or any member thereof) Board or the Claims Administrator more than ninety (90) days after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes of these claims proceduresprocedure purposes, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for benefits hereunder shall Manager” will be filed the Company’s Corporate Secretary, unless another individual, who may or may not be the Company’s Corporate Secretary, is designated by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunderCompany.
(c1) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of reason a claim for benefits hereunder shall (i) specify under this Agreement and Assignment is denied by Xxxxx Xxxxxx, the reason Claims Manager will deliver to the claimant a written explanation setting forth the specific reasons for the denial; (ii) reference , pertinent references to the provisions section of this Agreement and Assignment on which the denial is based; (iii) describe , such other data as may be pertinent, and information on the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps procedures to be taken followed by the Claimant if claimant in obtaining a review of his claim, all written in a manner calculated to be understood by the denial is desiredclaimant. For this purpose, including (A) the time limits applicable thereto; claimant’s claim will be deemed filed when presented in writing to the Claims Manager, and (vB) contain a statement the Claims Manager’s explanation will be in writing delivered to the claimant within 90 days of the Claimant’s right to bring a civil action under date the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on reviewclaim is filed.
(e2) If a The claimant will have 60 days following his receipt of the denial of the claim is denied and a review is desired, the Claimant shall notify to file with the Claims Administrator in writing within sixty (60) days after receipt Manager a written request for review of written notice of a denial of a claimthe denial. In requesting a For such review, the Claimant claimant or his representative may submit any pertinent documents and written issues and comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f3) The Claims Administrator shall Manager will decide the issue on review and furnish the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant claimant with written or electronic notification a copy of the benefit determination upon reviewdecision within 60 days of receipt of the claimant’s request for review of his claim. In the event of an adverse benefit determination The decision on review, the notice thereof shall (i) specify the reason or review will be in writing and will include specific reasons for the adverse determination; (ii) reference decision, written in a manner calculated to be understood by the claimant, as well as specific references to the pertinent provisions of this Agreement and Assignment on which the benefit determination decision is based; (iii) contain . If a statement that copy of the Claimant decision is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant not so furnished to the Claimant’s claim for benefits; and (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bankclaimant within such 60 days, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11claim will be deemed denied on review.
Appears in 1 contract
Samples: Split Dollar Life Insurance Agreement (PBSJ Corp /Fl/)
Claims Procedures. 8.5.1 In the event that the Buyer has a bona fide Claim (a) For purposes of these claims proceduresthat is not a Tax Deed Claim), the Administrator shall serve Buyer may send a written notice to the Seller stating that it has a right to receive payment and specifying in reasonable detail the basis for its Claim, as well as the “Claims Administrator.”
Losses relating thereto (bwhich, if not determinable at such time, may be a reasonable good faith estimate thereof) Any claim for benefits hereunder shall be filed by the Insured, his beneficiary or a duly authorized representative thereof (a “ClaimantPayment Notice”) through ).
8.5.2 The failure to so notify the provision Seller shall not relieve the Seller of any liability, except to the extent the Seller demonstrates that the defence of such action is materially prejudiced thereby.
8.5.3 The Seller shall deliver a written notification notice to the Claims Administrator. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunder.
Buyer within fifteen (c15) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days Business Days after receipt of the claimPayment Notice specifying in reasonable detail any objections to the Payment Notice.
8.5.4 If the Seller does so notify the Buyer of such an objection to the Payment Notice:
a) the Seller shall cause to be paid to the Buyer subject to the terms and conditions of this Agreement the amount designated in such Payment Notice that is not subject to dispute, if any; and
b) the parties shall in good faith attempt for ten (10) Business Days to resolve their differences with respect to the Claim that is the subject of the Payment Notice and the amount designated in such Payment Notice that is subject to dispute.
8.5.5 If a dispute remains as to the Claim that is the subject of the Payment Notice or any amount designated in such Payment Notice following the expiry of such ten (10)-Business Day period, the dispute shall be resolved by the ruling of a court of competent jurisdiction.
8.5.6 If, within fifteen (15) Business Days following receipt of a Payment Notice, the Seller has not notified the Buyer of any objection to such Payment Notice, the Seller shall cause to be paid to the Buyer the amount designated in such Payment Notice subject to the terms of this Agreement.
8.5.7 Subject to and in accordance with the terms and conditions of Schedule 3, upon the Escrow Release Date, any remaining portion of the Escrow Amount shall promptly be delivered to the Seller; provided, however, that such portion of the Escrow Amount shall not be so delivered with respect to, and to the extent of, any amount (such amount (together with the interest thereon), the “Holdback Amount”) as is reasonably necessary to satisfy any unsatisfied Claims Administrator may extend that have been either specified in a Payment Notice delivered to the Seller or in respect of which a claim has been made under the Tax Deed, in either case on or prior to the Escrow Release Date, or otherwise with respect to any Claims for Losses relating to facts and circumstances existing on or prior to the Escrow Release Date. As soon as any such Claims have been resolved (any such resolved claim, a “Resolved Claim”), the Seller and the Buyer shall deliver to the Seller’s Solicitors and the Buyer’s Solicitors (as in each case defined in Schedule 3) a written notice executed by both Parties instructing them to deliver to the Seller the Distribution Amount (after deducting the amount required to be distributed pursuant to the resolution of the Resolved Claims, if any, to the Buyer) in accordance with the terms and conditions of this Agreement.
8.5.8 In the event that the Seller disputes the amount of the Holdback Amount (an “Estimate”) then the Seller and the Buyer shall obtain an opinion of a Leading Junior Counsel in respect of the Payment Notice in question or, in the event that the Payment Notice in question relates to an accounting or Taxation matter or there is no Payment Notice as the Claim is one in respect of which a claim has been made under the Tax Deed, the Seller and the Buyer shall obtain an opinion in relation to the Payment Notice, or the amount of the Claim where there is no Payment Notice, from a partner in an international firm of chartered accountants with experience in the relevant area (in each case as expert and not as arbitrator) (the “Expert”). For the avoidance of doubt, such Expert shall be selected by agreement between the Buyer and the Seller or, failing agreement within seven (7) days upon the application of either the Buyer or the Seller, by the Chairman for the time being of the Bar Council or, as appropriate, by the President for processing the time being of the Institute of Chartered Accountants in England and Wales. The Expert shall receive submissions from the Parties in such form as he may request. The Seller and the Buyer shall jointly instruct the Expert to provide an opinion on whether the Buyer has established a reasonable basis for its claim together with his or her estimate of an amount reasonably necessary to satisfy such claim (which shall include all Losses suffered and reasonably likely to be suffered in connection with such claim) on the basis of the information presented to him (“Expert’s Estimate”). Immediately following receipt of the Expert’s opinion, the disputed Estimate shall be resolved in the amount of the Expert’s Estimate and any amount by which the Holdback Amount exceeds the Expert’s Estimate (together with the interest thereon) shall be treated as a Resolved Claim.
8.5.9 In the event that any claim, action or proceeding is made, brought or initiated by any third party against an Indemnified Party giving rise to a date Warranty Claim or an Indemnity Claim (other than in respect of clause 7.14 (Tax Matters)), the Buyer shall, as promptly as practicable, so notify the Seller in writing, specifying in reasonable detail, to the extent then known by the Buyer, the basis of the Indemnified Party’s belief that such claim, action or proceeding gives rise to a Warranty Claim or an Indemnity Claim (the “Third Party Claim Notice”). The failure to so notify the Seller shall not more than one hundred eighty relieve the Seller of any liability, except to the extent the Seller demonstrates that the defence of such action is materially prejudiced thereby. Without prejudice to clause 8.1 the Buyer shall have the right in its sole discretion, but not the obligation, to assume the defence of any such claim, action or proceeding and to defend, in good faith, any such claim, action or proceeding, and the Seller shall have the right (180at its expense), but not the obligation, to participate in (but not control), the defence of any such third-party claim, action or proceeding. If the Buyer fails to assume the defence of such third party claim in accordance with this clause 8.5.9 within thirty (30) days after receipt of the claim if special circumstances require an extension. Written notice of any extension such claim pursuant hereto, the Seller shall (upon delivering notice to such effect to the Buyer) have the right to undertake the defence of time such third party claim, and the Seller shall be sent to the Claimant within ninety (90) days after receipt liable for any resulting settlement of the such third party claim and shall include an explanation for any final judgment with respect thereto (subject to any right of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or informationappeal), if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating but only to the claim that the Claimant feels are appropriate. The Claimant shall be full extent otherwise provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of in this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon reviewAgreement. In the event the Seller assumes the defence of an adverse benefit determination on reviewthe claim pursuant to this clause 8.5.9, the notice thereof Seller shall keep the Indemnified Party reasonably informed of the progress of any such defence or settlement, and in the event the Buyer assumes the defence of the claim pursuant to this clause 8.5.9, the Buyer shall keep the Seller reasonably informed of the progress of any such defence or settlement. So long as the Seller is defending any such third-party claim, the Buyer shall not settle such third-party claim without the prior written consent of the Seller, which consent shall not be unreasonably withheld or delayed. The Seller may not settle or compromise such third-party claim without the prior written consent of the Buyer, which consent shall not be unreasonably withheld or delayed; provided, that notwithstanding the foregoing, the Buyer shall be entitled not to consent, in its sole discretion, to any proposed settlement or compromise that (i) specify does not include a provision whereby the reason plaintiff or reasons for claimant in the adverse determination; matter releases the Buyer from all Liability with respect thereto (which shall be in form and substance satisfactory to the Buyer or (ii) reference would obligate the specific provisions Buyer to pay or be liable for an amount related thereto in excess of this Agreement on which the benefit determination is based; (iii) contain a statement that amount then available for indemnification hereunder. The Buyer shall make available to the Claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, Seller all documents, records and other information relevant materials reasonably required for use in contesting any third-party claim, subject to any privileged or confidential information. The Buyer shall use commercially reasonable efforts to cooperate with the Claimant’s claim for benefits; and (iv) inform Seller in the Claimant defence of the right to bring a civil action under the provisions of ERISAall such claims.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Board shall serve as the “Claims Administrator.”
(b) Any If the Insured or any beneficiary of the Insured should have a claim for benefits hereunder he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
. Benefit claims shall be made by the Insured, his beneficiary or beneficiaries or a duly authorized representative thereof (c) the “claimant). If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension shall not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any . The notice of a denial of a claim for benefits hereunder adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), ERISA in the event of an adverse determination on review. If notice of the adverse benefit determination is not furnished in accordance with the preceding provisions of this Section, the claim shall be deemed denied and the claimant shall be permitted to exercise his right to review as set forth below.
(ec) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, do records and other information relevant “relevant” to the Claimantclaimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA. For purposes hereof, documents, records and information shall be considered “relevant” to the claimant’s claim if it (i) was relied upon in making the benefit determination, (ii) was submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(gd) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors Board, any member of the Bank (or any member thereof) Board or the Claims Administrator more than ninety one (901) days year after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. Other than in respect of claims to be made under the R&W Insurance Policy as set forth in this Section 8, any claim for indemnification pursuant to this Section 8 (and, at the option of any Buyer Indemnified Party, any claim pursuant to Section 8.2(a)(iv)) shall be brought and resolved as follows:
(a) For purposes of these If any Buyer Indemnified Party has or claims proceduresin good faith to have incurred or suffered, or believes in good faith that it may incur or suffer, a Loss for which it is or may be entitled to indemnification under this Section 8 or for which it is or may otherwise be entitled to a monetary remedy relating to this Agreement, the Administrator transactions contemplated hereby, such Buyer Indemnified Party may deliver a claim certificate (a “Claim Certificate”) to the Securityholders’ Representative. Each Claim Certificate shall: (i) contain a brief description of the facts and circumstances supporting the Buyer Indemnified Party’s claim; and (ii) if practicable, contain a non-binding, preliminary, good faith estimate of the amount to which the Buyer Indemnified Party might be entitled. Such Buyer Indemnified Party may update a Claim Certificate from time to time to reflect any change in circumstances following the date thereof. If a claim under this Section 8 may be brought under different or multiple sections, clauses or sub-clauses of Section 8 (or with respect to different or multiple representations, warrants or covenants), then, subject to the conditions, qualifications and limitations and other provisions of this Section 8, the Buyer Indemnified Party shall serve as have the right to bring such claim under any or each such section, clause, subclauses, representation, warranty or covenant (each a “Claims AdministratorSubject Provision”) that it chooses, and the Buyer Indemnified Party will not be precluded from seeking indemnification under any Subject Provision by virtue of the Buyer Indemnified Party not being entitled to seek indemnification under any other Subject Provision.”
(b) Any claim for benefits hereunder shall be filed by Notwithstanding the Insuredforegoing, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims Administratorextent permitted under this Section 8, any Buyer Indemnified Party may make a claim directly against the Indemnifying Securityholders by delivering a Claim Certificate to such Indemnifying Securityholder. The Claims Administrator shall make all determinations as Such Buyer Indemnified Party may update a Claim Certificate from time to time to reflect any change in circumstances following the right of any Claimant to a benefit hereunderdate thereof.
(c) If After the claim is wholly or partially deniedgiving of any Claim Certificate pursuant hereto, the Claims Administrator amount of indemnification to which a Buyer Indemnified Party shall provide be entitled under this Section 8 shall be determined (i) by the written agreement between the Buyer Indemnified Party and the Securityholders’ Representative, (ii) by a final judgment or electronic notice thereof decree of any court of competent jurisdiction or (iii) by any other means to which the Claimant within Buyer Indemnified Party and the Securityholders’ Representative shall agree. For purposes of this Agreement, the judgment or decree of a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend court shall be deemed final when the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim appeal, if special circumstances require an extension. Written notice of any extension of time any, shall be sent to the Claimant within ninety (90) days after receipt of the claim have expired and no appeal shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decisionhave been taken or when all appeals taken shall have been finally determined.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify Subject to Section 8.7 and the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”)limitations set forth in Section 8.3, in the event that any Losses are determined to be owed to any Buyer Indemnified Party, each Indemnifying Securityholder shall promptly, and in no event later than ten (10) Business Days after the determination of Losses hereunder, wire transfer to Buyer an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating amount equal to the claim that product of (x) such Indemnifying Securityholders’ Pro Rata Share, multiplied by (y) the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies aggregate amount of such Losses (other than Losses arising out of, all documentsrelated to or incurred or accrued in connection with any Fraud by a Indemnifying Securityholder, records and other information relevant for which the applicable Indemnifying Securityholder responsible for such breach or act shall wire transfer to Buyer an amount equal to the Claimant’s claim for benefits, upon request and free entire aggregate amount of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims proceduresuch Loss).
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes of these claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for by the Executive or Beneficiary ("Claimant") with respect to participation, contributions, benefits hereunder or other aspects of the operation of the Agreement shall be filed made in writing to the Secretary of the Company or such other person designated by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification Committee from time to the Claims Administratortime for such purpose. The Claims Administrator shall make all determinations as to the right of any Claimant to a benefit hereunder.
(c) If the designated person receiving a claim is wholly or partially deniedbelieves, following consultation with the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt Chairman of the claim; provided, howeverCommittee, that the Claims Administrator may extend claim should be denied, he or she shall notify the time for processing a claim to a date not more than one hundred eighty (180) days after receipt Claimant in writing of the denial of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after his or her receipt thereof (this period may be extended an additional ninety (90) days in special circumstances and, in such event, the Claimant shall be notified in writing of the claim and extension). Such notice shall include an explanation (a) set forth the specific reason or reasons for the denial making reference to the pertinent provisions of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; , (iiib) describe any additional material or information necessary to perfect the additional claim, and explain why such material or information, if any, necessary for is necessary, and (c) inform the Claimant of his or her right pursuant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps this section to be taken by the Claimant if a request review of the decision.
A Claimant may appeal the denial of a claim by submitting a written request for review to the Committee, within sixty (60) days after the date on which such denial is desiredreceived. Such period may be extended by the Committee for good cause shown. The claim will then be reviewed by the Committee. A Claimant or his or her duly authorized representative may discuss any issues relevant to the claim, including may review pertinent documents and may submit issues and comments in writing. If the time limits applicable thereto; and (v) contain Committee deems it appropriate, it may hold a statement of the Claimant’s right hearing as to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) claim. If a claim hearing is denied and a review is desiredheld, the Claimant shall notify be entitled to be represented by counsel. The Committee shall decide whether or not to grant the Claims Administrator in writing claim within sixty (60) days after receipt of written the request for review, but this period may be extended by the Committee for up to an additional sixty (60) days in special circumstances. Written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant such special circumstances shall be provided reasonable access to, and copies of, all documents, records and other information relevant sent to the Claimant’s . Any claim for benefits, not decided upon request and free of charge. For purposes of this Section 11, a document, record or other item of information in the required time period shall be considered “relevant” deemed denied. All interpretations, determinations and decisions of the Committee with respect to any claim shall be made in its sole discretion based on the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records Agreement and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, relevant documents and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination be final, conclusive and binding on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISApersons.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Samples: Executive Employment Agreement (Woolworth Corporation)
Claims Procedures. (a) For purposes You are required to notify the Company in writing of these claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any any written claim for benefits hereunder shall be filed by the Insured, his beneficiary Internal Revenue Service or a duly authorized representative thereof any state or local taxing authority (a “ClaimantTaxing Authority”) through that, if successful, would require you to pay an Excise Tax such that your aggregate liability for all Excise Taxes would exceed any Reimbursement Payments previously determined by the provision of a written Calculation Firm to be due and that were paid to you or to any Taxing Authority on your behalf. Such notification shall be given to the Claims Administrator. The Claims Administrator shall make all determinations Company as to the right of any Claimant to a benefit hereunder.
(c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of timesoon as practicable, but not in any event no later than ninety five (905) business days after receipt you receive written notice of such claim by the Taxing Authority. You are required to provide the Company a copy of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to claim by the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension Taxing Authority and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), set forth in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels Taxing Authority specifies as the due date for payment of such claim. You may not pay such claim prior to the expiration of the thirty (30) day period following the date on which you give such written notice to the Company (or such shorter period ending on the date that any payment of taxes with respect to such claim is due). If the Company does not notify you in writing prior to the expiration of such thirty (30) day period that the Company desires to contest such claim, the Company shall, within fifteen (15) business days after the expiration of such thirty (30) day period, pay to you or to any Taxing Authority on your behalf the amount claimed to be due by the Taxing Authority, such that, on an after-tax basis, you are appropriateheld harmless for any Excise Tax. If the Company notifies you in writing prior to the expiration of such thirty (30) day period that it desires to contest such claim, the Company shall control the defense of any such claims or disputes and bear all costs related to the defense thereof. In furtherance of the foregoing, you shall (a) give the Company any information reasonably requested by the Company relating to such claim, (b) take such action in connection with contesting such claim as the Company shall reasonably request in writing from time to time and (c) cooperate with the Company in good faith in order effectively to contest such claim. Without limiting the foregoing, the Company, in its sole discretion, may (x) pursue or forgo any and all administrative appeals, proceedings, hearings and conferences with the Taxing Authority in respect of such claim and (y) either pay the tax claimed to the appropriate Taxing Authority on behalf of you and direct you to sue for a refund or contest the claim in any permissible manner, it being understood that you agree to prosecute such contest to a determination before any administrative tribunal, in a court of initial jurisdiction and in one or more appellate courts, as the Company shall determine. The Claimant Company shall be provided bear and pay directly all costs and expenses (including additional taxes, interest and penalties and reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (iprofessional fees) was relied upon incurred in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance connection with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determinationcontest, and shall provide the Claimant with written indemnify and hold you harmless, on an after-tax basis, for any Excise Tax or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal tax (including interest or equitable remedy otherwise available, including the right to bring penalties thereon) imposed and any such costs and expenses incurred by you as a civil action under Section 502(a) result of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11such contest.
Appears in 1 contract
Samples: Payment and Reimbursement Agreement (American Equity Investment Life Holding Co)
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Board shall serve as the “Claims Administrator.”
(b) Any If the Director or any beneficiary of the Director should have a claim for benefits hereunder he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
. Benefit claims shall be made by the Director, his beneficiary or beneficiaries or a duly authorized representative thereof (c) the “claimant”). If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension shall not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any . The notice of a denial of a claim for benefits hereunder adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), ERISA in the event of an adverse determination on review. If notice of the adverse benefit determination is not furnished in accordance with the preceding provisions of this Section, the claim shall be deemed denied and the claimant shall be permitted to exercise his right to review as set forth below.
(ec) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, do records and other information relevant “relevant” to the Claimantclaimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA. For purposes hereof, documents, records and information shall be considered “relevant” to the claimant’s claim if it (i) was relied upon in making the benefit determination, (ii) was submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(gd) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors Board, any member of the Bank (or any member thereof) Board or the Claims Administrator more than ninety (90) days after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes Promptly after receipt by any indemnified Person of these claims proceduresnotice of the commencement or assertion of any Claim or Legal Proceeding by a third party or circumstances which, with the lapse of time, such indemnified Person believes is likely to give rise to a Claim or Legal Proceeding by a third party or of facts causing any indemnified Person to believe it has a Claim for indemnification hereunder (an “Asserted Liability”), such indemnified Person will give prompt written notice thereof (the “Claim Notice”) to the relevant indemnifying Person; provided that in any event, such indemnified Person will give the Claim Notice to the indemnifying Person no later than 30 days after becoming aware of such Asserted Liability. As long as the Claim Notice is given in accordance with Section 10.4(c), the Administrator shall serve as failure to so notify the “Claims Administratorindemnifying Person will not relieve the indemnifying Person of its obligations or liability hereunder, except to the extent such failure prejudices the indemnifying Person. The Claim Notice will describe the Asserted Liability in reasonable detail, and will indicate the amount (estimated, if necessary) of the Loss that has been or may be suffered. The indemnified Person and the indemnifying Person agree to keep each other reasonably appraised of any additional information concerning any Asserted Liability.”
(b) Any claim As to an Asserted Liability arising from a third party action, the indemnifying Person will be, subject to the limitations set forth in this Section 10.5, entitled to assume control of and appoint lead counsel for benefits hereunder such defense only for as long as it conducts such defense with reasonable diligence; provided, that the indemnifying Person shall not be filed entitled to assume control of such defense and shall pay the fees and expenses of counsel retained by the Insuredindemnified Person if (A) such Asserted Liability may give rise to Losses which are more than 200% of the Indemnity Cap or Special Indemnification Cap, his beneficiary as applicable, at the time such claim is submitted by the indemnified Person; (B) such Asserted Liability for indemnification relates to or arises in connection with any criminal proceeding, action, indictment, allegation or investigation; (C) such Asserted Liability seeks an injunction or equitable relief against the indemnified Person; (D) the indemnified Person has been advised in writing by counsel that a duly authorized representative thereof (a “Claimant”) through the provision reasonable likelihood exists of a written notification conflict of interest between the indemnifying Person and the indemnified Person; or (E) upon petition by the indemnified Person, the appropriate court rules that the indemnifying Person failed or is failing to vigorously prosecute or defend such Asserted Liability; provided further, that if both Sellers are indemnifying Persons with respect to an Asserted Liability arising from a third party action, the Sellers must mutually agree with respect to assuming control of the defense of any third party action and appointing lead counsel for such defense. The indemnifying Person will keep the indemnified Persons advised of the status of such third party action and the defense thereof on a reasonably current basis and will consider in good faith the recommendations made by the indemnified Persons with respect thereto. If the indemnifying Person assumes the control of the defense of any third party action in accordance with the provisions of this Section 10.5, the indemnified Person will be entitled to participate in the defense of any such third party action and to engage, at its expense, separate counsel of its choice for such purpose, it being understood, however, that the indemnifying Person will continue to control such defense; provided that notwithstanding the foregoing, the indemnifying Person will pay the reasonable costs and expenses of such defense (including reasonable attorneys’ fees) of the indemnified Persons if (x) the indemnified Person’s outside counsel will have reasonably concluded and advised in writing (with a copy to the Claims Administrator. The Claims Administrator shall make all determinations as indemnifying Person) that there are defenses available to such indemnified Person that are different from or additional to those available to the right indemnifying Person, or (y) the indemnified Person’s outside counsel will have advised in writing (with a copy to the indemnifying Person) the indemnified Person that there is a conflict of interest that would make it inappropriate under applicable standards of professional conduct to have common counsel for the indemnifying Person and the indemnified Person. Notwithstanding the foregoing, the indemnifying Person will obtain the prior written consent of the indemnified Person before entering into any Claimant settlement, compromise, admission or acknowledgement of the validity of such Asserted Liability if the settlement requires an admission of guilt or wrongdoing on the part of the indemnified Person, subjects the indemnified Person to a benefit hereundercriminal liability or does not unconditionally release the indemnified Person from all liabilities and obligations with respect to such Asserted Liability or the settlement imposes injunctive or other equitable relief against, or any continuing obligation or payment requirement on, the indemnified Person.
(c) If Each Party will cooperate in the claim is wholly defense or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice prosecution of any extension of time shall Asserted Liability arising from a third party action and will furnish or cause to be sent furnished such records, information and testimony (subject to the Claimant within ninety (90) days after receipt of the claim any applicable confidentiality agreement), and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decisionattend such conferences, discovery proceedings, hearings, trials or appeals as may be reasonably requested in connection therewith.
(d) Any notice In the case of a denial Claim not based upon a third party action (“Direct Claim”), the indemnifying Person shall have 60 days from its receipt of a claim for benefits hereunder shall the Claim Notice to either (i) specify the reason for the denial; admit its obligation to provide indemnification or (ii) reference dispute the provisions of this Agreement on which Claim for indemnification, and provide a written explanation for its position and supporting documentation (it being understood that during such 60-day period such indemnifying Person shall have the denial is basedright to investigate such Direct Claim and seek to cure the underlying breach, fact, or circumstance giving rise thereto; (iii) describe except that such indemnifying Person may not and shall not hold itself out as the additional material agent or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review representative of the denial is desiredindemnified Person or otherwise bind or purport to bind the indemnified Person or any of its Affiliates in connection with such investigation or cure). In the event that the indemnifying Person disputes a Claim Notice for a Direct Claim, the Parties, including appropriate management representatives, shall promptly seek to negotiate a resolution in good faith. If the time limits applicable thereto; Parties are unable to resolve the dispute within 90 days after the indemnifying Person first receives the Claim Notice for a Direct Claim, then the indemnified Person may seek any remedy available to it under this Agreement. If the indemnifying Person fails to respond to the Claim Notice relating to a Direct Claim within such 60 day period, then the indemnifying Person shall be conclusively deemed obligated to provide indemnity for all reasonable costs and (v) contain a statement of expenses relating to the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), Direct Claim referenced in the event of an adverse determination on reviewClaim Notice.
(e) If a claim is denied and a review is desired, To the Claimant shall notify extent any of the Claims Administrator in writing within sixty (60) days after receipt provisions of written notice of a denial of a claim. In requesting a review, Section 6.8 conflict with the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes provisions of this Section 1110.5, a document, record or other item of information Section 6.8 shall be considered “relevant” control with respect to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedureany Tax Proceeding.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Samples: Membership Interest Purchase and Sale Agreement (Laredo Petroleum, Inc.)
Claims Procedures. (a) a. For purposes of these claims procedures, the Administrator Committee shall serve as the “Claims Administrator.”
(b) Any b. If Insured or any beneficiary of Insured should have a claim for benefits hereunder hereunder, he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
. Benefit claims shall be made by Insured, Insured’s beneficiary(ies) or a duly authorized representative thereof (c) the “claimant”). If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) 90 days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim for benefits is allowable if special circumstances require an extension, but such an extension shall not extend beyond 180 days from the date the claim for benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) 90 days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any notice . Notice of a denial of a claim for benefits hereunder an adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) . If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, an adverse benefit determination is not furnished in accordance with the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes preceding provisions of this Section 11, a document, record or other item of information the claim shall be considered “relevant” deemed denied and the claimant shall be permitted to exercise the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies review as set forth in this Section 11below.
Appears in 1 contract
Claims Procedures. (a) For purposes Any controversy or claim arising out of these claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for benefits hereunder or relating to this Plan shall be filed by with the InsuredPlan Administrator, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims AdministratorMattel, Inc., 000 Xxxxxxxxxxx Xxxxxxxxx, Xx Xxxxxxx, XX 00000-0000, Attention: Secretary. The Claims Plan Administrator shall make all determinations concerning such claim. Any decision by the Plan Administrator denying such claim shall be in writing and shall be delivered to all parties in interest in accordance with the notice provisions of Section 10.02 hereof. Such decision shall set forth the reasons for denial in plain language. Pertinent provisions of the Plan shall be cited and, where appropriate, an explanation as to how the right of any Claimant to a benefit hereunder.
(c) If claimant can perfect the claim is wholly or partially denied, will be provided. This notice of denial of benefits will be provided within 90 days of the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after Plan Administrator’s receipt of the claimant’s claim for benefits. if the Plan Administrator fails to notify the claimant of its decision regarding the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension considered denied, and the date by which claimant then shall be permitted to proceed with the Claims Administrator expects appeal as provided in this Section. A claimant who has been completely or partially denied a benefit shall be entitled to render a final decision.
(d) Any notice of a appeal this denial of his/her claim by filing a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a written statement of his/her position with the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Plan Administrator in writing within no later than sixty (60) days after receipt of the written notice notification of such claim denial. The Plan Administrator shall schedule an opportunity for a denial full and fair review of a claimthe issue within thirty (30) days of receipt of the appeal. In requesting a reviewThe decision on review shall set forth specific reasons for the decision, the Claimant may submit any written comments, documents, records and other information relating shall cite specific references to the claim that pertinent Plan provisions on which the Claimant feels are appropriatedecision is based. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to Following the Claimant’s claim for benefits, upon request and free review of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other any additional information submitted by the Claimantclaimant, without regard to whether such information was submitted either through the hearing process or considered otherwise, the Plan Administrator shall render a decision on the review of the denied claim in the initial benefit determinationfollowing manner:
a. The Plan Administrator shall make its decision regarding the merits of the denied claim within 60 days following receipt of the request for review (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 Plan Administrator 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 extension shall be furnished to the claimant 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 shall provide cite specific references to the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific pertinent Plan provisions of this Agreement on which the benefit determination decision is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Samples: Key Executive Life Insurance Plan (Mattel Inc /De/)
Claims Procedures. (a) For purposes Promptly after receipt by any indemnified Person of these claims proceduresnotice of the commencement or assertion of any Claim or Legal Proceeding by a third party or circumstances which, with the lapse of time, such indemnified Person believes is likely to give rise to a Claim or Legal Proceeding by a third party or of facts causing any indemnified Person to believe it has a Claim for breach hereunder (an “Asserted Liability”), such indemnified Person shall give prompt written notice thereof (the “Claim Notice”) to the relevant indemnifying Person, provided that in any event, such indemnified Person shall give the Claim Notice to the indemnifying Person no later than thirty (30) days after becoming aware of such Asserted Liability. So long as the Claim Notice is given within the applicable survival period set forth in Section 9.1, the Administrator failure to so notify the indemnifying Person shall serve as not relieve the “Claims Administratorindemnifying Person of its obligations or liability hereunder, except to the extent such failure shall have actually prejudiced the indemnifying Person. The Claim Notice shall describe the Asserted Liability in reasonable detail, and shall indicate the amount (estimated, if necessary) of the Loss that has been or may be suffered. The indemnified Person and the indemnifying Person agree to keep each other reasonably appraised of any additional information concerning any Asserted Liability.”
(b) Any claim As to an Asserted Liability arising from a third party action, the indemnifying Person shall be, subject to the limitations set forth in this Section 9.5, entitled to assume control of and appoint lead counsel for benefits hereunder such defense only for so long as it conducts such defense with reasonable diligence. The indemnifying Person shall keep the indemnified Persons advised of the status of such third party action and the defense thereof on a reasonably current basis and shall consider in good faith the recommendations made by the indemnified Persons with respect thereto. If the indemnifying Person assumes the control of the defense of any third party action in accordance with the provisions of this Section 9.5, the indemnified Person shall be filed by entitled to participate in the Insureddefense of any such third party action and to employ, his beneficiary or at its expense, separate counsel of its choice for such purpose, it being understood, however, that the indemnifying Person shall continue to control such defense; provided that notwithstanding the foregoing, the indemnifying Person shall pay the reasonable costs and expenses of such defense (including reasonable attorneys’ fees and expenses) of the indemnified Persons if (i) the indemnified Person’s outside counsel shall have reasonably concluded and advised in writing (with a duly authorized representative thereof (a “Claimant”) through the provision of a written notification copy to the Claims Administrator. The Claims Administrator shall make all determinations as indemnifying Person) that there are defenses available to such indemnified Person that are different from or additional to those available to the right indemnifying Person, or (ii) the indemnified Person’s outside counsel shall have advised in writing (with a copy to the indemnifying Person) the indemnified Person that there is a conflict of interest that would make it inappropriate under applicable standards of professional conduct to have common counsel for the indemnifying Person and the indemnified Person. Notwithstanding the foregoing, (A) the indemnifying Person shall obtain the prior written consent of the indemnified Person before entering into any Claimant settlement, compromise, admission or acknowledgement of the validity of such Asserted Liability if the settlement requires an admission of guilt or wrongdoing on the party of the indemnified Person, subjects the indemnified Person to a benefit hereundercriminal liability or does not unconditionally release the indemnified Person from all liabilities and obligations with respect to such Asserted Liability or the settlement imposes injunctive or other equitable relief against, or any continuing obligation or payment requirement on, the indemnified Person and (B) the indemnified Person shall be entitled to participate, at its own cost and expense, in the defense of such Asserted Liability and to employ separate counsel of its choice for such purpose.
(c) If Each Party shall cooperate in the claim is wholly defense or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice prosecution of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim Asserted Liability arising from a third party action and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material furnish or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps cause to be taken by the Claimant if a review of the denial is desiredfurnished such records, including the time limits information and testimony (subject to any applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”confidentiality agreement), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desiredattend such conferences, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a reviewdiscovery proceedings, the Claimant may submit any written commentshearings, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record trials or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action appeals as may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth reasonably requested in this Section 11connection therewith.
Appears in 1 contract
Claims Procedures. 11.11.1 Any Participant or Beneficiary (a) For purposes of these claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for benefits hereunder shall be filed by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through may file a written claim for a benefit under the provision Plan with the Committee or with a person named by the Committee to receive such claims;
11.11.2 In the event of a denial or limitation of any benefit or payment due or requested by any Claimant, such Claimant shall be given a written notification containing specific reasons for the denial or limitation of his benefit. The written notification shall contain specific reference to the Claims Administratorpertinent Plan provisions on which the denial or limitation is based. The Claims Administrator In addition, it shall make all determinations contain a description of any additional material or information necessary for the Claimant to perfect a claim and an explanation of why such material or information is necessary. Further, the notification shall provide appropriate information as to the right of any steps to be taken if the Claimant wishes to submit his claim for review. This written notification shall be given to a benefit hereunder.
(c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of his claim by the claim Committee (or its delegatee to receive such claims), unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the Claimant prior to the termination of the ninety-day period and such notice shall include an explanation of indicate the special circumstances requiring which make the extension and postponement appropriate;
11.11.3 In the date by which the Claims Administrator expects to render a final decision.
(d) Any notice event of a denial or limitation of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desiredbenefits, the Claimant or his duly authorized representative shall notify the Claims Administrator be permitted to review pertinent documents and to submit issues and comments in writing to the Administrative Committee. In addition, the Claimant or his duly authorized representative may make a written request for a full and fair review of his claim and its denial by the Committee; provided, however, that such written request must be received by the Committee (or its delegatee to receive such requests) within sixty (60) days after receipt by the Claimant of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon denial or limitation. The sixty-day requirement may be waived by the Committee in appropriate cases; and
(a) A decision shall be rendered by the Committee within sixty days after the receipt of the request for review. In ; provided, however, that where special circumstances require an extension of time for processing the event of an adverse benefit determination decision, it may be postponed, on review, the written notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that to 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 (prior to the Claimant’s claim for benefits; and (iv) inform the Claimant expiration of the right to bring a civil action under initial sixty-day period) for an additional sixty (60) days, but in no event shall the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may decision be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator rendered more than ninety one hundred and twenty (90120) days after the receipt of such request for review.
(b) Notwithstanding Subsection 11.11.4(a), if the Committee holds regularly scheduled meetings at least quarterly to review such appeals, a Claimant’s request for review shall be acted upon at the meeting immediately following the receipt of the Claimant’s request unless such request is filed within thirty (30) days preceding such meeting. In such instance, the decision shall be made no later than the date of the second meeting following the receipt of such request by the Committee (or its delegatee to receive such requests). If special circumstances require a further extension of time for processing a request, a decision shall be rendered not later than the third meeting of the Committee following the receipt of such request for review, and written notice of the extension shall be furnished to the Claimant has exhausted prior to the procedures commencement of the extension.
(c) Any decision by the Committee shall be furnished to the Claimant in writing and remedies in a manner calculated to be understood by the Claimant and shall set forth in this Section 11the specific reason(s) for the decision and the specific Plan provision(s) on which the decision is based.
Appears in 1 contract
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Committee shall serve as the “Claims Administrator.”
(b) Any If the Insured or any beneficiary of the Insured should have a claim for benefits hereunder hereunder, he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder.
. Benefit claims shall be made by Insured, Insured’s beneficiary(ies) or a duly authorized representative thereof (c) the “claimant”). If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) 90 days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim for benefits is allowable if special circumstances require an extension, but such an extension shall not extend beyond 180 days from the date the claim for benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) 90 days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any notice . Notice of a denial of a claim for benefits hereunder an adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review. If notice of an adverse benefit determination is not furnished in accordance with the preceding provisions of this Section 11, the claim shall be deemed denied and the claimant shall be permitted to exercise the claimant’s right to review as set forth below.
(ec) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) 60 days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that claim, the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and . The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, records and other information relevant “relevant” to the Claimantclaimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA. For purposes hereof, documents, records and information shall be considered “relevant” to the claimant’s claim if they (i) were relied upon in making the benefit determination; (ii) were submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrate compliance with the administrative processes and safeguards of this claims procedure.
(gd) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (Committee, whether in its capacity as Claims Administrator or otherwise, or any member thereof) or of the Claims Administrator Committee more than ninety one (901) days year after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. (a) For purposes If this Agreement is subject to ERISA, any controversy or claim arising out of these claims procedures, the Administrator shall serve as the “Claims Administrator.”
(b) Any claim for benefits hereunder or relating to this Agreement shall be filed by with the Insured, his beneficiary Plan Administrator or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to the Claims Administrator. The Claims Administrator its designee which shall make all determinations concerning such claim. Any decision by the Plan Administrator denying such claim shall be in writing and shall be delivered to all parties in interest in accordance with the notice provisions of Section 8 hereof. Such decision shall set forth the reasons for denial in plain language. Pertinent provisions of the Agreement shall be cited and, where appropriate, an explanation as to how the right of any Claimant to a benefit hereunder.
(c) If claimant can perfect the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; will be provided, however, that the Claims Administrator may extend the time for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written This notice of any extension denial of time shall benefits will be sent to the Claimant provided within ninety (90) days after of the Plan Administrator's receipt of the claim and for benefits. If the Plan Administrator fails to notify the claimant of its decision regarding the claim, the claim shall include an explanation of the special circumstances requiring the extension be considered denied, and the date by which the Claims Administrator expects claimant then shall be permitted to render proceed with an appeal as provided for in this Section 14. A claimant who has been completely or partially denied a final decision.
(d) Any notice of a benefit shall be entitled to appeal this denial of his or her claim by filing a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a written statement of his or her position with the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Plan Administrator in writing within no later than sixty (60) days after receipt of the written notice notification of such denial. The Plan Administrator shall schedule an opportunity for a denial full and fair review of a claimthe issue within thirty (30) days of receipt of the appeal. In requesting a reviewThe decision on review shall set forth specific reasons for the decision, the Claimant may submit any written comments, documents, records and other information relating shall cite specific references to the claim that pertinent provisions of the Claimant feels are appropriateAgreement on which the decision is based. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to Following the Claimant’s claim for benefits, upon request and free review of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other any additional information submitted by the Claimantclaimant, without regard to whether such information was submitted either through the hearing process or considered in otherwise, the initial benefit determination, and Plan Administrator shall provide make its decision regarding the Claimant with written or electronic notification merits of the benefit determination upon reviewdenied claim within sixty (60) days following receipt of the request for review (or within 120 days after such receipt, in a case where there are special circumstances requiring extension of time for reviewing the appealed claim). In The Plan Administrator shall deliver the event decision to the claimant in writing. If an extension of an adverse benefit determination time for reviewing the appealed claim is required because of special circumstances, written notice of the extension shall be furnished to the claimant 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, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain 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 (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.
Appears in 1 contract
Claims Procedures. Section 12.1 A claim for retirement benefits under the Plan must be submitted to the Plan Administrator at the time and in the manner prescribed by the Plan Administrator. If the Plan Administrator determines that you are not entitled to receive all or part of the benefits you claim, a notice will be provided to you within a reasonable period of time, but no later than 90 days from the day your claim was received by the Plan Administrator. This notice (awhich will be provided to you in writing by mail or hand delivery, or through email) For purposes will describe: The Plan Administrator's determination; The basis for the determination (along with appropriate references to pertinent Plan provisions on which the denial is based); A description of these claims proceduresany additional material or information necessary to perfect the claim and an explanation of why such material is necessary, and The procedure you must follow to obtain a review of the determination, including a description of the appeals procedure and your right to bring a cause of action for benefits under section 502(a) of ERISA. This notice will also, if appropriate, explain how you may properly complete your claim and why the submission of additional information may be necessary. In certain instances, the Plan Administrator shall serve as may not be able to make a determination within 90 days from the “Claims Administrator.”
(b) Any day your claim for benefits hereunder shall be filed was submitted. In such situations, the Plan Administrator, in its sole and absolute discretion, may extend the 90-day period for up to 180 days, as long as the Plan Administrator provides you with a written notice within the initial 90-day period that explains: The reason for the extension, and The date on which a decision is expected.
Section 12.2 If your claim for benefits is denied, either in whole or in part, you may appeal the Plan Administrator's denial by requesting a review of your claim by the InsuredCommittee (or its delegate). Your written request for an appeal must be received by the Plan Administrator within 60 days of the date you received your notice that the Plan Administrator denied your claim. As part of your appeal, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a you may submit written notification comments, documents, records and other information relating to the Claims Administratoryour claim for benefits. You may also request reasonable access to, and copies of, all documents, records, and other information relevant to your claim. You will not be charged for this information. The Claims Administrator shall make Committee's (or its delegate's) review of the Plan Administrator's adverse determination will take into account all determinations as comments, documents, records and other information you submitted, without regard to whether such information was submitted and considered in the right Plan Administrator's initial determination of your claim. If, after reviewing your appeal and any Claimant to a benefit hereunder.
(c) If the claim is wholly or partially deniedfurther information that you have submitted, the Claims Administrator shall provide written Committee (or electronic its delegate) denies your claim, either in whole or in part, a notice thereof (which will be provided to the Claimant you in writing by mail or hand delivery, or through email) will be provided to you within a reasonable period of time, but not later than ninety (90) 60 days after receipt of from the claim; provided, however, that the Claims Administrator may extend the time day your request for processing a claim to a date not more than one hundred eighty (180) days after receipt of the claim if special circumstances require an extension. Written notice of any extension of time shall be sent to the Claimant within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a final decision.
(d) Any notice of a denial of a claim for benefits hereunder shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken review was received by the Claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant may submit any written comments, documents, records and other information relating to the claim that the Claimant feels are appropriate. The Claimant shall be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) The Claims Administrator shall review the claim, taking into account all comments, documents, records and other information submitted by the Claimant, without regard to whether such information was submitted or considered in the initial benefit determination, and shall provide the Claimant with written or electronic notification of the benefit determination upon reviewPlan Administrator. In the event that an extension of an adverse benefit determination on reviewtime for processing is required, you will be provided a written notice of the extension not later than 60 days from the day your request for a review was received by the Plan Administrator. In such situations, the Committee (or its delegate), in its sole and absolute discretion, may extend the 60- day period for up to 120 days, as long as the Committee (or its delegate) provides you with a written notice thereof shall within the initial 60-day period that explains: The reason for the extension, and The date on which a decision is expected. The notice describing the Committee's (ior its delegate's) specify the decision will describe: The specific reason or reasons for the its decision, including any adverse determinationdeterminations; (ii) reference References to the specific Plan or Base Defined Benefit Plan or $uper $aver Plus Plan provisions of this Agreement on which the benefit determination is basedCommittee (or its delegate) based its determination; (iii) contain a statement that the Claimant is entitled Your right to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records records, and other information relevant to the Claimant’s claim for benefits; and (iv) inform the Claimant of the right to bring a civil action under the provisions of ERISA.
(g) After exhausting the claims procedure described herein, nothing shall prevent the Claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors of the Bank (or any member thereof) or the Claims Administrator more than ninety (90) days after the Claimant has exhausted the procedures and remedies set forth in this Section 11.your claim;
Appears in 1 contract
Samples: Trust Agreement (Amr Corp)
Claims Procedures. (a) For purposes of these claims procedures, the Administrator Board shall serve as the “Claims Administrator.”
(b) Any If the Insured or any beneficiary of the Insured should have a claim for benefits hereunder he or she shall be filed file such claim by the Insured, his beneficiary or a duly authorized representative thereof (a “Claimant”) through the provision of a written notification to notifying the Claims AdministratorAdministrator in writing. The Claims Administrator shall make all determinations as to the right of any Claimant person or persons to a benefit hereunder. Benefit claims shall be made by the Insured, his beneficiary or beneficiaries or a duly authorized representative thereof (the “claimant”).
(c) If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the Claimant claimant within a reasonable period of time, but not later than ninety (90) days after receipt of the claim; provided, however, that the Claims Administrator may extend the . An extension of time for processing a the claim to a date for benefits is allowable if special circumstances require an extension, but such an extension shall not more than extend beyond one hundred eighty (180) days after receipt of from the date the claim if special circumstances require an extensionfor benefits is received by the Claims Administrator. Written notice of any extension of time shall be sent to the Claimant delivered or mailed within ninety (90) days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a the final decision.
(d) Any The notice of a denial of a claim for benefits hereunder adverse benefit determination shall (i) specify the reason for the denial; (ii) reference the provisions of this Agreement on which the denial is based; (iii) describe the additional material or information, if any, necessary for the Claimant claimant to receive benefits and explain why such material or information is necessary; (iv) indicate the steps to be taken by the Claimant claimant if a review of the denial is desired, including the time limits applicable thereto; and (v) contain a statement of the Claimantclaimant’s right to bring a civil action under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), ERISA in the event of an adverse determination on review.
(e) If a claim is denied and a review is desired, the Claimant claimant shall notify the Claims Administrator in writing within sixty (60) days after receipt of written notice of a denial of a claim. In requesting a review, the Claimant claimant may submit any written comments, documents, records records, and other information relating to the claim that the Claimant claimant feels are appropriate. The Claimant shall claimant shall, upon request and free of charge, be provided reasonable access to, and copies of, all documents, records and other information relevant to the Claimant’s claim for benefits, upon request and free of charge. For purposes of this Section 11, a document, record or other item of information shall be considered “relevant” to the Claimantclaimant’s claim if it (i) was relied upon in making the benefit determination; (ii) was submitted, considered or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(f) for benefits. The Claims Administrator shall review the claim, claim taking into account all comments, documents, records and other information submitted by the Claimantclaimant, without regard to whether such information was submitted or considered in the initial benefit determination, and .
(f) The Claims Administrator shall provide the Claimant claimant with written or electronic notification of the benefit determination upon review. In the event of an adverse benefit determination on review, the notice thereof shall (i) specify the reason or reasons for the adverse determination; (ii) reference the specific provisions of this Agreement on which the benefit determination is based; (iii) contain a statement that the Claimant claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, of all documents, records and other information relevant “relevant” to the Claimantclaimant’s claim for benefits; and (iv) inform the Claimant claimant of the right to bring a civil action under the provisions of ERISA.
(g) For purposes hereof, documents, records and information shall be considered “relevant” to the claimant’s claim if it (i) was relied upon in making the benefit determination, (ii) was submitted, considered, or generated in the course of making the benefit determination, whether or not actually relied upon in making the determination; or (iii) demonstrates compliance with the administrative processes and safeguards of this claims procedure.
(h) After exhausting exhaustion of the claims procedure described as provided herein, nothing shall prevent the Claimant claimant from pursuing any other legal or equitable remedy otherwise available, including the right to bring a civil action under Section 502(a) of ERISA, if applicable. Notwithstanding the foregoing, no legal action may be commenced or maintained against the Bank, the Board of Directors Board, any member of the Bank (or any member thereof) Board or the Claims Administrator more than ninety (90) days after the Claimant claimant has exhausted the procedures and administrative remedies set forth in this Section 11.
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