Common use of Contents of Notice of Claims Denial Clause in Contracts

Contents of Notice of Claims Denial. In the event the Plan Administrator denies a claim made under the Plan, the Plan Administrator’s will deliver a written response to the claimant including the following information: (1) the specific reason(s) for the denial; (2) reference to the specific Plan provision(s) upon which the denial was based; (3) a description of any additional or material information that is necessary for the appeal of the denied claim to be successful, and an explanation of why this information is necessary; (4) a description of any voluntary appeal procedures available under the Plan and your right to receive information about them; (5) an explanation of the review procedure summarized below, including the time limits applicable to the review procedures and the claimant’s rights to submit written comments and have them considered, the claimant’s right to review (upon request and at no charge) relevant documents and other information; and (6) statement that the claimant has a right to bring a civil action under Section 502(a) of ERISA following a denial of an appeal of the claim. If the Plan Administrator relied on an internal rule, guideline, protocol, or other similar criterion in denying the claim, then the Plan Administrator either will provide the claimant with a copy of the criterion or will notify the claimant that it relied on such a criterion and inform the claimant that he or she may request a copy of the criterion free of charge.