Disability Claims Procedure Sample Clauses

Disability Claims Procedure. Notwithstanding Sections 10-11, if a claim for benefits involves a determination as to whether a Participant suffered a Disability, the procedures of this Section 10 will apply. Any reference to the claimant includes the claimant’s authorized representative. If the claimant’s claim is denied in whole or in part, the HR Representative will notify the claimant within a reasonable period of time, but not later than forty-five (45) days after the HR Representative receives the claim. The forty-five (45) day period will begin to run once a claim is filed, without regard to whether the claimant has provided all the information necessary to make the benefit determination. If the HR Representative determines that an extension is needed for reasons beyond the HR Representative’s control, it may take up to two thirty (30) day extensions for consideration of the claim. If the HR Representative takes an extension, he or she will notify the claimant in writing of the reason for the extension and the date by which a decision is expected before the end of the initial forty-five (45) day period (or, for a second extension, before the end of the first extension). The notice of extension will include an explanation of the standards on which the entitlement to the benefit claimed is based, the unresolved issues that are preventing a decision, and the additional information needed to resolve the issues. If the HR Representative requests additional information, the claimant will have at least forty-five (45) days after receipt of the notice of extension to provide the information. The period during which the HR Representative waits for the claimant to respond to the request for information will not count against the thirty (30) day extension period (i.e. the thirty (30) day extension period will be tolled from the date the notice of extension is sent to the claimant to the date on which the claimant responds to the request for additional information). The HR Representative’s notice of denial will explain the reason for the denial, refer to the specific Plan provisions on which the denial is based describe any additional information or material needed from the claimant to perfect his or her claim and why this information or material is necessary, and describe the Plan’s claims review procedures and time limits. Additionally, if the HR Representative relies on an internal rule, guideline, or protocol in denying the claim, it will either provide a copy of the rule, guideline or p...

Disability Claims Procedure. Notwithstanding anything herein to the contrary, with respect to a claim for benefits under this Agreement based on Disability (other than approval for payment of benefits, directly or indirectly, under any long-term disability plan maintained by the Company), the Claims Manager shall furnish to the claimant written notice of the disposition of a claim within 45 days after the application therefore is submitted; provided, if matters beyond the control of the Claims Manager require an extension of time for processing the claim, the Claims Manager shall furnish written notice of the extension to the claimant prior to the end of the initial 45-day period; and, provided further, if matters beyond the control of the Claims Manager require an additional extension of time for processing the claim, the Claims Manager shall furnish written notice of the second extension to the claimant prior to the end of the initial 30-day extension period, and such extension shall not exceed an additional, consecutive 30-day period. Notice of any extension under this Section 12(c)(i) 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. In the event the claim is denied, the notice of the disposition of the claim shall provide the specific reasons for the denial, citations of the pertinent provisions of this Agreement, explanation as to how the claimant can perfect the claim and/or submit the claim for review (where appropriate), and a statement of the claimant’s right to bring a civil action under Section 502(a) of ERISA following an adverse determination on review.

Disability Claims Procedure. 6.3.1 Each person having or claiming an interest in this Agreement shall have the right to submit a claim with respect to a benefit under this Section 6.3 if the benefit is Disability-related or under Section 6.1 if not Disability-related. Such claim shall be in writing addressed to the Bank and shall be delivered personally or by certified or registered mail, return receipt requested. The claim shall state with particularity: