Disposition of Disputed Claims Sample Clauses

Disposition of Disputed Claims. Upon receipt of a request for review, the Plan Administrator shall make a prompt decision on the review matter. The review shall take into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. The decision on review shall be made not later than 60 days after the Plan Administrator’s receipt of a request for a review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered not later than 120 days after receipt of the request for review. If an extension is necessary, the claimant shall be given written notice of the extension prior to the expiration of the initial 60-day period, and such written notice shall set forth the special circumstances requiring the extension and the date by which the Plan expects to render the benefit determination. For purposes of calculating the 60 day period, the time period shall begin at the time the request for review is filed in accordance with this Article 6, without regard to whether all the information necessary to make a benefit determination accompanies the filing. In the event that the 60 day period is extended, as permitted in the above paragraph, due to a claimant’s failure to submit information necessary to decide a claim, the period for making the benefit determination shall be tolled from the date on which the notification of the extension is sent to the claimant until the date on which the claimant responds to the request for additional information. The Plan Administrator shall provide the claimant with written or electronic notification of the Plan’s determination on review. Any electronic notification shall comply with the standards imposed by 29 C.F.R. §2520.104b-1(c)(1)(i),(iii), and (iv). In the case of an adverse determination, the notification shall set forth, in a manner calculated to be understood by the claimant, the specific reason or reasons for the decision as well as specific references to the pertinent Plan provisions on which the decision was based. The notification shall also include 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. Moreover, the decision shall contain a statement of the claimant’s right to b...

Disposition of Disputed Claims. Upon its receipt of notice of a request for review, the Claims Administrator shall make a prompt decision on the review. The decision on review shall be written in a manner calculated to be understood by the claimant and shall include specific reasons for the decision and specific references to the pertinent plan provisions on which the decision is based. The decision on review shall be made not later than sixty