Common use of Initial Claims Clause in Contracts

Initial Claims. If benefits under this Agreement become due, Cerner will notify you as to the amount of benefits you are entitled to, the duration of such benefit, the time the benefit is to commence and other pertinent information concerning your benefit. If you have been denied a benefit under the Agreement, or if you feel that the benefit which has been given to you is not accurate, you may file a claim with Cerner. If a claim for benefit is denied by Cerner, Cerner shall provide you with written or electronic notification of any adverse benefit determination within ninety (90) days after receipt of the claim unless special circumstances require an extension of time for processing the claim. If such an extension of time for processing is required, written or electronic notice indicating the special circumstances and the date by which a final decision is expected to be rendered shall be furnished to you. In no event shall the period of extension exceed one hundred eighty (180) days after receipt of the claim. The notice of denial of the claim shall set forth: (a) The specific reason or reasons for the adverse determination; (b) Reference to the specific Agreement provisions on which the determination is based; (c) A description of any additional material or information necessary for you to perfect the claim, and an explanation of why such material or information is necessary; and (d) A description of the applicable review procedures and the time limits applicable to such procedures, including a statement of your right to bring a civil action under ERISA section 502(a) following an adverse benefit determination on review. You (or your duly authorized representative) may review pertinent documents and submit issues and comments in writing to Cerner. If you fail to appeal such action to Cerner in writing within the prescribed period of time described in the next section, Cerner’s adverse determination shall be final, binding and conclusive. Executive’s Initials

Initial Claims. If benefits under this Agreement become due, Cerner will notify you as to the amount of benefits you are entitled to, the duration of such benefit, the time the benefit is to commence and other pertinent information concerning your benefit. If you have been denied a benefit under the Agreement, or if you feel that the benefit which has been given to you is not accurate, you may file a claim with Cerner. If a claim for benefit is denied by Cerner, Cerner shall provide you with written or electronic notification of any adverse benefit determination within ninety (90) days after receipt of the claim unless special circumstances require an extension of time for processing the claim. If such an extension of time for processing is required, written or electronic notice indicating the special circumstances and the date by which a final decision is expected to be rendered shall be furnished to you. In no event shall the period of extension exceed one hundred eighty (180) days after receipt of the claim. The notice of denial of the claim shall set forth: (a) The specific reason or reasons for the adverse determination; (b) Reference to the specific Agreement provisions on which the determination is based; (c) A description of any additional material or information necessary for you to perfect the claim, and an explanation of why such material or information is necessary; and (d) A description of the applicable review procedures and the time limits applicable to such procedures, including a statement of your right to bring a civil action under ERISA section 502(a) following an adverse benefit determination on review. You (or your duly authorized representative) may review pertinent documents and submit issues and comments in writing to Cerner. If you fail to appeal such action to Cerner in writing within the prescribed period of time described in the next section, Cerner’s 's adverse determination shall be final, binding and conclusive. Executive’s Initials.