Notice of Claim Denial Sample Clauses

Notice of Claim Denial. If the Employee is denied a claim for benefits, the Administrative Committee, or its delegate, will provide such Employee with a written or electronic notice setting forth:

Notice of Claim Denial. The Plan Administrator or his delegate will provide adequate notice in writing to any employee, Participant or beneficiary whose claim for benefits under the Plan has been denied, setting forth the specific reasons for such denial. Subject to the express provisions of any applicable collective bargaining agreement, the employee, Participant or beneficiary will be given an opportunity for a full and fair review by the Plan Administrator (or his delegate) of the decision denying the claim. The employee, Participant or beneficiary will be given 60 days from the date of the notice denying such claim within which to request such review.

Notice of Claim Denial. 1 f. Process requests for exclusion from the Settlement; 2 g. Process objections to the Class Settlement; 3 h. Within 30 days after the payment of all Valid Claims for 4 monetary compensation by the Settlement Administrator, 5 provide to Whirlpool and Class Counsel, under penalty of 6 perjury, a statement of the total number of claims submitted 7 (in total and by category of benefit), the total number of 8 claims adjudicated as Valid Claims (in total and by category 9 of benefit), and the total dollar amount paid to Class 10 Members (in total and by category of benefit). 11 6. Approve the form, contents, and methods of notice to be given to 12 the Settlement Class and direct the Settlement Administrator to 13 provide and cause to be provided such notices and to file with the 15 notice program. 16 7. Establish procedures and schedule deadlines for Settlement Class 17 Members to object to the Settlement or certification of the 18 Settlement Class, to exclude themselves from the Settlement, and 19 to submit Claim Forms to the Settlement Administrator, all 20 consistent with the terms of this Agreement. 21 8. Schedule the Fairness Hearing; and 22 9. Schedule deadlines for the filing of (a) papers in support of final 23 approval of the certification of the Settlement Class, (b) the 24 appointment of Class Counsel as counsel for the Settlement Class, 25 and the Settlement, and (c) Class Counsel’s Fee Petition. 26 B. At the Fairness hearing the Parties will jointly request the Court to enter a 28 Plaintiff as the representative of the Settlement Class, and designates 1 Class Counsel as counsel for the Settlement Class; (2) grants final 2 approval of the Settlement and this Agreement as fair, reasonable, and 3 adequate to the Settlement Class; (3) provides for the release of all 4 Released Claims and enjoins Settlement Class Members from asserting, 5 filing, maintaining, or prosecuting any of the Released Claims in the 7 Agreement as set forth in the attached proposed order and judgment and 8 that incorporates the releases and covenant not to xxx stated in this 9 Agreement, with each of the Parties to bear its, his, or her own costs and 10 attorney fees, except as provided in Section VIII, below; (5) authorizes 11 the payment by Whirlpool of Valid Claims approved by the Settlement 12 Administrator as Valid Claims, and otherwise reviewed by Class Counsel 13 and Counsel for Whirlpool and determined to be Valid Claims, in 14 accordance with the terms of the Agreement...

Notice of Claim Denial. The notice of denial will include the reasons for the denial, the specific Plan provisions on which the denial is based, a description of any additional information or material required to appeal the denial, the procedure and time limits for filing an appeal so that the Plan Administrator will reconsider its decision, and a statement of your right to sue in court if the claim is again denied after an appeal. For adverse disability determinations, the notice of denial will also advise you of your right to request and receive (free of charge): • the identity of any medical or vocational experts whose advice was obtained on behalf of the plan in connection with the adverse benefit determination (without regard to whether such expert advice was relied upon by the joint board); • an explanation of any scientific or clinical judgment used in applying the Plan’s terms to your medical circumstances; • any policy, statement, or guidance concerning your medical condition; and • any rule, document, guideline, protocol, or other similar criterion if it was submitted to the Plan, considered by the Plan, or generated in the course of making the benefit determination.

Notice of Claim Denial. If the plan determines that a claim provides insufficient information for the plan to pay the claim, the plan shall provide written or electronic notice of this determination to the person submitting the claim, promptly but in no instance later than thirty (30) calendar days following the date that the plan receives written or electronic notice of the claim, including the following information: (a) Reasons for the denial of the claim; (b) The date the service was rendered, the type of service rendered, the name of the provider who rendered the service and the name of the person to whom the service was rendered; (c) The address of the office responsible for handling the claim, and means by which the office may be contacted without toll charges exceeding the charges that otherwise apply for the provider or member to place a call in his/her areas code; and (d) The date the claim was received. Requests for information made by the plan on a contested claim shall be reasonable and relevant to the determination of whether the claim is a clean claim or claim that will be denied.