Common use of Review of Claims Clause in Contracts

Review of Claims. The Plan Administrator shall provide a claimant with written or electronic notification of the Plan's benefit determination. Any electronic notification shall comply with the standards imposed by 29 CFR 2560.503- 1. In the case of an adverse benefit determination, the notification shall be set forth, in a manner calculated to be understood by the claimant and include: (a) The specific reason or reasons for the adverse determination; (b) Reference to the specific Plan provisions on which the benefit determination is based; (c) 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; (d) A description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; (e) An explanation that a full and fair review by the Plan Administrator of the decision denying the claim may be requested by the claimant or his authorized representative by filing with the Plan Administrator, within 180 days after such notice of denial has been received, a written request for such review;