Time of Notice of Adverse Benefit Determination Sample Clauses

Time of Notice of Adverse Benefit Determination. If a claim for benefits (other than benefits on account of a Participant’s Disability) is wholly or partially denied, the Plan Administrator shall notify the claimant within a reasonable time period but not later than ninety (90) days after receipt of such claim, unless special circumstances require an extension of time for processing the claim. In no event may the extension exceed ninety (90) days from the end of the initial period. If such extension is necessary, the Plan Administrator will give the claimant notice to this effect prior to the expiration of the initial 90-day period. Such notice shall indicate the special circumstances requiring an extension of time and the date by which the Plan intends to render the determination. Notwithstanding the above, in the event a claim for benefits is submitted on account of the Participant’s Disability, notification in the event such claim is wholly or partially denied shall be provided in accordance with this paragraph. The Plan Administrator shall notify the claimant of the adverse benefit determination with regard to a claim due to Disability no later than forty-five (45) days after receipt of the claim by the Plan Administrator. This period may be extended by the Plan Administrator for up to thirty (30) days provided that the Plan Administrator determines that such an extension is necessary due to matters beyond the control of the Plan and the claimant is notified prior to the expiration of the initial forty-five (45) day period of the circumstances requiring the extension of time and a date by which the Plan Administrator expects to render a decision. If, prior to the end of the first thirty (30) day extension period, the Plan Administrator determines that, due to matters beyond the control of the Plan, a decision cannot be rendered within that extension period, the period for making the determination may be extended for up to an additional thirty (30) days provided that the claimant is notified prior to the expiration of the first thirty (30) day extension period of the circumstances requiring the extension and the date as of which the Plan Administrator expects to render a decision. The notice of extension 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, and the claimant shall be afforded at least forty-five (45) days within which to provide the s...