Common use of Timing of Delivery of Notice of Denial Clause in Contracts

Timing of Delivery of Notice of Denial. The denial notice shall be furnished to the claimant no later than ninety (90) days after receipt of the claim by the Plan Administrator, unless the Plan Administrator determines that special circumstances require an extension of time for processing the claim. If the Plan Administrator determines than an extension of time for processing is required, then notice of the extension shall be furnished to the claimant prior to the termination of the initial ninety (90) day period. In no event shall such extension exceed a period of ninety (90) days from the end of such initial period. The notice shall inform the claimant of the following: (1) the special circumstances requiring the extension of time; (2) the date by which the claimant can expect a decision; (3) the standards for determining the claimant’s entitlement to benefits; (4) the unresolved issue(s) that prevent a decision on the claim; and (5) a description of any additional information that the claimant needs to submit.