Decision on a Claim. The Claims Administrator shall make all determinations as to the right of any person or persons to a benefit hereunder. If the claim is wholly or partially denied, the Claims Administrator shall provide written or electronic notice thereof to the claimant within a reasonable period of time, but not later than 90 days after receipt of the claim. An extension of time for processing the claim for benefits is allowable if special circumstances require an extension, but such an extension shall not extend beyond 180 days from the date the claim for benefits is received by the Claims Administrator. Written notice of any extension of time shall be delivered or mailed within 90 days after receipt of the claim and shall include an explanation of the special circumstances requiring the extension and the date by which the Claims Administrator expects to render the final decision. Notice of an adverse benefit determination shall (A) specify the specific reason for the denial; (B) reference the specific provisions of this Agreement on which the denial is based; (C) describe the additional material or information, if any, necessary for the claimant to receive benefits and explain why such material or information is necessary; (D) indicate the steps to be taken by the claimant if a review of the denial is desired, including the time limits applicable thereto; and (E) contain a statement of the claimant's right to bring a civil action under the ERISA, in the event of an adverse determination on review. If notice of an adverse benefit determination is not furnished in accordance with the preceding provisions of this Section 4, the claim shall be deemed denied and the claimant shall be permitted to exercise the claimant's right to review as set forth below.
Decision on a Claim. If a claim is denied, the Corporation shall deliver a written explanation to the Claimant, setting forth: (1) the specific reason or reasons for the denial; (2) references to the pertinent provisions of this Agreement on which the denial is based; (3) a description of any additional material or information necessary for the Claimant to perfect the claim and an explanation of why that material or information is necessary; (4) appropriate information as to the steps to be taken if the Claimant wishes to submit the claim for review; and (5) the time limit for requesting a review of the claim under section 6.4(c). The written explanation shall be delivered to the Claimant within 90 days after receipt of the claim by the Corporation.
Decision on a Claim. If a claim is denied, the Claims Manager shall deliver a written explanation to the Claimant, setting forth: (1) the specific reason or reasons for the denial; (2) references to the pertinent provisions of this Agreement on which the denial is based; (3) a description of any additional material or information necessary; (4) appropriate information as to the steps to be taken if the Claimant wishes to submit the claim for review; and (5) the time limit for requesting a review of the claim under section 6.4(c). The written explanation shall be delivered to the Claimant within 90 calendar days after receipt of the claim by the Corporation.
Decision on a Claim. If a claim for benefits is denied in full or in part, the Plan Administrator will notify you in writing within 90 days after the claim is filed. This time limit may be extended for another 90 days in special cases, if the Plan Administrator provides notice of the reasons for the delay. Claims for disability benefits under Article III, Section 4 Early Retirement Benefits) are decided by Act- MedicalTec, 0000 Xxxx Xxxxxxxxx, Ann Arbor, Michigan 48104. For claims involving disability determinations, the initial claim review period is 45 days, subject to a maximum of two extensions (both with advance notice) of up to 30 days each (i.e., the maximum extension is 60 days). The written notice of extension will advise you of: • the standards and criteria on which disability status is based; • the outstanding issues preventing a decision; • the time period in which you must submit required information to resolve such issues, if applicable (not less than 45 days); and • the time period in which Act-MedicalTec must make its determination, except that such determination period will be tolled (i.e., extended by the number of days that elapse) during the period between a request for information and the date such information is received. At such time as it becomes necessary to replace Act-MedicalTec, the parties will mutually agree upon a vendor to provide like services.
