Common use of Failure of Plan to Follow Procedures Clause in Contracts

Failure of Plan to Follow Procedures. In the case of a claim for Disability benefits, if the Administrator fails to strictly adhere to all the requirements of this claims procedure with respect to a Disability claim, the Claimant is deemed to have exhausted the administrative remedies available under the Agreement, and shall be entitled to pursue any available remedies under ERISA Section 502(a) on the basis that the Administrator has failed to provide a reasonable claims procedure that would yield a decision on the merits of the claim, except where the violation was: (a) de minimis; (b) non-prejudicial; (c) attributable to good cause or matters beyond the Administrator’s control; (d) in the context of an ongoing good-faith exchange of information; and (e) not reflective of a pattern or practice of noncompliance. The Claimant may request a written explanation of the violation from the Administrator, and the Administrator must provide such explanation within ten (10) days, including a specific description of its basis, if any, for asserting that the violation should not cause the administrative remedies to be deemed exhausted. If a court rejects the Claimant’s request for immediate review on the basis that the Administrator met the standards for the exception, the claim shall be considered as re-filed on appeal upon the Administrator’s receipt of the decision of the court. Within a reasonable time after the receipt of the decision, the Administrator shall provide the claimant with notice of the resubmission.

Failure of Plan to Follow Procedures. Except for a Disability claim, if the Plan fails to establish or follow the claims procedures required by this Article, a Claimant shall be deemed to have exhausted the administrative remedies available under the Plan and shall be entitled to immediately pursue any available remedy under ERISA Section 502(a) on the basis that the Plan has failed to provide a reasonable claims procedure that would yield a decision on the merits of the claim. In the case of a claim for Disability benefits, if the Administrator Plan fails to strictly adhere to all the requirements of this claims procedure Article with respect to a Disability claim, the Claimant is deemed to have exhausted the administrative remedies available under the AgreementPlan, and shall be entitled to pursue any available remedies under ERISA Section 502(a) on the basis that the Administrator Plan has failed to provide a reasonable claims procedure that would yield a decision on the merits of the claim, except where the violation was: (a) de minimis; (b) non-prejudicial; (c) attributable to good cause or matters beyond the Administrator’s Plan's control; (d) in the context of an ongoing good-faith exchange of information; and (e) not reflective of a pattern or practice of noncompliancenon-compliance. The Claimant may request a written explanation of the violation from the AdministratorPlan, and the Administrator Plan must provide such explanation within ten (10) days, including a specific description of its basisbases, if any, for asserting that the violation should not cause the administrative remedies to be deemed exhausted. If a court rejects the Claimant’s 's request for immediate review on the basis that the Administrator Plan met the standards for the exception, the claim shall be considered as re-filed on appeal upon the Administrator’s Plan's receipt of the decision of the court. Within a reasonable time after the receipt of the decision, the Administrator Plan shall provide the claimant with notice of the resubmission.

Failure of Plan to Follow Procedures. In the case of a claim for Disability benefits, if the Administrator Plan fails to strictly adhere to all the requirements of this claims procedure with respect to a Disability disability claim, the Claimant is deemed to have exhausted the administrative remedies available under the AgreementPlan, and shall be entitled to pursue any available remedies under ERISA Section 502(a) on the basis that the Administrator Plan has failed to provide a reasonable claims procedure that would yield a decision on the merits of the claim, except where the violation was: (a) de minimisdeminimis; (b) non-prejudicial; (c) attributable to good cause or matters beyond the AdministratorPlan’s control; (d) in the context of an ongoing good-faith exchange of information; and (e) not reflective of a pattern or practice of noncompliance. The Claimant may request a written explanation of the violation from the AdministratorPlan, and the Administrator Plan must provide such explanation within ten (10) days, including a specific description of its basis, if any, for asserting that the violation should not cause the administrative remedies to be deemed exhausted. If a court rejects the Claimant’s request for immediate review on the basis that the Administrator Plan met the standards for the exception, the claim shall be considered as re-filed on appeal upon the AdministratorPlan’s receipt of the decision of the court. Within a reasonable time after the receipt of the decision, the Administrator Plan shall provide the claimant with notice of the resubmission.

Failure of Plan to Follow Procedures. In the case of a claim for Disability benefits, if the Plan Administrator fails to strictly adhere to all the requirements of this claims procedure with respect to a Disability claim, the Claimant is deemed to have exhausted the administrative remedies available under the AgreementPlan, and shall be entitled to pursue any available remedies under ERISA Section 502(a) on the basis that the Plan Administrator has failed to provide a reasonable claims procedure that would yield a decision on the merits of the claim, except where the violation was: (a) de minimis; (b) non-prejudicial; (c) attributable to good cause or matters beyond the Plan Administrator’s control; (d) in the context of an ongoing good-faith exchange of information; and (e) not reflective of a pattern or practice of noncompliance. The Claimant may request a written explanation of the violation from the Plan Administrator, and the Plan Administrator must provide such explanation within ten (10) days, including a specific description of its basis, if any, for asserting that the violation should not cause the administrative remedies to be deemed exhausted. If a court rejects the Claimant’s request for immediate review on the basis that the Plan Administrator met the standards for the exception, the claim shall be considered as re-filed on appeal upon the Plan Administrator’s receipt of the decision of the court. Within a reasonable time after the receipt of the decision, the Plan Administrator shall provide the claimant with notice of the resubmission. Both the Company and the Director agree that this amendment shall not be considered a “material modification” of the Agreement for purposes of Internal Revenue Code Section 409A. Consequently, the Agreement shall continue to be “grandfathered” such that Code Section 409A does not apply to this Agreement.

Failure of Plan to Follow Procedures. In the case of a claim for Disability benefits, if the Administrator Plan fails to strictly adhere to all the requirements of this claims procedure with respect to a Disability disability claim, the Claimant is deemed to have exhausted the administrative remedies available under the AgreementPlan, and shall be entitled to pursue any available remedies under ERISA Section 502(a) on the basis that the Administrator Plan has failed to provide a reasonable claims procedure that would yield a decision on the merits of the claim, except where the violation was: (a) de minimisdeminimis; (b) non-prejudicial; (c) attributable to good cause or matters beyond the AdministratorPlan’s control; (d) in the context of an ongoing good-faith exchange of information; and (e) not reflective of a pattern or practice of noncompliance. The Claimant may request a written explanation of the violation from the AdministratorPlan, and the Administrator Plan must provide such explanation within ten (10) days, including a specific description of its basis, if any, for asserting that the violation should not cause the administrative remedies to be deemed exhausted. If a court rejects the Claimant’s request for immediate review on the basis that the Administrator Plan met the standards for the exception, the claim shall be considered as re-filed on appeal upon the AdministratorPlan’s receipt of the decision of the court. Within a reasonable time after the receipt of the decision, the Administrator Plan shall provide the claimant with notice of the resubmission.. ARTICLE 11 MISCELLANEOUS 11.1

Failure of Plan to Follow Procedures. In the case of a claim for Disability benefits, if the Administrator Plan fails to strictly adhere to all the requirements of this claims procedure with respect to a Disability disability claim, the Claimant is deemed to have exhausted the administrative remedies available under the AgreementPlan, and shall be entitled to pursue any available remedies under ERISA Section 502(a) on the basis that the Administrator Plan has failed to provide a reasonable claims procedure that would yield a decision on the merits of the claim, except where the violation was: (a) de minimis; (b) non-prejudicial; (c) attributable to good cause or matters beyond the AdministratorPlan’s control; (d) in the context of an ongoing good-faith exchange of information; and (e) not reflective of a pattern or practice of noncompliance. The Claimant may request a written explanation of the violation from the AdministratorPlan, and the Administrator Plan must provide such explanation within ten (10) days, including a specific description of its basis, if any, for asserting that the violation should not cause the administrative remedies to be deemed exhausted. If a court rejects the Claimant’s request for immediate review on the basis that the Administrator Plan met the standards for the exception, the claim shall be considered as re-filed on appeal upon the AdministratorPlan’s receipt of the decision of the court. Within a reasonable time after the receipt of the decision, the Administrator Plan shall provide the claimant with notice of the resubmission.