Initial Benefit Determination Sample Clauses
Initial Benefit Determination. (1) The Administrator will notify the Claimant of the Administrator’s determination within a reasonable period of time, but in any event (except as described in paragraph (2) below) within 90 days after receipt of the Claim by the Administrator.
(2) The Administrator may extend the period for making the benefit determination by 90 days if it determines that such an extension is necessary due to matters beyond the control of the Plan and if it notifies the Claimant, prior to the expiration of the initial-90 day period, of circumstances requiring the extension of time and the date by which the Administrator expects to render a decision.
Initial Benefit Determination. A claim for benefits under this Agreement must be submitted in writing to the Board of Directors of USB, or its duly authorized representative (“Claims Administrator”), and such claim shall be subject to a full and fair review. If a claim is denied, the Claims Administrator shall provide written notice of the denial not later than ninety (90) days after the claim is received by the Claims Administrator. If an extension of time is required, written notice of the extension shall be given to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed ninety (90) days from the end of the initial period. In the event a claim is denied, the Claims Administrator shall disclose to the claimant in writing the reasons for the denial, the provisions of the Agreement on which the denial is based, a description of any additional material or information necessary to perfect the claim and an explanation of why such material or information is necessary, a description of the Agreement’s review procedures and the applicable time limits, and a statement of the right to bring a civil action under Section 502(a) of ERISA following an adverse benefit determination on review.