INITIAL CLAIM DETERMINATION Sample Clauses

INITIAL CLAIM DETERMINATION. All claims of Employees for benefits under the Plan, including those claims for benefits that require notification or approval prior to receiving medical care, shall be filed and processed in accordance with procedures established by the applicable Contract Administrator. The claims procedures of each Contract Administrator that are applicable to the Plan are hereby incorporated by reference. Claims and review procedures shall comply with applicable law, including PPACA, to the extent required. A claimant is entitled to a full review of his or her claim by the Company's Pension Board after he or she has been notified by the Contract Administrator of a denial or a reduction of benefits. A claimant desiring a review must make a written request to the Pension Board requesting such a review, which may include whatever comments or arguments such claimant wishes to submit. During the review, the claimant may represent himself or herself or appoint a representative to do so, and will have the right to inspect all documents pertaining to the claim. A request for a review must be filed with the Pension Board within sixty (60) days after the date the claim for benefits under the Plan was denied or reduced by the Contract Administrator. If no request is received within the time limit, the denial or reduction of benefits will be final. However, if a request for a review is filed, the Pension Board must render its decision under normal circumstances within thirty (30) days of the receipt of the request for review. In special circumstances the decision may be delayed, but must in any event be rendered no later than sixty (60) days after the receipt of the request. All decisions of the Pension Board shall be in writing and shall include specific reasons for whatever action has been taken and the Plan provisions on which the decision is based.