GENERAL CLAIMS REVIEW PROCEDURE Sample Clauses

GENERAL CLAIMS REVIEW PROCEDURE. This provision shall apply only to the extent that a claim for benefits is not governed by a similar provision of a benefit program available under this Plan or is not governed by Section 12.10.
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GENERAL CLAIMS REVIEW PROCEDURE. Upon the denial of your claim for benefits, you or your authorized representative may file your appeal, in writing, with the Pension Committee. You must file the appeal no later than 90 days (180 days for a disability claim) after you have received written notification of the denial of your claim for benefits. You or your authorized representative may, free of charge, review and request copies of relevant documents, records, and other information relevant to your claim. Your appeal may include written comments, documents, records, and other information relating to the claim, regardless of whether the information was submitted or considered as part of your initial claim. You or your authorized representative’s appeal will be given a full and fair review. If your appeal is denied, the Pension Committee will provide you or your authorized representative with written notice of this denial within a reasonable time frame, but no more than 60 days (45 days for a disability claim) after the Pension Committee’s receipt of your written appeal. There may be times when this period must be extended due to special circumstances. If this is the case, the Pension Committee will notify you or your authorized representative in writing before the end of the initial 60-day period of the special circumstances that make the extension necessary and the date by which a decision may be expected. If there is an extension, a decision will be made as soon as possible, but not later than 120 days (90 days for a disability claim) after receipt by the Pension Committee of your appeal. The Pension Committee’s decision on your appeal will be communicated to you or your authorized representative in writing; will explain the reasons for the decision; will include specific references to the pertinent Plan provisions on which the decision was based; and will inform you or your authorized representative of any additional rights you may have. The determination on appeal by the Pension Committee is the final determination under this claims procedure and is final and binding on all persons involved. You must pursue and exhaust the Plans claims procedures before you can take any legal action against the Plan or its fiduciaries. This requirement applies to any and all disputes involving the interpretation of the terms of the Plan and supporting Plan documents, as well as Plan administrative and operational issues. Any legal action must be brought within six months after receiving the denial of your...

Related to GENERAL CLAIMS REVIEW PROCEDURE

  • Claims Review Findings a. Narrative Results.‌‌

  • Claims Review The IRO shall perform the Claims Review annually to cover each of the five Reporting Periods. The IRO shall perform all components of each Claims Review.

  • Review Procedure If the Plan Administrator denies part or all of the claim, the claimant shall have the opportunity for a full and fair review by the Plan Administrator of the denial, as follows:

  • Claims Review Population A description of the Population subject to the Claims Review.

  • Claims Review Methodology a. C laims Review Population. A description of the Population subject to the Quarterly Claims Review.‌

  • Claims Review Objective A clear statement of the objective intended to be achieved by the Claims Review.

  • Claims Review Report The IRO shall prepare a Claims Review Report as described in this Appendix for each Claims Review performed. The following information shall be included in the Claims Review Report for each Discovery Sample and Full Sample (if applicable).

  • Claims Procedure An Executive or Beneficiary (“claimant”) who has not received benefits under this Agreement that he or she believes should be distributed shall make a claim for such benefits as follows:

  • Appeals Procedure If Employee appeals to the Administrator, Employee or his authorized representative may submit in writing whatever issues and comments he believes to be pertinent. The Administrator shall reexamine all facts related to the appeal and make a final determination of whether the denial of benefits is justified under the circumstances. The Administrator shall advise Employee in writing of:

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