Common use of Claim Review Procedure Clause in Contracts

Claim Review Procedure. 7.1. In the event that a Participant or Beneficiary is denied a claim for benefits under the Plan, the Plan Committee shall provide to such claimant written notice of the denial which shall set forth: (a) the specific reasons for the denial; (b) specific references to the pertinent provisions of the Plan on which the denial is based; (c) a description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; and (d) an explanation of the Plan's claim review procedure. 7.2. After receiving written notice of the denial of a claim, a claimant or his representative may: (a) request a full and fair review of such denial by written application to the Plan Committee; (b) review pertinent documents; and (c) submit issues and comments in writing to the Plan Committee. 7.3. If the claimant wishes such a review of the decision denying his claim to benefits under the Plan, he must submit such written application to the Plan Committee within sixty (60) days after receiving written notice of the denial. 7.4. Upon receiving such written application for review, the Plan Committee may schedule a hearing for purposes of reviewing the claimant's claim, which hearing shall take place not more than thirty (30) days from the date on which the Plan Committee received such written application for review. 7.5. At least ten (10) days prior to the scheduled hearing, the claimant and his representative designated in writing by him, if any, shall receive written notice of the date, time, and place of such scheduled hearing. The claimant or his representative, if any, may request that the hearing be rescheduled, for his convenience, on another reasonable date or at another reasonable time or place. 7.6. All claimants requesting a review of the decision denying their claim for benefits may employ counsel for purposes of the hearing. 7.7. No later than sixty (60) days following the receipt of the written application for review, the Plan Committee shall submit its decision on the review in writing to the claimant involved and to his representative, if any; provided, however, a decision on the written application for review may be extended, in the event special circumstances such as the need to hold a hearing require an extension of time, to a day no later than one hundred twenty (120) days after the date of receipt of the written application for review. The decision shall include specific reasons for the decision and specific references to the pertinent provisions of the Plan on which the decision is based.

Claim Review Procedure. 7.1. 11.1 In the event that a Participant Member or Beneficiary is denied a claim for benefits under the a Plan, the Plan Committee Administrator shall provide to such claimant written notice of the denial which shall set forth: (a) the specific reasons for the denial; (b) specific references to the pertinent provisions of the Plan on which the denial is based; (c) a description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; and (d) an explanation of the Plan's claim review procedure. 7.2. 11.2 After receiving written notice of the denial of a claim, a claimant or his representative may: (a) request a full and fair review of such denial by written application to the Plan CommitteeAdministrator; (b) review pertinent documents; and (c) submit issues and comments in writing to the Plan CommitteeAdministrator. 7.3. 11.3 If the claimant wishes such a review of the decision denying his or her claim to benefits under the Plan, he or she must submit such written application applications to the Plan Committee Administrator within sixty (60) days after receiving written notice of the denial. 7.4. 11.4 Upon receiving such written application for review, the Plan Committee Administrator may schedule a hearing for purposes of reviewing the claimant's claim, which hearing shall take place not more than thirty (30) days from the date on which the Plan Committee Administrator received such written application for review. 7.5. 11.5 At least ten (10) days prior to the scheduled hearing, the claimant and his representative designated in writing by him, if any, shall receive written notice of the date, time, and place of such scheduled hearing. The claimant or his representative, if any, may request that the hearing be rescheduled, for his or her convenience, on another reasonable date or at another reasonable time or place. 7.6. All claimants requesting a review of the decision denying their claim for benefits may employ counsel for purposes of the hearing. 7.7. 11.6 No later than sixty (60) days following the receipt of the written application for review, the Plan Committee Administrator shall submit its decision on the review in writing to the claimant involved and to his representative, if anyinvolved; provided, however, a decision on the written application for review may be extended, in the event special circumstances such as the need to hold a hearing require an extension of time, to a day no later than one hundred twenty (120) days after the date of receipt of the written application for review. The decision shall include specific reasons for the decision and specific references to the pertinent provisions of the Plan on which the decision is based.

Claim Review Procedure. 7.1Within 60 days after the date on which Executive receives a notice of denial, Executive or his duly authorized representative (“Applicant”) may (i) file a written request with the CEO for a review of his denied claim; (ii) review pertinent documents; and (iii) submit issues and comments in writing. In The Applicant may submit written comments, documents, records and other information relating to the event that a Participant or Beneficiary is denied a claim for benefits under this Agreement. The Applicant may request a formal hearing before the PlanCEO, which the CEO may grant in his discretion. The CEO shall notify the Applicant of his decision with regard to Applicant’s claim not later than 60 days of the receipt of Applicant’s request; provided, however, that CEO may determine that an extension of up to 60 days from the termination date of the initial 60-day review period is required and shall advise the Applicant in writing of the special circumstances requiring any such extension and the date by which the expects to render a decision. Such special circumstances that require an extension of time for rendering a decision include, but are not limited to, the Plan Committee need to hold a hearing. The decision on review shall provide to such claimant be in written or electronic notice of the denial final determination. If the claim is denied in whole or part, such notice, which shall set forth: be in a manner calculated to be understood by the person receiving such notice, shall include (aA) the specific reasons for the denial; decision, (bB) the specific references to the pertinent Agreement provisions of the Plan on which the denial is based; (c) a description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; and (d) an explanation of the Plan's claim review procedure. 7.2. After receiving written notice of the denial of a claim, a claimant or his representative may: (a) request a full and fair review of such denial by written application to the Plan Committee; (b) review pertinent documents; and (c) submit issues and comments in writing to the Plan Committee. 7.3. If the claimant wishes such a review of the decision denying his claim to benefits under the Plan, he must submit such written application to the Plan Committee within sixty (60) days after receiving written notice of the denial. 7.4. Upon receiving such written application for review, the Plan Committee may schedule a hearing for purposes of reviewing the claimant's claim, which hearing shall take place not more than thirty (30) days from the date on which the Plan Committee received such written application for review. 7.5. At least ten (10) days prior to the scheduled hearing, the claimant and his representative designated in writing by him, if any, shall receive written notice of the date, time, and place of such scheduled hearing. The claimant or his representative, if any, may request that the hearing be rescheduled, for his convenience, on another reasonable date or at another reasonable time or place. 7.6. All claimants requesting a review of the decision denying their claim for benefits may employ counsel for purposes of the hearing. 7.7. No later than sixty (60) days following the receipt of the written application for review, the Plan Committee shall submit its decision on the review in writing to the claimant involved and to his representative, if any; provided, however, a decision on the written application for review may be extended, in the event special circumstances such as the need to hold a hearing require an extension of time, to a day no later than one hundred twenty (120) days after the date of receipt of the written application for review. The decision shall include specific reasons for the decision and specific references to the pertinent provisions of the Plan on which the decision is based, (C) that the Applicant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claim for benefits, and (D) a statement of the Applicant’s right to file a lawsuit under ERISA. Benefits under this Agreement will only be paid if the CEO decides, in his discretion, that an Applicant is entitled to them. The decision of the CEO on review of the claim denial shall be binding on all parties when Executive has exhausted the claims procedure under this Section 6.8. Moreover, no action at law or in equity shall be brought to recover benefits under this Agreement prior to the date the Applicant has exhausted the administrative remedies under this Section 6.8.