Common use of Claims and Appeals Procedure Clause in Contracts

Claims and Appeals Procedure. A. A Claimant shall have the right to submit a claim for benefits under the Plan and to appeal any denial of a claim for benefits. Any request for a Plan benefit or to clarify the Claimant’s rights to future benefits under the terms of the Plan shall be considered to be a claim. (However, this claims procedure does not govern casual inquiries about benefits or the circumstances under which benefits might be paid under the terms of the Plan, nor does it govern a request for a determination regarding eligibility for coverage except such a determination as is requested or necessary in connection with a claim for benefits.) An authorized representative of the Claimant may act on behalf of the Claimant in pursuing a benefit claim or appeal of an Adverse Benefit Determination. The individual or individuals responsible for deciding the benefit claim or appeal, as applicable, may require the representative to provide reasonable written proof that the representative has in fact been authorized to act on behalf of the Claimant. The Plan requires no fee or other cost for the making of a claim or appealing an Adverse Benefit Determination. B. A claim for benefits will be considered as having been made when submitted in writing by the Claimant to the Administrator, in care of: EnPro Industries, Inc. Attn: Senior Vice President — Human Resources (Severance Claim) 5▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇., ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ Any claim should include the following: Claimant’s name, address, telephone number, and social security number. Claimant’s dates of employment with the Company. Claimant’s job title and position with Company. The reasons for Claimant’s termination of employment; and A statement of the reasons why Claimant is entitled to severance benefits under the Plan. C. The Administrator will determine whether, or to what extent, the claim may be allowed or denied under the terms of the Plan. If the claim is wholly or partially denied, the Administrator shall notify the Claimant of the Plan’s Adverse Benefit Determination within a reasonable period of time, but not later than 90 days after the Administrator receives the claim, unless the Administrator determines that special circumstances require an extension of time for processing the claim. If such an extension of time for processing is required, written notice of the extension shall be furnished to the Claimant prior to the termination of the initial 90-day period. Such extension may not exceed an additional 90 days from the end of the initial 90-day period. The extension notice shall indicate the special circumstances requiring an extension of time and the date by which the Administrator expects to render the final decision. For the purposes of this Article V.C, the period of time within which a benefit determination is required to be made shall begin at the time a claim is filed in accordance with the Plan’s filing requirements, without regard to whether all the information necessary to make a benefit determination accompanies the filing.

Claims and Appeals Procedure. A. A Claimant (a) The Committee shall have prescribe a form or such alternate procedure for the right to submit a claim for benefits presentation of claims under the Plan and as it may determine is permitted under applicable law. (b) Upon presentation to appeal any denial the Committee of a claim for benefits. Any request for claim, the Committee shall make a Plan benefit or to clarify the Claimant’s rights to future benefits under the terms determination of the Plan shall be considered to be a claim. (However, this claims procedure does not govern casual inquiries about benefits or the circumstances under which benefits might be paid under the terms of the Plan, nor does it govern a request for a determination regarding eligibility for coverage except such a determination as is requested or necessary in connection with a claim for benefits.) An authorized representative of the Claimant may act on behalf of the Claimant in pursuing a benefit claim or appeal of an Adverse Benefit Determination. The individual or individuals responsible for deciding the benefit claim or appeal, as applicable, may require the representative to provide reasonable written proof that the representative has in fact been authorized to act on behalf of the Claimant. The Plan requires no fee or other cost for the making of a claim or appealing an Adverse Benefit Determination. B. A claim for benefits will be considered as having been made when submitted in writing by the Claimant to the Administrator, in care of: EnPro Industries, Inc. Attn: Senior Vice President — Human Resources (Severance Claim) 5▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇., ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ Any claim should include the following: Claimant’s name, address, telephone number, and social security number. Claimant’s dates of employment with the Company. Claimant’s job title and position with Company. The reasons for Claimant’s termination of employment; and A statement of the reasons why Claimant is entitled to severance benefits under the Plan. C. The Administrator will determine whether, or to what extent, the claim may be allowed or denied under the terms of the Planvalidity thereof. If the claim determination is wholly or partially deniedadverse to the claimant, the Administrator Committee shall notify furnish to the Claimant of the Plan’s Adverse Benefit Determination claimant within a reasonable period of timetime after the receipt of the claim a notice setting forth the following: (i) The specific reason or reasons for the denial; (ii) Specific reference to pertinent provisions of the Plan on which the denial is based; (iii) A description of any material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; and (iv) An explanation of the Plan’s claim review procedure. (c) If a claim is denied, but the claimant may appeal such denial to the Board of Administration, as established pursuant to Section (19), Board of Administration, of the FCA US LLC – UAW Pension Agreement, and pursuant to the procedures set forth below, for a review of the adverse determination. The claimant’s request for review must be made in writing to the Board of Administration or its designee within 60 days after receipt by the claimant of the notification required under subsection (b) above. The claimant or his duly authorized representative may submit issues and comments in writing for consideration by the Board of Administration in its review. (d) A decision on a request for review shall be made by the Board of Administration not later than 90 60 days after receipt of the Administrator receives request; provided, however, that if special circumstances arise, as determined by the Board of Administration in its sole discretion, such decision shall be made not later than 120 days after receipt of such request. The Board of Administration’s decision on review shall state in writing the specific reasons and references to this Plan provisions on which it is based. Subject to any rights to remedies accorded by applicable law, the final decision of the Board of Administration shall be conclusive and binding upon the Company, the claimant and all other persons interested in the claim. (e) The Committee will adopt additional claims procedures with respect to claims involving disability determinations under the Plan in accordance with applicable Department of Labor regulations. (f) The Committee may allocate its responsibilities among its several members, unless except that all matters regarding (a) or (b), above, shall be made by the Administrator full Committee or its designee. No member of the Committee or the Board of Administration shall participate in any matter relating solely to himself. (g) A claimant may not bring a civil action contesting the Board of Administration’s denial of a benefit claim on review more than 24 months following the date of the Board of Administration’s denial of such benefit claim on review. If a court determines that special circumstances require this provision allows an extension of time for processing the claim. If such an extension of time for processing is required, written notice of the extension shall be furnished to the Claimant prior to the termination of the initial 90-day period. Such extension may not exceed an additional 90 days from the end of the initial 90-day period. The extension notice shall indicate the special circumstances requiring an extension of time and the date by which the Administrator expects to render the final decision. For the purposes of this Article V.C, the unreasonably short period of time to bring a civil action, then the court shall enforce this provision as far as possible and declare the civil action barred unless it was started within which a benefit determination is required to be made shall begin at the minimum reasonable time a claim is filed in accordance with that the Plan’s filing requirements, without regard to whether all the information necessary to make a benefit determination accompanies the filingaction should have been started.