Claims Procedure. Any claim for benefits under this Agreement shall be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent provisions upon which the denial is based; (iii) 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 (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 23 contracts
Sources: Executive Consultation, Separation From Service and Death Benefit Agreement (First Citizens Bancshares Inc /De/), Founder’s Supplemental Executive Retirement Plan Agreement (Scansource Inc), Executive Consultation, Separation From Service and Death Benefit Agreement (First Citizens Bancshares Inc /De/)
Claims Procedure. Any claim for If Executive believes that he is entitled to receive severance benefits under this Agreement shall be made Agreement, he may file a claim in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of with the decision shall be furnished to the claimant Committee within a reasonable period of time, not to exceed 90 ninety (90) days after the date such Executive believes he or she should have received such benefits. No later than ninety (90) days after the receipt of the claim, the Committee shall either allow or deny the claim by Companyin writing. A denial of a claim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is requiredin whole or in part, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by Executive and shall include the claimant, the following: (i) specific reason or reasons for the denial; (ii) specific reference to the pertinent provisions upon of this Agreement on which the denial is based; (iii) a description of any additional material or information necessary for the claimant Executive to perfect the claim and an explanation of why such material or information is necessary; and (iv) an explanation of the Agreement’s claims claim review procedure as set forth belowprocedure. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant Executive (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within sixty 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, claim request a review upon written application to Company, to the Committee; review pertinent documents, ; and submit issues and comments in writing. The Committee shall notify Executive of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 within sixty (60) days after Company receives the receipt of a request for review, review unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one-hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is required, written notice Notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing writing. The Committee’s decision on review shall be final and shall include reasons for binding on Executive and any successor in interest. If Executive subsequently wishes to file a claim under Section 502(a) of ERISA, any legal action must be filed within ninety (90) days of the Committee’s final decision, written . Executive must exhaust the claims procedure provided in this section 6 before filing a manner calculated claim under ERISA with respect to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedany benefits provided under section 2 of this Agreement.
Appears in 20 contracts
Sources: Severance/Change in Control Agreement (Hanesbrands Inc.), Severance/Change in Control Agreement (Hanesbrands Inc.), Severance/Change in Control Agreement (Hanesbrands Inc.)
Claims Procedure. Any claim for benefits If you believe you have been incorrectly denied a benefit or are entitled to a greater benefit than the benefit you received under this Agreement shall the Agreement, you may submit a signed, written application to the Company’s Senior Vice President of Human Resources (“Claims Administrator”). You will be made notified in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant approval or denial of this claim within a reasonable period of time, not to exceed 90 ninety (90) days after receipt of the claim by Companydate that the Claims Administrator receives the claim, unless special circumstances require an extension of time for processing the claim. If such In the event an extension of time is requirednecessary, you will be provided written notice of the extension shall be furnished to the claimant prior to the termination end of the initial ninety (90-) day periodperiod indicating the special circumstances requiring the extension and the date by which the Claims Administrator expects to notify you of approval or denial of the claim. In no event shall such will an extension exceed the period of 90 extend beyond ninety (90) days from after the end of such the initial ninety (90) day period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who If your claim is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimantdenied, the following: (i) written notification will state specific reasons for the denial; (ii) , make specific reference to pertinent provisions upon the Agreement provision(s) on which the denial is based; (iii) , and provide a description of any additional material or information necessary for the claimant you to perfect the claim and an explanation of why such material or information is necessary; and (iv) an explanation . The written notification will also provide a description of the Agreement’s claims review procedure as set forth belowprocedures and the applicable time limits, including a statement of your right to bring a civil suit under section 502(a) of ERISA following denial of your claim on review. The claimant may appeal You will have sixty (60) days from receipt of the written notification of the denial of his your claim to Company file a signed, written request for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial by a review panel which will be a named fiduciary of his the Agreement for purposes of such review. This request should include the reasons you are requesting a review and may include facts supporting your request and any other relevant comments, documents, records and other information relating to your claim. The claimant or his duly authorized representative may requestUpon request and free of charge, upon written application to Companyyou will be provided with reasonable access to, to review pertinent and copies of, all documents, records and submit issues and comments other information relevant to your claim, including any document, record or other information that was relied upon in, or submitted, considered or generated in writingthe course of, denying your claim. The decision on review A final, written determination of your eligibility for benefits shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 within sixty (60) days after Company receives the of receipt of your request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is requiredprocessing the claim, in which case you will be provided written notice of the reasons for the delay within the initial sixty (60) day period and the date by which you should expect notification of approval or denial of your claim. This review will take into account all comments, documents, records and other information submitted by you relating to your claim, whether or not submitted or considered in the initial review of your claim. In no event will an extension extend beyond sixty (including 60) days after the special circumstances requiring end of the initial sixty (60) day period. If an extension is required because you fail to submit information that is necessary to decide your claim, the period for making the benefit determination on review will be tolled from the date the notice of time) shall be furnished extension is sent to you until the date on which you respond to the claimant prior request for additional information. If your claim is denied on review, the written notification will state specific reasons for the denial, make specific reference to the commencement Agreement provision(s) on which the denial is based and state that you are entitled to receive upon request, and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your claim, including any document, record or other information that was relied upon in, or submitted, considered or generated in the course of, denying your claim. The written notification will also include a statement of your right to bring an action under section 502(a) of ERISA. If your claim is initially denied or is denied upon review, you are entitled to receive upon request, and free of charge, reasonable access to, and copies of, any document, record or other information that demonstrates that (1) your claim was denied in accordance with the terms of the extensionAgreement, and (2) the provisions of the Agreement have been consistently applied to similarly situated participants, if any. In the event that the decision on review is not furnished within the time period pursuing any of your rights set forth in this paragraphsection, your authorized representative may act on your behalf. If you do not receive notice within the claim shall be deemed denied time periods described above, whether on initial determination or review. The decision on review shall be in writing and shall include reasons for the decision, written in you may initiate a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedlawsuit under Section 502(a) of ERISA.
Appears in 19 contracts
Sources: Change of Control Agreement (LKQ Corp), Change of Control Agreement (LKQ Corp), Change of Control Agreement (LKQ Corp)
Claims Procedure. Any claim for benefits under this Agreement 7.7.1 The Contractor shall be made provide a Notice in writing Writing to Company. If the Owner and the Contract Administrator of any claim for benefits under this Agreement is wholly or partially denieda change in the Contract Price, notice extension of the decision Contract Time or other changes to the Work or amendments to the Agreement (“Claim Notice”) within ten (10) Working Days after the Contractor knows, or should know applying the Standard of Care, of the event or circumstance giving rise to such claim. Any Claims by the Contractor in respect of such claim or Claim Notice shall be furnished irrevocably barred, and waived and released by the Contractor unless the Contractor has strictly complied with the applicable requirements of 7.CHANGES IN THE WORK and the Contractor has provided such Claim Notice within the prescribed time period.
7.7.2 Without limiting the generality of any other provision in the Agreement, the Contractor shall immediately upon commencing Work that may result in a Claim Notice, keep such Contractor Records that relate to such Work (including any T&M Change in the Work) and the Claim Notice arising therefrom (including Daily Contractor Work Records) as may be necessary to support and substantiate such Claim Notice. The Contractor shall attempt, on a daily basis, to reconcile its Daily Contractor Work Records with the records of the Contract Administrator or Owner Representative, as applicable and have the Daily Contractor Work Records signed by the Contract Administrator or Owner Representative, as applicable. For clarity, the reconciling of the Contractor’s Daily Work Records with the records of the Contract Administrator or Owner Representative, as applicable, shall not be construed to be acceptance of a Claim Notice. If it is not possible to reconcile the Daily Contractor Work Records, then the Contractor shall submit the un-reconciled Daily Contractor Work Records with its Claim Notice, whereby the resolution of the dispute about the Daily Contractor Work Records shall not be resolved until there is a resolution of the applicable Claim Notice.
7.7.3 Subject to GC 7.7.4, the Claim Notice shall: .2 include the date the Contractor first became aware of the event or circumstance giving rise to the claimant within a reasonable period of timeClaim Notice; .3 state the grounds, not to exceed 90 days after receipt of the claim by Companycontractual or otherwise, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent provisions upon which the denial Claim Notice is basedmade; .4 provide sufficient and detailed information and documentation to allow the Contract Administrator and the Owner to properly consider the Claim Notice of the Contractor including:
(iii1) a description of any additional material or information necessary for the claimant to perfect portions of the claim and Work affected thereby;
(2) the cause of the change in the Contract Time, a description of such change, an assessment of the impact such change will have on the Construction Schedule (including an explanation of why such material or information is necessary; as to how the critical path will be affected) and (iv) an explanation a reasonable estimate of the Agreement’s claims review procedure as set forth below. The claimant may appeal number of Calendar Days by which the denial of his claim to Company for Work will be delayed and date and time when the delay was experienced;
(3) a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice detailed account of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, amount claimed and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt breakdown of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions change in the relevant documents on which the decision is based.Contract Price;
(4) details of mitigation strategies applied; and
(5) all other pertinent details and backup information and documents; and
Appears in 12 contracts
Sources: Construction Agreement, Construction Agreement, Construction Agreement
Claims Procedure. Any In the event a dispute arises over benefits under the Executive Plan or this Agreement and benefits are not paid to the Employee and a claimant feels that he or she is entitled to receive such benefits, then a written claim for benefits under this Agreement shall must be made in writing to Companythe Named Fiduciary and Plan Administrator named above. The Named Fiduciary and Plan Administrator shall give any such written claim a full and fair review. If any the claim for benefits under this Agreement is wholly or partially denied, in whole or in part, the Named Fiduciary and Plan Administrator will furnish the claimant with a written notice of the decision shall this denial. This written notice must be furnished provided to the claimant within a reasonable period of time, not to exceed time (generally 90 days days) after the receipt of the claim by Companythe Named Fiduciary and Plan Administrator. There may be times when this 90-day period will be extended. Such an extension may be made, unless however, only where there are special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished that are communicated to the claimant prior to the termination of in writing within the initial 90-day period. In no event shall such extension exceed If there is an extension, the period Named Fiduciary and Plan Administrator will render a decision as soon as possible, but not later than 180 days after receipt by the Named Fiduciary and Plan Administrator of 90 days from the end of such initial periodwritten claim. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in of denial must provide a manner calculated to be understood by the claimant, the following: (i) specific reason or reasons for the such denial; (ii) , specific reference to pertinent the provisions of the Executive Plan or this Agreement upon which the denial is based; (iii) , and 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 (iv) an explanation . The written notice of denial shall further indicate the additional steps to be taken by the claimant if a further review of the Agreement’s claims review procedure as set forth below. The claimant may appeal the claim denial of his claim to Company for a full and fair reviewis desired. A claim shall be deemed denied if the Named Fiduciary and Plan Administrator fail act on the claim within the initial 90-day period or any extension thereof. If the claimant (or his duly authorized representative) may does not request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may requesther claim in accordance with the procedures set forth below, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The the decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If Named Fiduciary and Plan Administrator on such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied final and binding on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedall parties.
Appears in 11 contracts
Sources: Employee Supplemental Compensation Benefits Agreement (Greater Bay Bancorp), Employee Supplemental Compensation Benefits Agreement (Greater Bay Bancorp), Employee Supplemental Compensation Benefits Agreement (Greater Bay Bancorp)
Claims Procedure. Any claim for benefits under this Agreement shall be made in writing to CompanyEmployer. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by CompanyEmployer, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company Employer shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent provisions upon which the denial is based; (iii) 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 (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company Employer for a full and fair review. The claimant or his duly authorized representative may request a review upon written application to Employer, review pertinent documents, and submit issues and comments in writing. A claimant (or his duly authorized representative) may shall request a review by filing a written application for review with Employer or its designee (the Administrator “Reviewer”) at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the AdministratorReviewer, who may, in its or his/her his discretion, hold a hearing on the denied claim; the Administrator Reviewer shall make this decision promptly, and not later than 60 days after Company Employer receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 11 contracts
Sources: Employee Death Benefit and Post Retirement Noncompetition and Consultation Agreement (First Citizens Bancorporation Inc), Employee Deferred Compensation, Post Retirement Non Competition and Death Benefit Agreement (Southern Bancshares Nc Inc), Employee Deferred Compensation, Consultation, Post Retirement Non Competition and Death Benefit Agreement (Fidelity Bancshares Nc Inc /De/)
Claims Procedure. Any claim for If Executive believes that he is entitled to receive severance benefits under this Agreement shall be made Agreement, he may file a claim in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of with the decision shall be furnished to the claimant Committee within a reasonable period of time, not to exceed 90 ninety (90) days after the date such Executive believes he should have received such benefits. No later than ninety (90) days after the receipt of the claim, the Committee shall either allow or deny the claim by Companyin writing. A denial of a claim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is requiredin whole or in part, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by Executive and shall include the claimant, the following: (i) specific reason or reasons for the denial; (ii) specific reference to the pertinent provisions upon of this Agreement on which the denial is based; (iii) a description of any additional material or information necessary for the claimant Executive to perfect the claim and an explanation of why such material or information is necessary; and (iv) an explanation of the Agreement’s claims claim review procedure as set forth belowprocedure. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant Executive (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within sixty 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, claim request a review upon written application to Company, to the Committee; review pertinent documents, ; and submit issues and comments in writing. The Committee shall notify Executive of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 within sixty (60) days after Company receives the receipt of a request for review, review unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one-hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is required, written notice Notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing writing. The Committee ’s decision on review shall be final and shall include reasons for binding on Executive and any successor in interest. If Executive subsequently wishes to file a claim under section 502(a) of ERISA, any legal action must be filed within ninety (90) days of the Committee’s final decision, written . Executive must exhaust the claims procedure provided in this section 6 before filing a manner calculated claim under ERISA with respect to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedany benefits provided under section 2 of this Agreement.
Appears in 9 contracts
Sources: Severance/Change in Control Agreement (Hanesbrands Inc.), Severance/Change in Control Agreement (Hanesbrands Inc.), Severance/Change in Control Agreement (Hanesbrands Inc.)
Claims Procedure. Subject to the provisions of Section 7, the Company shall determine the rights of any employee of the Company to any Severance Compensation or a Gross-up Payment hereunder. Any employee or former employee of the Company who believes that he has not received any benefit under the Plan to which he believes he is entitled, may file a claim for benefits under this Agreement shall be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice with the General Counsel of the decision shall be furnished to Company (or the claimant within a reasonable period of timeSecretary, not to exceed in the case the Executive is the General Counsel). The Company shall, no later than 90 days after the receipt of a claim, either allow or deny the claim by Company, unless special circumstances require an extension of time for processing written notice to the claimclaimant. If such an extension of time is required, a claimant does not receive written notice of the extension shall be furnished to the claimant prior to the termination of the initial Company’s decision on his claim within such 90-day period, the claim shall be deemed to have been denied in full. In no event shall such extension exceed the period A denial of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits by the Company, wholly or partially, shall be written notice setting forth, in a manner calculated to be understood by the claimant, the following: claimant and shall include:
(i) the specific reason or reasons for the denial; ;
(ii) specific reference to pertinent Plan provisions upon on which the denial is based; ;
(iii) 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 and
(iv) an explanation of the Agreement’s claims claim review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair reviewprocedure. A claimant whose claim is denied (or his duly authorized representative) may may, within thirty (30) days after receipt of denial of his claim, request a review of such denial by the Company by filing with the Secretary of the Company (or the General Counsel, in the case the Executive is the Secretary) a written application request for review of his claim. If the claimant does riot file a request for review with the Administrator at any time Company within 60 days after receipt by such 30-day period, the claimant of written notice shall be deemed to have acquiesced in the original decision of the denial of Company on his claim. The If a written request for review is so filed within such 30-day period, the Company shall conduct a full and fair review of such claim. During such full review, the claimant or his duly authorized representative may request, upon written application to Company, shall be given the opportunity to review documents that are pertinent documents, to his claim and to submit issues and comments in writing. The Company shall notify the claimant of its decision on review within sixty (60) days after receipt of a request for review. Notice of the decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for reviewwriting. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished to the claimant within the time period set forth in this paragraphsuch 60-day period, the claim shall be deemed to have been denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 9 contracts
Sources: Employment Agreement (Cooper-Standard Holdings Inc.), Employment Agreement (Cooper-Standard Holdings Inc.), Employment Agreement (Cooper-Standard Holdings Inc.)
Claims Procedure. Any The Executive or his designated beneficiary or beneficiaries may make a claim for benefits under this Agreement shall be made in writing to Companyby filing a written request with the Committee. If any a claim for benefits under this Agreement is wholly or partially denied, notice of the decision Committee shall be furnished to furnish the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits with written notice setting forth, forth in a manner calculated to be understood by the claimant, :
(a) the following: (i) specific reason or reasons for the denial; ;
(iib) specific reference to the pertinent provisions upon of this Agreement on which the denial is based; ;
(iiic) a description of any additional material or information necessary for the claimant to perfect the his claim and an explanation of why such material or information is necessary; and and
(ivd) appropriate information as to the steps to be taken if the claimant wishes to submit his claim for review. Such notice shall be furnished to the claimant within ninety (90) days after the receipt of his claim, unless special circumstances require an explanation extension of time for processing his claim. If an extension of time for processing is required, the Committee shall, prior to the termination of the Agreement’s claims review procedure as set forth belowinitial ninety (90) day period, furnish the claimant with written notice indicating the special circumstances requiring an extension and the date by which the Committee expects to render its decision. The claimant may appeal In no event shall an extension exceed a period of ninety (90) days from the denial end of his claim to Company for a full and fair reviewthe initial ninety (90) day period. A claimant (or his duly authorized representative) may request the Committee to review a review by filing a written application for review with denied claim. Such request shall be in writing and must be delivered to the Administrator at any time Committee within 60 sixty (60) days after receipt by the claimant of written notice notification of the denial of his claim. The A claimant or his duly authorized representative may request, upon written application to Company, to may:
(a) review pertinent documents, and and
(b) submit issues and comments in writing. The Committee shall notify the claimant of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives the receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is requiredrequired because of special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) shall must be furnished to the claimant prior to the commencement of the extension. In the event that the The Committee’s decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and as well as specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based.
Appears in 8 contracts
Sources: Supplemental Executive Retirement Agreement (Louisiana Bancorp Inc), Supplemental Executive Retirement Agreement (Home Federal Bancorp, Inc. Of Louisiana), Supplemental Executive Retirement Agreement (Home Federal Bancorp, Inc. Of Louisiana)
Claims Procedure. Any claim for benefits under this Agreement shall be made in writing to CompanyEmployer. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by CompanyEmployer, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company Employer shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent provisions upon which the denial is based; (iii) 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 (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company Employer for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with Employer or its designee (the Administrator “Reviewer”) at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to CompanyEmployer, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the AdministratorReviewer, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator Reviewer shall make this decision promptly, and not later than 60 days after Company Employer receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 8 contracts
Sources: Employee Consultation, Post Retirement Non Competition and Death Benefit Agreement (First Citizens Bancshares Inc /De/), Employee Consultation, Post Retirement Non Competition and Death Benefit Agreement (First Citizens Bancshares Inc /De/), Employee Consultation, Post Retirement Non Competition and Death Benefit Agreement (First Citizens Bancshares Inc /De/)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company ("Administrator"), whose address is 555 ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇.O. ▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇d whose telephone number is (734) ▇▇▇-▇▇▇▇. ▇▇e "Named Fiduciary" as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive ("the claimant") shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreement’s claims best of the Administrator's ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within 10 days following the date of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the claimant shall consider relevant to a determination of the claim, and the claimant may appeal the denial of his claim to Company include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting the request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by shall agree are pertinent to the claimant of written notice of the denial of his claim. The claimant may, at all stages of review, be represented by counsel, legal or his duly authorized representative may requestotherwise, upon written application to Company, to review pertinent documents, and submit issues and comments in writingof the claimant's choice. The decision on All requests for review shall be made by promptly resolved. The Administrator's decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 10 days after Company receives following receipt by the Administrator of the claimant's request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator's decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this Section, but who has not obtained full relief on the claim for benefits, may, within 60 days following the claimant's receipt of the Administrator's written decision on review, apply in writing to the Administrator for binding arbitration of the claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Ann Arbor, Michigan, in accordance with the arbitration rules of the American Arbitration Association, as then in effect. If such the parties are unable to mutually agree upon an extension arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of time for review is requiredwhich shall be designated by the Company, written notice one of which shall be designated by the claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the arbitration rules referenced above. The arbitrator(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of the extension (including Agreement's provisions. The arbitrator(s) shall have the special circumstances requiring power to compel attendance of witnesses at the extension hearing. Any court having jurisdiction may enter a judgment based upon such arbitration. All decisions of timethe arbitrator(s) shall be furnished to final and binding on the claimant prior and the Company without appeal to the commencement any court. Upon execution of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraphAgreement, the claim Executive shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for to have waived any right to commence litigation proceedings outside of arbitration without the decision, express written in a manner calculated to be understood by consent of the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedCompany.
Appears in 8 contracts
Sources: Change in Control Severance Agreement (Comshare Inc), Change in Control Severance Agreement (Comshare Inc), Change in Control Severance Agreement (Comshare Inc)
Claims Procedure. Any person claiming a benefit under the Agreement (a "Claimant") shall present the claim, in writing, to the Bank, and the Bank shall respond in writing. If the claim is denied, the written notice of denial shall state, in a manner calculated to be understood by the Claimant:
(i) The specific reason or reasons for benefits under this denial, with specific references to the Agreement provisions on which the denial is based;
(ii) A description of any additional material or information necessary for the Claimant to perfect his, her or its claim and an explanation of why such material or information is necessary; and
(iii) An explanation of the Agreement's claims review procedure. The written notice denying or granting the Claimant's claim shall be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished provided to the claimant Claimant within a reasonable period of time, not to exceed 90 ninety (90) days after the Bank's receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished by the Bank to the claimant prior to the termination of Claimant within the initial ninety (90-) day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The Any extension notice shall indicate the special circumstances requiring an the extension of time and the date on which the administrator Bank expects to render a decisiondecision on the claim. Company Any claim not granted or denied within the period noticed above shall provide every claimant who be deemed to have been denied. Any Claimant whose claim is denied a claim for benefits written notice setting forthdenied, in a manner calculated or deemed to be understood by denied under the claimantpreceding sentence, or such Claimant's authorized representative, may, within sixty (60) days after the following: (i) specific reasons for Claimant's receipt of notice of the denial; (ii) specific reference to pertinent provisions upon which , or after the denial is based; (iii) 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 (iv) an explanation date of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may deemed denial, request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may requestby notice given, upon written application to Companyin writing, to review the Bank. Upon such a request for review, the claim shall be reviewed by the Bank (or its designated representative). In connection with the review, the Claimant may have representation, may examine pertinent documents, and may submit issues and comments in writing. The decision on review normally shall be made by within sixty (60) days of the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after Bank's receipt of the request for review. If such an extension of time for review is requiredrequired due to special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) Claimant shall be furnished to notified, in writing, by the claimant prior to Bank, and the commencement of the extension. In the event that time limit for the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on reviewextended to one hundred twenty (120) days. The decision on review shall be in writing and shall include reasons for the decisionstate, written in a manner calculated to be understood by the claimantClaimant, the specific reasons for the decision and specific shall include references to the pertinent relevant Agreement provisions in the relevant documents on which the decision is based. The written decision on review shall be given to the Claimant within the sixty (60) days (or, if applicable, the one hundred twenty (120) day) time limit discussed above. If the decision on review is not communicated to the Claimant with the sixty (60) days (or, if applicable, the one hundred twenty (120) day) period discussed above, the claim shall be deemed to have been denied upon review. All decisions on review shall be final and binding with respect to all concerned parties.
Appears in 8 contracts
Sources: Endorsement Split Dollar Insurance Agreement (First United Corp/Md/), Endorsement Split Dollar Insurance Agreement (First United Corp/Md/), Endorsement Split Dollar Insurance Agreement (First United Corp/Md/)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made PROASSURANCE (“Administrator”), whose address is ▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇ Telephone: (▇▇▇) ▇▇▇ ▇▇▇▇. The “Named Fiduciary” as defined in writing Section 402(a)(2) of ERISA, also shall be PROASSURANCE. PROASSURANCE shall have the right to Companydesignate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. If PROASSURANCE shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (“the claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 ten (10) days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 ten (10) days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (10) days following the receipt of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the claimant shall consider relevant to a determination of the claim, and the claimant may appeal the denial of his claim to Company include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting the request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by shall agree are pertinent to the claimant of written notice of the denial of his claim. The claimant may, at all stages of review, be represented by counsel, legal or his duly authorized representative may requestotherwise, upon written application to Company, to review pertinent documents, and submit issues and comments in writingof the claimant’s choice. The decision on All requests for review shall be made by promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 ten (10) days after Company receives following receipt by the Administrator of the claimant’s request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 twenty (20) days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedrequest.
Appears in 7 contracts
Sources: Retention and Severance Compensation Agreement (Proassurance Corp), Retention and Severance Compensation Agreement (Eastern Insurance Holdings, Inc.), Retention and Severance Compensation Agreement (Eastern Insurance Holdings, Inc.)
Claims Procedure. Any claim for benefits under this Letter Agreement by ---------------- you shall be made in writing and sent to Companythe Company at its principal offices in Mechanicsburg, Pennsylvania, or such other place as the Company shall hereafter designate in writing. If you, or any claim for beneficiary following your death (collectively, the "Claimant"), believes he or she has been denied any benefits or payments under this Agreement is wholly Letter Agreement, either in total or partially deniedin an amount less than the full benefit or payment to which the Claimant would normally be entitled, notice the Company shall advise the Claimant in writing of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt amount of the claim by Companybenefit, unless special circumstances require an extension of time for processing the claim. If such an extension of time is requiredor payment, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time if any, and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; denial within thirty (ii30) days of the receipt of the Claimant's claim. The Company shall also furnish the Claimant at that time with a written notice containing:
(A) A specific reference to pertinent provisions upon which the denial is based; of this Letter Agreement;
(iiiB) a A description of any additional material or information necessary for the claimant Claimant to perfect the claim if possible, and an explanation of why such material or information is necessaryneeded; and and
(ivC) an An explanation of the Agreement’s claims claim review procedure as set forth belowin this Section 7. Within sixty (60) days of receipt of the information described above, the Claimant shall, if further review is desired, file a written request of reconsideration of the Company's decision with the Appeal Committee. The claimant Appeal Committee shall consist of those individuals who were serving as the Compensation Committee of the Board of Directors of the Company immediately prior to the Change of Control. The Appeal Committee shall select from its membership a chairperson and a secretary and may appeal adopt such rules and procedures as it deems necessary to carry out its functions. In the denial event any individual is unable to serve on the Appeal Committee, then the chairperson of his claim the Appeal Committee shall appoint a successor provided such successor must have been a member of the Board of Directors of the Company prior to Company the Change of Control ("Prior Board Member"). So long as the Claimant's request for a full and fair review. A claimant review is pending with the Appeal Committee (including such 60-day period), the Claimant, or his duly authorized representative) , may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, documents and may submit issues and comments in writingwriting to the Appeal Committee. The A final and binding decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on Appeal Committee within thirty (30) days of the denied claim; filing by the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt Claimant of the request for reviewreconsideration. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) The Appeal Committee's decision shall be furnished conveyed to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be Claimant in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, decision and specific references to the pertinent provisions in the relevant documents of this Letter Agreement on which the decision is based. The Appeal Committee shall discharge its duties under this claims procedure in accordance with the fiduciary standards of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), and in doing so, to the extent permitted by law, shall be indemnified and held harmless by the Company (to the extent not indemnified or saved harmless under any liability insurance or other indemnification arrangement with the Company) for or against all liability to which the Appeal Committee may be subjected by reason of any act done in good faith with respect to the adjudication of any claim under this Letter Agreement, including reasonable expenses. Notwithstanding anything to the contrary herein contained, the Claimant shall be entitled to submit his or her claim for determination to any court having competent jurisdiction regardless of whether he or she has first exercised his or her right to have the Company's decision reconsidered by the Appeal Committee."
4. Except as amended hereby, the Letter Agreement shall continue in effect in accordance with its terms.
Appears in 6 contracts
Sources: Amendment to Agreement in the Event of a Change of Control of SMC (Select Medical Corp), Amendment to Agreement in the Event of a Change of Control of SMC (Select Medical Corp), Amendment to Agreement in the Event of a Change of Control of SMC (Select Medical Corp)
Claims Procedure. Any If an Executive or the Executive's beneficiary (or qualified executor or administrator) fails to receive benefits to which such Executive or beneficiary (or qualified executor or administrator) feels entitled under this Agreement, such Executive or beneficiary (or qualified executor or administrator) shall submit a claim for such benefits under this Agreement shall be made in writing to Companythe Corporation within 60 days of the date the Executive or beneficiary (or qualified executor or administrator) would have received such benefits if so entitled. Such claim shall be reviewed by the Corporation. If any the claim for benefits under this Agreement is wholly or partially denied, notice of in full or in part, the decision Corporation shall be furnished to the claimant within provide a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, claimant within 90 days setting forth the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent the provisions of this Agreement upon which the denial is based; (iii) a description of , and any additional material or information necessary for the claimant to perfect the claim claim, if any, and an explanation of why such material or information is necessary; and (iv) an explanation . Also, such written notice shall indicate the steps to be taken if a review of the Agreement’s claims denial is desired. If a claim is denied in full or in part and a review procedure as set forth below. The claimant may appeal is desired, the Executive or his beneficiary (or qualified executor or administrator) shall so notify the Corporation in writing within 60 days after receiving a denial of claim and a claim shall be deemed denied if the Corporation does not take any action within the aforesaid 90-day period. In requesting a review, the Executive or his claim to Company for a full and fair review. A claimant beneficiary (or his duly authorized representativequalified executor or administrator) may request a review by filing this Agreement or any documents relating to it and submit any written issues and comments he may feel appropriate. In its sole discretion, the Corporation shall then review the claim and provide a written application for review with the Administrator at any time decision within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, review unless special circumstances require an extension of time for processing, processing in which case a decision shall be rendered as soon as possible, but not no later than 120 days after receipt of the a request for review. If such an extension of time This decision shall state the specific reasons for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for reference to specific provisions of this Agreement on which the decision, decision is based and be written in a manner calculated to be understood by the claimant. All determinations made by the Corporation shall be conclusive upon the Executive, and specific references his beneficiary (or qualified executor or administrator) or any other person claiming benefits pursuant to the pertinent provisions in the relevant documents on which the decision is basedthis Agreement.
Appears in 4 contracts
Sources: Executive Supplemental Defined Contribution Benefit Agreement (Elco Industries Inc), Executive Supplemental Defined Contribution Benefit Agreement (Elco Industries Inc), Executive Supplemental Defined Contribution Benefit Agreement (Elco Industries Inc)
Claims Procedure. Any The Executive or his designated beneficiary or beneficiaries may make a claim for benefits under this Agreement shall be made in writing to Companyby filing a written request with the Committee. If any a claim for benefits under this Agreement is wholly or partially denied, notice of the decision Committee shall be furnished to furnish the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits with written notice setting forth, forth in a manner calculated to be understood by the claimant, ;
(a) the following: (i) specific reason or reasons for the denial; ;
(iib) specific reference to the pertinent provisions upon of this Agreement on which the denial is based; ;
(iiic) a description of any additional material or information necessary for the claimant to perfect the his claim and an explanation of why such material or information is necessary; and and
(ivd) appropriate information as to the steps to be taken if the claimant wishes to submit his claim for review. Such notice shall be furnished to the claimant within ninety (90) days after the receipt of his claim, unless special circumstances require an explanation extension of time for processing his claim. If an extension of time for processing is required, the Committee shall, prior to the termination of the Agreement’s claims review procedure as set forth belowinitial ninety (90) day period, furnish the claimant with written notice indicating the special circumstances requiring an extension and the date by which the Committee expects to render its decision. The claimant may appeal In no event shall an extension exceed a period of ninety (90) days from the denial end of his claim to Company for a full and fair reviewthe initial ninety (90) day period. A claimant (or his duly authorized representative) may request the Committee to review a review by filing a written application for review with denied claim. Such request shall be in writing and must be delivered to the Administrator at any time Committee within 60 sixty (60) days after receipt by the claimant of written notice notification of the denial of his claim. The A claimant or his duly authorized representative may request, upon written application to Company, to may;
(a) review pertinent documents, and and
(b) submit issues and comments in writing. The Committee shall notify the claimant of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives the receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is requiredrequired because of special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) shall must be furnished to the claimant prior to the commencement of the extension. In the event that the The Committee's decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and as well as specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based.
Appears in 4 contracts
Sources: Supplemental Retirement Agreement (Minden Bancorp Inc), Supplemental Retirement Agreement (Minden Bancorp Inc), Supplemental Retirement Agreement (Minden Bancorp Inc)
Claims Procedure. Any claim for In the event a dispute arises over benefits under this Agreement shall Executive Plan and benefits are not paid to the Executive (or to the Executive’s beneficiary(ies) in the case of the Executive’s death) and such claimants feel they are entitled to receive such benefits, then a written claim must be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant Named Fiduciary and Plan Administrator named above within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 sixty (60) days from the end date payments are refused. The Named Fiduciary and Plan Administrator shall review the written claim and if the claim is denied, in whole or in part, they shall provide in writing within sixty (60) days of receipt of such initial period. The extension notice shall indicate claim the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the such denial; (ii) specific , reference to pertinent the provisions of this Executive Plan upon which the denial is based; (iii) a description of based and 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 (iv) an explanation claim. Such written notice shall further indicate the additional steps to be taken by claimants if a further review of the Agreement’s claims review procedure as set forth below. The claimant may appeal the claim denial of his claim to Company for a full and fair reviewis desired. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on reviewif the Named Fiduciary and Plan Administrator fail to take any action within the aforesaid sixty (60) day period. The decision on If claimants desire a second review they shall be notify the Named Fiduciary and Plan Administrator in writing within sixty (60) days of the first claim denial. Claimants may review this Executive Plan or any documents relating thereto and submit any written issues and comments it may feel appropriate. In their sole discretion, the Named Fiduciary and Plan Administrator shall then review the second claim and provide a written decision within sixty (60) days of receipt of such claim. This decision shall likewise state the specific reasons for the decision and shall include reasons for reference to specific provisions of the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on Plan Agreement upon which the decision is based.
Appears in 4 contracts
Sources: Executive Salary Continuation Agreement (Centra Financial Holdings Inc), Executive Salary Continuation Agreement (Centra Financial Holdings Inc), Executive Salary Continuation Agreement (Centra Financial Holdings Inc)
Claims Procedure. Any claim for In the event a dispute arises over benefits under this Agreement shall Executive Plan and benefits are not paid to the Executive (or to the Executive’s beneficiary(ies) in the case of the Executive’s death) and such claimants feel they are entitled to receive such benefits, then a written claim must be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant Named Fiduciary and Plan Administrator named above within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90forty-day period. In no event shall such extension exceed the period of 90 five (45) days from the end date payments are refused. The Named Fiduciary and Plan Administrator shall review the written claim and if the claim is denied, in whole or in part, they shall provide in writing within forty-five (45) days of receipt of such initial period. The extension notice shall indicate claim the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the such denial; (ii) specific , reference to pertinent the provisions of this Executive Plan upon which the denial is based; (iii) a description of based and 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 (iv) an explanation claim. Such written notice shall further indicate the additional steps to be taken by claimants if a further review of the Agreement’s claims review procedure as set forth below. The claimant may appeal the claim denial of his claim to Company for a full and fair reviewis desired. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on reviewif the Named Fiduciary and Plan Administrator fail to take any action within the aforesaid forty-five (45) day period. The decision on If claimants desire a second review they shall be notify the Named Fiduciary and Plan Administrator in writing within forty-five (45) days of the first claim denial. Claimants may review this Executive Plan or any documents relating thereto and submit any written issues and comments it may feel appropriate. In their sole discretion, the Named Fiduciary and Plan Administrator shall then review the second claim and provide a written decision within forty-five (45) days of receipt of such claim. This decision shall likewise state the specific reasons for the decision and shall include reasons for reference to specific provisions of the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on Plan Agreement upon which the decision is based.
Appears in 4 contracts
Sources: Executive Salary Continuation Agreement (Surrey Bancorp), Executive Salary Continuation Agreement (Surrey Bancorp), Executive Salary Continuation Agreement (Surrey Bancorp)
Claims Procedure. Any The Executive or his designated beneficiary or beneficiaries may make a claim for benefits under this Agreement shall be made in writing to Companyby filing a written request with the Committee. If any a claim for benefits under this Agreement is wholly or partially denied, notice of the decision Committee shall be furnished to furnish the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits with written notice setting forth, forth in a manner calculated to be understood by the claimant, ;
(a) the following: (i) specific reason or reasons for the denial; ;
(iib) specific reference to the pertinent provisions upon of this Agreement on which the denial is based; ;
(iiic) a description of any additional material or information necessary for the claimant to perfect the his claim and an explanation of why such material or information is necessary; and and
(ivd) appropriate information as to the steps to be taken if the claimant wishes to submit his claim for review. Such notice shall be furnished to the claimant within ninety (90) days after the receipt of his claim, unless special circumstances require an explanation extension of time for processing his claim. If an extension of time for processing is required, the Committee shall, prior to the termination of the Agreement’s claims review procedure as set forth belowinitial ninety (90) day period, furnish the claimant with written notice indicating the special circumstances requiring an extension and the date by which the Committee expects to render its decision. The claimant may appeal In no event shall an extension exceed a period of ninety (90) days from the denial end of his claim to Company for a full and fair reviewthe initial ninety (90) day period. A claimant (or his duly authorized representative) may request the Committee to review a review by filing a written application for review with denied claim. Such request shall be in writing and must be delivered to the Administrator at any time Committee within 60 sixty (60) days after receipt by the claimant of written notice notification of the denial of his claim. The A claimant or his duly authorized representative may request, upon written application to Company, to may:
(a) review pertinent documents, and and
(b) submit issues and comments in writing. The Committee shall notify the claimant of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives the receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is requiredrequired because of special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) shall must be furnished to the claimant prior to the commencement of the extension. In the event that the The Committee’s decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and as well as specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based.
Appears in 4 contracts
Sources: Supplemental Executive Retirement Agreement (Meridian Bancorp, Inc.), Supplemental Executive Retirement Agreement (Meridian Interstate Bancorp Inc), Supplemental Executive Retirement Agreement (Louisiana Bancorp Inc)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company ("Administrator"), whose address is 47827 Halyard Drive, Plymouth, Michigan 48170, and whose telephone nu▇▇▇▇ ▇▇ (▇▇▇) ▇▇▇-▇▇▇▇. ▇▇▇ "▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇" as defined in writing to Section 402(a)(2) ▇▇ ▇▇▇▇▇, ▇▇▇o shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive ("the claimant") shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreement’s claims best of the Administrator's ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within 60 days following the date of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the claimant shall consider relevant to a determination of the claim, and the claimant may appeal the denial of his claim to Company include a request for a full and fair reviewhearing in person before the Administrator. A claimant (or his duly authorized representative) may request a review by filing a written application for review with Prior to submitting the Administrator at any time within 60 days after receipt by request, the claimant of written notice of shall be entitled to review such documents as are pertinent to the denial of his claim. The claimant may, at all stages of review, be represented by counsel, legal or his duly authorized representative may requestotherwise, upon written application to Company, to review pertinent documents, and submit issues and comments in writingof the claimant's choice. The decision on All requests for review shall be made by promptly resolved. The Administrator's decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 10 days after Company receives following receipt by the Administrator of the claimant's request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator's decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this Section, but who has not obtained full relief on the claim for benefits, may, within 60 days following the claimant's receipt of the Administrator's written decision on review, apply in writing to the Administrator for binding arbitration of the claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Plymouth, Michigan, in accordance with the arbitration rules of the American Arbitration Association, Commercial Disputes Resolution Procedures, as then in effect. If such the parties are unable to mutually agree upon an extension arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of time for review is requiredwhich shall be designated by the Company, written notice one of which shall be designated by the claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the arbitration rules referenced above. The arbitrator(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of the extension (including Agreement's provisions. The arbitrator(s) shall have the special circumstances requiring power to compel attendance of witnesses at the extension hearing. Any court having jurisdiction may enter a judgment based upon such arbitration. All decisions of timethe arbitrator(s) shall be furnished to final and binding on the claimant prior and the Company without appeal to any court. The Executive and the commencement Company hereby acknowledge that as arbitration is the exclusive remedy with respect to any grievance hereunder, neither party has the right to resort to any federal, state or local court or administrative agency concerning breaches of this Agreement, and the decision of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim arbitrator shall be deemed denied on review. The decision on review shall be a complete defense to any suit, action or proceeding instituted in writing and shall include reasons for the decisionany federal, written in a manner calculated state or local court or before any administrative agency with respect to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on any dispute which the decision is basedarbitrable as herein set forth.
Appears in 4 contracts
Sources: Severance Agreement (Perceptron Inc/Mi), Severance Agreement (Perceptron Inc/Mi), Severance Agreement (Perceptron Inc/Mi)
Claims Procedure. In the event a dispute arises over the benefits under this executive plan and benefits are not paid to the Executive (or to the Executive’s beneficiary[ies], if applicable) and such claimants feel they are entitled to receive such benefits, then a written claim must be made to the Named Fiduciary and Plan Administrator named above within forty-five (45) days from the date payments are refused. The Named Fiduciary and Plan Administrator shall review the written claim and if the claim is denied, in whole or in part, they shall provide in writing within forty-five (45) days of receipt of such claim the specific reasons for such denial, reference to the provision of the plan agreement upon which the denial is based and any additional material or information necessary to perfect the claim. Such written notice shall further indicate the additional steps to be taken by claimants if further review of the claim denial is desired. Any decision by the Bank denying a claim by the Executive for benefits under this Agreement shall be made stated in writing to Company. If any claim for benefits under this Agreement is wholly and delivered or partially deniedmailed, notice of the decision shall be furnished via registered or certified mail, to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimantExecutive, the following: (i) specific reasons for Executive's spouse or the denial; (ii) specific reference to pertinent provisions upon which Executive's beneficiaries, as the denial is based; (iii) case may be. Furthermore, 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 (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on if the Named Fiduciary and Plan Administrator fail to take any action within the aforesaid forty-five (45) day period. If claimants desire a second review. The decision on review , they shall be notify the Named Fiduciary and Plan Administrator in writing within forty-five (45) days of the first claim denial. Claimants may review this Executive Plan or any documents relating thereto and submit any written issues and comments they may feel appropriate. In their sole discretion, the Named Fiduciary and Plan Administrator shall then review the second claim and provide a written decision within forty-five (45) days of receipt of such claim. This decision shall likewise state the specific reasons for the decision and shall include reasons for reference to specific provisions of the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on plan agreement upon which the decision is based.
Appears in 4 contracts
Sources: Executive Supplemental Compensation Agreement (Pacific Financial Corp), Executive Supplemental Compensation Agreement (Pacific Financial Corp), Executive Supplemental Compensation Agreement (Pacific Financial Corp)
Claims Procedure. Any claim for (a) If the payment of benefits under this Agreement shall be made in writing disputed by the Company, the Executive, or other person claiming through the Executive, must file a written claim with the Board as a prerequisite to Companythe payment of such benefits. If The Board shall make all determinations as to the right of any person to receive benefits under subsections (a) and (b) of this Section 11. Any denial by the Board of a claim for benefits under this Agreement is wholly by the Executive, his heirs or partially denied, notice of personal representative (“the decision claimant”) shall be furnished stated in writing by the Board and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 ten (10) days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day ten (10)-day period. In no event shall such extension exceed the a period of 90 ten (10) days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and his claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Board’s claims ability in a manner that may be understood without legal or actuarial counsel.
(b) A claimant whose claim for benefits has been wholly or partially denied by the Board may request, within ten (10) days following the date of such denial, in a writing addressed to the Board, a review procedure as set forth belowof such denial. The claimant may appeal the denial shall be entitled to submit such issues or comments in writing or otherwise as he shall consider relevant to a determination of his claim to Company claim, and he may include a request for a full and fair reviewhearing in person before the Board. A claimant (or Prior to submitting his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by request, the claimant of written notice of shall be entitled to review such documents as the denial of Board shall agree are pertinent to his claim. The claimant may, at all stages of review, be represented by counsel, legal or otherwise, of his duly authorized representative may requestchoice, upon written application to Company, to review pertinent documents, provided that such fees and submit issues and comments in writingexpenses shall be borne by the Corporation. The decision on All requests for review shall be made by promptly resolved. The Board’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 ten (10) days after Company receives following receipt by the Board of the claimant’s request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Board’s decision shall be rendered as soon as possible, but so mailed not later than 120 twenty (20) days after receipt of such request.
(c) A claimant who has followed the request procedure in subsections (a) and (b) of this Section, but who has not obtained full relief on his claim for review. If benefits, may submit such claim for expedited and binding arbitration of his claim before an extension of time for review is requiredarbitrator in Hennepin County, written notice Minnesota, in accordance with the commercial arbitration rules of the extension American Arbitration Association, as then in effect, or pursuant to such other form of alternative dispute resolution as the parties may agree (including collectively, the special circumstances requiring the extension of time) “arbitration”). The arbitrator’s sole authority shall be furnished to interpret and apply the provisions of this Agreement; the arbitrator shall not change, add to, or subtract from, any of its provisions. The arbitrator shall have the power to compel attendance of witnesses at the hearing. Any court having competent jurisdiction may enter a judgment based upon such arbitration. The arbitrator shall be appointed by mutual agreement of the Corporation and the claimant pursuant to the applicable commercial arbitration rules. The arbitrator shall be a professional person with a national reputation for expertise in employee benefit matters and who is unrelated to the claimant prior to the commencement and any employees of the extensionCorporation. In All decisions of the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim arbitrator shall be deemed denied final and binding on review. The decision on review shall be in writing the claimant and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedCorporation.
Appears in 4 contracts
Sources: Employment Agreement (Regis Corp), Employment Agreement (Regis Corp), Employment Agreement (Regis Corp)
Claims Procedure. The Company shall determine the rights of any claimant to any Severance Compensation hereunder. Any claim for benefits claimant who believes that he has not received any benefit under this Agreement shall be made to which he believes he is entitled, may file a claim in writing to Companywith the Executive Vice President, Human Resources. If any claim for benefits under this Agreement is wholly or partially deniedThe Company shall, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed no later than 90 days after the receipt of a claim, either allow or deny the claim by Company, unless special circumstances require an extension of time for processing written notice to the claimclaimant. If such an extension of time is required, a claimant does not receive written notice of the extension shall be furnished to the claimant prior to the termination of the initial Company’s decision on his claim within such 90-day period, the claim shall be deemed to have been denied in full. In no event shall such extension exceed the period A denial of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits by the Company, wholly or partially, shall be written notice setting forth, in a manner calculated to be understood by the claimant, the following: claimant and shall include:
(i) the specific reason or reasons for the denial; ;
(ii) specific reference to pertinent provisions upon of this Agreement on which the denial is based; ;
(iii) 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 and
(iv) an explanation of the Agreement’s claims claim review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair reviewprocedure. A claimant whose claim is denied (or his duly authorized representative) may may, within 30 days after receipt of denial of his claim, request a review of such denial by the Company by filing with the Secretary of the Company a written application request for review of his claim. If the claimant does not file a request for review with the Administrator at any time Company within 60 days after receipt by such 30-day period, the claimant of written notice shall be deemed to have acquiesced in the original decision of the denial of Company on his claim. The If a written request for review is so filed within such 30-day period, the Company shall conduct a full and fair review of such claim. During such full review, the claimant or his duly authorized representative may request, upon written application to Company, shall be given the opportunity to review documents that are pertinent documents, to his claim and to submit issues and comments in writing. The Company shall notify the claimant of its decision on review within 60 days after receipt of a request for review. Notice of the decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for reviewwriting. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished to the claimant within the time period set forth in this paragraphsuch 60-day period, the claim shall be deemed to have been denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 3 contracts
Sources: Change in Control Severance Agreement (Cliffs Natural Resources Inc.), Severance Agreement (Cliffs Natural Resources Inc.), Severance Agreement (Cliffs Natural Resources Inc.)
Claims Procedure. Any When a benefit is due, the Participant, former Participant or Beneficiary should submit his claim for benefits under this Agreement to the person or office designated by the Committee to receive claims. Under normal circumstances, a final decision shall be made in writing as to Company. If any a claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to Committee notifies the claimant prior to the termination of in writing during the initial 90-day period. In no event shall such extension exceed , it may extend the period up to 180 days after the initial receipt of 90 days from the end of such initial periodclaim. The written notice must contain the circumstances necessitating the extension notice shall indicate the special circumstances requiring an extension of time and the anticipated date on which for the administrator expects to render a final decision. Company shall provide every claimant who If a claim is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by during the claimantclaims period, the following: (i) Committee must notify the claimant in writing. The denial must include the specific reasons for it, the denial; (ii) specific reference to pertinent Plan provisions upon which the denial is based; (iii) , and the claims review procedure. If no action is taken during the claims period, the claim is treated as if it were denied on the last day of the claims period. If a description of Participant's, former Participant's or Beneficiary's claim is denied and he wants a review, he must apply to the Committee in writing. That application may include any additional material comment or information necessary for argument the claimant wants to perfect the claim and an explanation of why such material or information is necessary; and (iv) an explanation of the Agreement’s claims review procedure as set forth belowmake. The claimant may appeal either represent himself or appoint a representative, either of whom has the denial of right to inspect all documents pertaining to the claim and its denial. The Committee may schedule any meeting with the claimant or his claim representative that it finds necessary or appropriate to Company for a full and fair complete its review. A claimant (or his duly authorized representative) may The request a review by filing a written application for review with the Administrator at any time must be filed within 60 days after receipt by the claimant of written notice denial. If it is not, the denial becomes final. If a timely request is made, the Committee must make its decision, under normal circumstances, within 60 days of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is requiredHowever, written notice of if the extension (including the special circumstances requiring the extension of time) shall be furnished to Committee notifies the claimant prior to the commencement expiration of the extension. In initial review period, it may extend the event that period of review up to 120 days following the decision on review is not furnished within initial receipt of the time period set forth in this paragraph, the claim shall be deemed denied on request for a review. The decision on review shall All decisions of the Committee must be in writing and shall must include the specific reasons for their action and the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent Plan provisions in the relevant documents on which the their decision is based. If a decision is not given to the claimant within the review period, the claim is treated as if it were denied on the last day of the review period.
Appears in 3 contracts
Sources: Employee Savings Plan (Quanex Corp), 401(k) Savings Plan Amendment and Restatement (Quanex Corp), Employee Savings Plan (Quanex Corp)
Claims Procedure. Subject to the provisions of Section 5, the Company shall determine the rights of any employee of the Company to any Severance Compensation or a Gross-up Payment hereunder. Any claim for benefits employee or former employee of the Company or a Subsidiary who believes that he has not received any benefit under this Agreement shall be made to which he believes he is entitled, may file a claim in writing to Companywith the Vice President Human Resources. If any claim for benefits under this Agreement is wholly or partially deniedThe Company shall, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed no later than 90 days after the receipt of a claim, either allow or deny the claim by Company, unless special circumstances require an extension of time for processing written notice to the claimclaimant. If such an extension of time is required, a claimant does not receive written notice of the extension shall be furnished to the claimant prior to the termination of the initial Company’s decision on his claim within such 90-day period, the claim shall be deemed to have been denied in full. In no event shall such extension exceed the period A denial of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits by the Company, wholly or partially, shall be written notice setting forth, in a manner calculated to be understood by the claimant, the following: claimant and shall include:
(i) the specific reason or reasons for the denial; ;
(ii) specific reference to pertinent provisions upon of this Agreement on which the denial is based; ;
(iii) 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 and
(iv) an explanation of the Agreement’s claims claim review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair reviewprocedure. A claimant whose claim is denied (or his duly authorized representative) may may, within 30 days after receipt of denial of his claim, request a review of such denial by the Company by filing with the Secretary of the Company a written application request for review of his claim. If the claimant does not file a request for review with the Administrator at any time Company within 60 days after receipt by such 30-day period, the claimant of written notice shall be deemed to have acquiesced in the original decision of the denial of Company on his claim. The If a written request for review is so filed within such 30-day period, the Company shall conduct a full and fair review of such claim. During such full review, the claimant or his duly authorized representative may request, upon written application to Company, shall be given the opportunity to review documents that are pertinent documents, to his claim and to submit issues and comments in writing. The Company shall notify the claimant of its decision on review within 60 days after receipt of a request for review. Notice of the decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for reviewwriting. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished to the claimant within the time period set forth in this paragraphsuch 60-day period, the claim shall be deemed to have been denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 3 contracts
Sources: Severance Agreement (Cleveland Cliffs Inc), Severance Agreement (Cliffs Natural Resources Inc.), Severance Agreement (Cleveland Cliffs Inc)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company (“Administrator”), whose address is ▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, and whose telephone number is (▇▇▇) ▇▇▇-▇▇▇▇. The “Named Fiduciary” as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (“the claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within 60 days following the date of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the claimant shall consider relevant to a determination of the claim, and the claimant may appeal the denial of his claim to Company include a request for a full and fair reviewhearing in person before the Administrator. A claimant (or his duly authorized representative) may request a review by filing a written application for review with Prior to submitting the Administrator at any time within 60 days after receipt by request, the claimant of written notice of shall be entitled to review such documents as are pertinent to the denial of his claim. The claimant may, at all stages of review, be represented by counsel, legal or his duly authorized representative may requestotherwise, upon written application to Company, to review pertinent documents, and submit issues and comments in writingof the claimant’s choice. The decision on All requests for review shall be made by promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 10 days after Company receives following receipt by the Administrator of the claimant’s request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this Section, but who has not obtained full relief on the claim for benefits, may, within 60 days following the claimant’s receipt of the Administrator’s written decision on review, apply in writing to the Administrator for binding arbitration of the claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Plymouth, Michigan, in accordance with the arbitration rules of the American Arbitration Association, Commercial Disputes Resolution Procedures, as then in effect. If such the parties are unable to mutually agree upon an extension arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of time for review is requiredwhich shall be designated by the Company, written notice one of which shall be designated by the claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the arbitration rules referenced above. The arbitrator(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of the extension (including Agreement’s provisions. The arbitrator(s) shall have the special circumstances requiring power to compel attendance of witnesses at the extension hearing. Any court having jurisdiction may enter a judgment based upon such arbitration. All decisions of timethe arbitrator(s) shall be furnished to final and binding on the claimant prior and the Company without appeal to any court. The Executive and the commencement Company hereby acknowledge that as arbitration is the exclusive remedy with respect to any grievance hereunder, neither party has the right to resort to any federal, state or local court or administrative agency concerning breaches of this Agreement, and the decision of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim arbitrator shall be deemed denied on review. The decision on review shall be a complete defense to any suit, action or proceeding instituted in writing and shall include reasons for the decisionany federal, written in a manner calculated state or local court or before any administrative agency with respect to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on any dispute which the decision is basedarbitrable as herein set forth.
Appears in 3 contracts
Sources: Severance Agreement (Perceptron Inc/Mi), Severance Agreement (Perceptron Inc/Mi), Severance Agreement (Perceptron Inc/Mi)
Claims Procedure. Any claim for benefits (a) In the event the Executive (or his beneficiary in the case of the Executive’s death) or their authorized representative (hereinafter the “Claimant”) asserts a right to a benefit under this Agreement shall be made in writing to Company. If any which has not been received, the Claimant must file a claim for benefits under this Agreement is wholly or partially denied, notice of such benefit with the Bank on forms provided by the Bank. The Bank shall render its decision shall be furnished to on the claimant claim within a reasonable period of time, not to exceed 90 days after its receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such special circumstances apply, the 90-day period may be extended by an extension of time is requiredadditional 90 days; provided, written notice of the extension shall be furnished is provided to the claimant prior to the termination of Claimant during the initial 90-day period. In no event shall period and such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate indicates the special circumstances requiring an extension of time and the date on by which the administrator Bank expects to render a decisionits decision on the claim. Company If the Bank wholly or partially denies the claim, the Bank shall provide every claimant who is denied a claim for benefits written notice setting to the Claimant within the time limitations of the immediately preceding paragraph. Such notice shall set forth, in a manner calculated to be understood by the claimant, the following: :
(i) the specific reasons for the denial; denial of the claim;
(ii) specific reference to pertinent provisions upon of the Agreement on which the denial is based; ;
(iii) 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 ;
(iv) an explanation a description of the Agreement’s claims review procedure procedures, and the time limitations applicable to such procedures; and
(v) a statement of the Claimant’s right to bring a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974, as set forth below. The claimant amended (“ERISA”), if the claim denial is appealed to the Bank and the Bank fully or partially denies the claim.
(b) A Claimant whose application for benefits is denied may appeal the denial of his claim to Company for request a full and fair review. A claimant (or his duly authorized representative) review of the decision denying the claim by filing, in accordance with such procedures as the Bank may request a review by filing establish, a written application for review with appeal which sets forth the Administrator at any time documents, records and other information relating to the claim within 60 days after receipt by of the claimant of written notice of the denial of his from the Bank. In connection with such appeal and upon request by the Claimant, a Claimant may review (or receive free copies of) all documents, records or other information relevant to the Claimant’s claim for benefit, all in accordance with such procedures as the Bank may establish. If a Claimant fails to file an appeal within such 60-day period, he shall have no further right to appeal.
(c) A decision on the appeal by the Bank shall include a review by the Bank that takes into account all comments, documents, records and other information submitted by the Claimant relating to the claim, without regard to whether such information was submitted or considered in the initial claim determination. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The Bank shall render its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and appeal not later than 60 days after Company receives the request for review, unless receipt by the Bank of the appeal. If special circumstances require extension of time for processingapply, in which case a decision shall the 60-day period may be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such extended by an extension of time for review is requiredadditional 60 days; provided, written notice of the extension (including is provided to the Claimant during the initial 60-day period and such notice indicates the special circumstances requiring the an extension of time) time and the date by which the Bank expects to render its decision on the claim on appeal. If the Bank wholly or partly denies the claim on appeal, the Bank shall be furnished provide written notice to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished Claimant within the time period limitations of the immediately preceding paragraph. Such notice shall set forth in this paragraph, forth:
(i) the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated denial of the claim;
(ii) specific reference to be understood by the claimant, and specific references to the pertinent provisions in of the relevant documents Agreement on which the decision denial is based;
(iii) a statement of the Claimant’s right to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Claimant’s claim for benefits; and
(iv) a statement of the Claimant’s right to bring a civil action under Section 502(a) of ERISA.
Appears in 3 contracts
Sources: Supplemental Executive Retirement Agreement (Meridian Interstate Bancorp Inc), Supplemental Executive Retirement Agreement (Meridian Interstate Bancorp Inc), Supplemental Executive Retirement Agreement (Meridian Interstate Bancorp Inc)
Claims Procedure. Any claim for benefits A. In the event of a disagreement between the Corporation and the Executive on any matter arising under this Agreement Agreement, the Executive, in claiming a benefit or requesting an interpretation or ruling under this Agreement, shall be made present the claim or request in writing to Company. the Administrative Committee, which shall respond in writing as soon as practicable.
B. If any a claim for benefits under this Agreement or request is wholly or partially denied, notice of the decision Administrative Committee shall be furnished prepare and deliver to the claimant within Executive a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of denial which shall state (1) the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim reason for benefits written notice setting forthdenial, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) with specific reference to pertinent the provisions upon of this Agreement on which the denial is based; (iiiii) a description of any additional material or information necessary for the claimant required to perfect prevail with the claim or request and an explanation of why such material or information it is necessary; and (iviii) an explanation of the Agreement’s claims 's claim review procedure as set forth below. The claimant may appeal procedure.
C. If a claim or request is denied or the denial of his claim to Company for Executive has not received a full and fair review. A claimant response within thirty (or his duly authorized representative30) days, the Executive may request a review by filing a written application for review with notice given in writing to the Administrator at any time Administrative Committee. Such request must be made within 60 sixty (60) days after receipt by the claimant Executive of the written notice of denial, or in the denial event the Executive has not received a response, within ninety (90) days after receipt by the Administrative Committee of his claimthe Executive's claim or request. The claimant claim or his duly authorized representative request shall be reviewed by the Administrative Committee which may, but shall not be required to, grant the Executive a hearing. On review, the Executive may requesthave representation, upon written application to Company, to review examine pertinent documents, and submit issues and comments in writing. .
D. The decision on review shall normally be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 within thirty (30) days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after Administrative Committee's receipt of the Executive's request for a review. If such an extension of time is required for review is requireda hearing or other special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) Executive shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within notified and the time period set forth in this paragraph, the claim limit shall be deemed denied on reviewsixty (60) days. The decision on review shall be in writing and shall include state the reasons for and the relevant provisions of the Agreement. Unless the Executive elects to pursue judicial review of the Administrative Committee's decision, written in a manner calculated to all decisions on review shall be understood by the claimant, final and specific references to the pertinent provisions in the relevant documents on which the decision is basedbind all parties concerned.
Appears in 3 contracts
Sources: Agreement for Termination Benefits in the Event of a Change in Corporate Control (Longs Drug Stores Corp), Agreement for Termination Benefits in the Event of a Change in Corporate Control (Longs Drug Stores Corp), Agreement for Termination Benefits in the Event of a Change in Corporate Control (Longs Drug Stores Corp)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made ProAssurance (“Administrator”), whose address is ▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇; Telephone: (▇▇▇) ▇▇▇-▇▇▇▇. The “Named Fiduciary” as defined in writing Section 402(a)(2) or ERISA, also shall be ProAssurance. ProAssurance shall have the right to Companydesignate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. If ProAssurance shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (“the claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 ten (10) days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 ten (10) days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (10) days following the receipt of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the claimant shall consider relevant to a determination of the claim, and the claimant may appeal the denial of his claim to Company include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting the request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by shall agree are pertinent to the claimant of written notice of the denial of his claim. The claimant may, at all stages of review, be represented by counsel, legal or his duly authorized representative may requestotherwise, upon written application to Company, to review pertinent documents, and submit issues and comments in writingof the claimant’s choice. The decision on All requests for review shall be made by promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 ten (10) days after Company receives following receipt by the Administrator of the claimant’s request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 twenty (20) days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedrequest.
Appears in 3 contracts
Sources: Release and Severance Compensation Agreement (Meemic Holdings Inc), Release and Severance Compensation Agreement (Meemic Holdings Inc), Severance Agreement (Meemic Holdings Inc)
Claims Procedure. Any (a) The Committee shall prescribe a form for the presentation of claims under the terms of this Agreement.
(b) Upon presentation to the Committee of the claim for benefits under this Agreement on the prescribed form, the Committee shall be made in writing to Companymake the determination of the validity thereof. If any claim for benefits under this Agreement the determination is wholly or partially deniedadverse to the claimant, notice of the decision Committee shall be furnished furnish to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, forth the following: :
(i) The specific reason or reasons for the denial; ;
(ii) specific reference Specific references to pertinent provisions upon of the Agreement on which the denial is based; ;
(iii) a A description of any additional material materials or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; and and
(iv) an explanation Appropriate information as to the steps to be taken if the claimant wishes to submit his or her claim for review.
(c) In the event of a denial of a claim, the Agreement’s claims review procedure as set forth below. The claimant or his or her duly authorized representative may appeal such denial to the denial of his claim to Company Committee for a full and fair reviewreview of the adverse determination. A claimant (or his duly authorized representative) may The claimant's request for a review by filing a written application for review with must be in writing and made to the Administrator at any time Committee within 60 days after receipt by the claimant of the written notice of notification required under paragraph (b) above; provided, however, such 60-day period shall be extended if the denial of his claimcircumstances so warrant. The claimant or his or her duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall writing which will be made given full consideration by the Administrator, who Committee in its review.
(d) The Committee may, in its or his/her sole discretion, hold conduct a hearing. A request for a hearing on made by the denied claim; claimant will be given full consideration. At such hearing, the Administrator claimant shall be entitled to appear and present evidence and to be represented by counsel.
(e) The Committee shall make this a decision promptly, and on a request for review not later than 60 days after Company receives receipt of the request for reviewrequest; provided, unless special circumstances require extension of time for processinghowever, in which case the event of a hearing or other special circumstances, such decision shall be rendered as soon as possible, but made not later than 120 days after receipt of the request for reviewsuch request. If such an it is necessary to extend the period of time for making a decision beyond 60 days after the receipt of the request, the claimant shall be notified in writing of the extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement beginning of such extension.
(f) The Committee's decision on review shall state in writing the specific reasons and references to the provisions of the extensionAgreement upon which it is based. In Such decision shall be promptly provided to the event that claimant. If the decision on review is not furnished within in accordance with the time period set forth in this paragraphforegoing, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 3 contracts
Sources: Supplemental Executive Retirement Plan Agreement (Tasty Baking Co), Supplemental Executive Retirement Plan Agreement (Tasty Baking Co), Employment Agreement (Tasty Baking Co)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made ProAssurance ("Administrator"), whose address is 100 Brookwood Place, Birmingham, Alabama 35209; Telephone: (205) 877-▇▇▇▇. ▇▇▇ "▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇" ▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇▇ion 402(a)(2) ▇▇ ▇▇▇▇▇, ▇▇▇o shall be ProAssurance. ProAssurance shall have the right to designate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. ProAssurance shall give the Executive written notice of any change in writing the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to Companythe right of any person to receive benefits under the Agreement. If any Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive ("the claimant") shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 ten (10) days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 ten (10) days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreement’s claims best of the Administrator's ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (10) days following the receipt of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the claimant shall consider relevant to a determination of the claim, and the claimant may appeal the denial of his claim to Company include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting the request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by shall agree are pertinent to the claimant of written notice of the denial of his claim. The claimant may, at all stages of review, be represented by counsel, legal or his duly authorized representative may requestotherwise, upon written application to Company, to review pertinent documents, and submit issues and comments in writingof the claimant's choice. The decision on All requests for review shall be made by promptly resolved. The Administrator's decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 ten (10) days after Company receives following receipt by the Administrator of the claimant's request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator's decision shall be rendered as soon as possible, but so mailed not later than 120 twenty (20) days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedrequest.
Appears in 3 contracts
Sources: Release and Severance Compensation Agreement (Proassurance Corp), Severance Agreement (Proassurance Corp), Release and Severance Compensation Agreement (Proassurance Corp)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company ("Administrator"), whose address is Champion Enterprises, Inc., 2701 ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇, ▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇ ▇▇▇▇▇ ▇▇▇ whose telephone number is (248) 340-9090. The "Named Fiduciary" as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive ("the claimant") shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and his claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreement’s claims best of the Administrator's ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within 10 days following the date of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant may appeal the denial shall be entitled to submit such issues or comments in writing or otherwise, as he shall consider relevant to a determination of his claim to Company claim, and he may include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting his request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of shall agree are pertinent to his claim. The claimant may, at all stages of review, be represented by counsel, legal or otherwise, of his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writingchoice. The decision on All requests for review shall be made by promptly resolved. The Administrator's decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 10 days after Company receives following receipt by the Administrator of the claimant's request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator's decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this section, but who has not obtained full relief on his claim for benefits, may, within 60 days following his receipt of the Administrator's written decision on review, apply in writing to the Administrator for binding arbitration of his claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Detroit, Michigan, in accordance with the commercial arbitration rules of the American Arbitration Association, as then in effect. If such the parties are unable to mutually agree upon an extension of time for review is requiredarbitrator, written notice of then the extension (including the special circumstances requiring the extension of time) arbitration proceedings shall be furnished to held before three arbitrators, one of which shall be designated by the Company, one of which shall be designated by the claimant prior to and the commencement third of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim which shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.designated
Appears in 3 contracts
Sources: Change in Control Agreement (Champion Enterprises Inc), Change in Control Agreement (Champion Enterprises Inc), Change in Control Agreement (Champion Enterprises Inc)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company (“Administrator”), whose address is ▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, and whose telephone number is (▇▇▇) ▇▇▇-▇▇▇▇. The “Named Fiduciary” as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (the ‘Claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant Claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant Claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant Claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims review procedure as set forth below. The claimant ability in a manner that may appeal the denial of his be understood without legal or actuarial counsel.
(c) A Claimant whose claim to Company for a full and fair review. A claimant (benefits has been wholly or his duly authorized representative) may request a review partially denied by filing a written application for review with the Administrator at any time may request, within 60 days after following the date of such denial, in a writing addressed to the Administrator, a review of such denial. The Claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant shall consider relevant to a determination of the claim, and the Claimant may include a request for a hearing in person before the Administrator. Prior to submitting the request, the Claimant shall be entitled to review such documents as are pertinent to the claim. The Claimant may, at all stages of review, be represented by counsel, legal or otherwise, of the Claimant’s choice. All requests for review shall be promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Claimant not later than 10 days following receipt by the claimant of written notice Administrator of the denial of his claim. The claimant or his duly authorized representative may requestClaimant’s request unless special circumstances, upon written application such as the need to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptlyhearing, and not later than 60 days after Company receives the request for review, unless special circumstances require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A Claimant who has followed the request procedure in paragraphs (b) and (c) of this Section, but who has not obtained full relief on the claim for benefits, may, within 60 days following the Claimant’s receipt of the Administrator’s written decision on review, apply in writing to the Administrator for binding arbitration of the claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Plymouth, Michigan, in accordance with the arbitration rules of the American Arbitration Association, Commercial Disputes Resolution Procedures, as then in effect. If such the parties are unable to mutually agree upon an extension arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of time for review is requiredwhich shall be designated by the Company, written notice one of which shall be designated by the Claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the arbitration rules referenced above. The arbitrator(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of the extension (including Agreement’s provisions. The arbitrator(s) shall have the special circumstances requiring power to compel attendance of witnesses at the extension hearing. Any court having jurisdiction may enter a judgment based upon such arbitration. All decisions of timethe arbitrator(s) shall be furnished final and binding on the Claimant and the Company without appeal to any court. The Executive and the claimant prior Company hereby acknowledge that as arbitration is the exclusive remedy with respect to any grievance hereunder, neither party has the commencement right to resort to any federal, state or local court or administrative agency concerning breaches of this Agreement, and the decision of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim arbitrator shall be deemed denied on review. The decision on review shall be a complete defense to any suit, action or proceeding instituted in writing and shall include reasons for the decisionany federal, written in a manner calculated state or local court or before any administrative agency with respect to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on any dispute which the decision is basedarbitrable as herein set forth.
Appears in 3 contracts
Sources: Severance Agreement (Perceptron Inc/Mi), Severance Agreement (Perceptron Inc/Mi), Severance Agreement (Perceptron Inc/Mi)
Claims Procedure. Any claim for The Company shall promptly notify the Executive (or one of her beneficiaries in the case of the Executive’s death) if payment of benefits is not being made, or is not to be made, under this Agreement. In the event that benefits under this Agreement are not paid to the Executive (or one of her beneficiaries in the case of the Executive’s death), and such person believes that he or she is entitled to receive them, a claim shall be made in writing to the Company within 90 days after written notice from the Company to the Executive, her beneficiary, or an appropriate personal representative that payments are not being made, or are not to be made, under this Agreement. Such claim shall be reviewed by the Company. If any the claim for benefits under this Agreement is wholly approved or partially denied, in full or in part, the Company shall provide a written notice of the decision shall be furnished to the claimant approval or denial within a reasonable period 30 days of time, not to exceed 90 days after its receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, A written notice of denial shall set forth the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim specific reason for benefits written notice setting forthdenial, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent the provision or provisions of this Agreement upon which the denial is based; (iii) a description of based and any additional material or information necessary for the claimant to perfect the claim and an explanation of why claim, if any. Also, such material or information is necessary; and (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of denial shall indicate the steps to be taken if a review of the denial of his claimis desired. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the A claim shall be deemed denied on if the Company does not take action within the aforesaid 30-day period. If a claim is denied and a review is desired, the Executive (or beneficiary in the case of the Executive’s death), shall notify the Company in writing within 30 days after such claim is denied. In requesting a review, the Executive or her beneficiary may review this Agreement or any document relating to it and submit any written issues and comments he or she may feel appropriate. The Company shall then review the claim and provide a written decision within 30 days. The decision on review likewise shall be in writing state the specific reasons for the decision and shall include reasons for the decision, written in a manner calculated reference to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based. Any decision of the Company shall be binding on the Executive, any beneficiary, or any personal representative. However, no decision shall preclude legal action by the Executive, beneficiary or personal representative. If the Executive, any beneficiary, or any personal representative shall prevail in any such legal action, such person or persons shall be entitled to receive reimbursement of reasonable attorneys’ fees from the Company, unless the Company acted in good faith in the reasonable belief that its position was justified.
Appears in 3 contracts
Sources: Supplemental Retirement Agreement (Service Bancorp Inc), Supplemental Retirement Agreement (Service Bancorp Inc), Supplemental Retirement Agreement (Service Bancorp Inc)
Claims Procedure. Any When a benefit is due, the Participant, former Participant or Beneficiary should submit his claim for benefits under this Agreement to the person or office designated by the Committee to receive claims. Under normal circumstances, a final decision shall be made in writing as to Company. If any a claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to Committee notifies the claimant prior to the termination of in writing during the initial 90-day period. In no event shall such extension exceed , it may extend the period up to 180 days after the initial receipt of 90 days from the end of such initial periodclaim. The written notice must contain the circumstances necessitating the extension notice shall indicate the special circumstances requiring an extension of time and the anticipated date on which for the administrator expects to render a final decision. Company shall provide every claimant who If a claim is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by during the claimantclaims period, the following: (i) Committee must notify the claimant in writing. The denial must include the specific reasons for it, the denial; (ii) specific reference to pertinent Plan provisions upon which the denial is based; (iii) , and the claims review procedure. If no action is taken during the claims period, the claim is treated as if it were denied on the last day of the claims period. If a description of Participant's, former Participant's or Beneficiary's claim is denied and he wants a review, he must apply to the Committee in writing. That application may include any additional material comment or information necessary for argument the claimant wants to perfect the claim and an explanation of why such material or information is necessary; and (iv) an explanation of the Agreement’s claims review procedure as set forth belowmake. The claimant may appeal either represent himself or appoint a representative, either of whom has the denial of right to inspect all documents pertaining to the claim and its denial. The Committee may schedule any meeting with the claimant or his claim representative that it finds necessary or appropriate to Company for a full and fair complete its review. A claimant (or his duly authorized representative) may The request a review by filing a written application for review with the Administrator at any time must be filed within 60 days after receipt by the claimant of written notice denial. If it is not, the denial becomes final. If a timely request is made, the Committee must make its decision, under normal circumstances, within 60 days of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is requiredHowever, written notice of if the extension (including the special circumstances requiring the extension of time) shall be furnished to Committee notifies the claimant prior to the commencement expiration of the extension. In initial review period, it may extend the event that period of review up to 120 days following the decision on review is not furnished within initial receipt of the time period set forth in this paragraph, the claim shall be deemed denied on request for a review. The decision on review shall All decisions of the Committee must be in writing and shall must include the specific reasons for their action and the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent Plan provisions in the relevant documents on which the their decision is based.. If a decision is not given to the claimant within the review period, the claim is treated as if it were denied on the last day of the review period. ARTICLE VI IN-SERVICE DISTRIBUTIONS
Appears in 3 contracts
Sources: 401(k) Savings Plan Amendment and Restatement (Quanex Corp), Hourly Bargaining Unit Employees Savings Plan (Quanex Corp), 401(k) Plan Amendment and Restatement (Quanex Corp)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company (“Administrator”), whose address is ▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, and whose telephone number is (▇▇▇) ▇▇▇-▇▇▇▇. The “Named Fiduciary” as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (“the Claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant Claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant Claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant Claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims review procedure as set forth below. The claimant ability in a manner that may appeal the denial of his be understood without legal or actuarial counsel.
(c) A Claimant whose claim to Company for a full and fair review. A claimant (benefits has been wholly or his duly authorized representative) may request a review partially denied by filing a written application for review with the Administrator at any time may request, within 60 days after following the date of such denial, in a writing addressed to the Administrator, a review of such denial. The Claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant shall consider relevant to a determination of the claim, and the Claimant may include a request for a hearing in person before the Administrator. Prior to submitting the request, the Claimant shall be entitled to review such documents as are pertinent to the claim. The Claimant may, at all stages of review, be represented by counsel, legal or otherwise, of the Claimant’s choice. All requests for review shall be promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Claimant not later than 10 days following receipt by the claimant of written notice Administrator of the denial of his claim. The claimant or his duly authorized representative may requestClaimant’s request unless special circumstances, upon written application such as the need to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptlyhearing, and not later than 60 days after Company receives the request for review, unless special circumstances require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A Claimant who has followed the request procedure in paragraphs (b) and (c) of this Section, but who has not obtained full relief on the claim for benefits, may, within 60 days following the Claimant’s receipt of the Administrator’s written decision on review, apply in writing to the Administrator for binding arbitration of the claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Plymouth, Michigan, in accordance with the arbitration rules of the American Arbitration Association, Commercial Disputes Resolution Procedures, as then in effect. If such the parties are unable to mutually agree upon an extension arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of time for review is requiredwhich shall be designated by the Company, written notice one of which shall be designated by the Claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the arbitration rules referenced above. The arbitrator(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of the extension (including Agreement’s provisions. The arbitrator(s) shall have the special circumstances requiring power to compel attendance of witnesses at the extension hearing. Any court having jurisdiction may enter a judgment based upon such arbitration. All decisions of timethe arbitrator(s) shall be furnished final and binding on the Claimant and the Company without appeal to any court. The Executive and the claimant prior Company hereby acknowledge that as arbitration is the exclusive remedy with respect to any grievance hereunder, neither party has the commencement right to resort to any federal, state or local court or administrative agency concerning breaches of this Agreement, and the decision of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim arbitrator shall be deemed denied on review. The decision on review shall be a complete defense to any suit, action or proceeding instituted in writing and shall include reasons for the decisionany federal, written in a manner calculated state or local court or before any administrative agency with respect to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on any dispute which the decision is basedarbitrable as herein set forth.
Appears in 3 contracts
Sources: Severance Agreement (Perceptron Inc/Mi), Severance Agreement (Perceptron Inc/Mi), Severance Agreement (Perceptron Inc/Mi)
Claims Procedure. Benefits shall be payable in accordance with the Plan provisions. Should the Executive or beneficiary fail to receive benefits to which such Executive or beneficiary believes he is entitled, a claim may be filed. Any claim for benefits under this Agreement a Plan benefit hereunder shall be filed by Executive or beneficiary (claimant) of this Plan by written communication which is made in writing by the claimant or the claimant's authorized representative which is reasonably calculated to Companybring the claim to the attention of the Named Fiduciary. If any a claim for benefits under this Agreement a Plan benefit is wholly or partially denied, a written notice of the decision shall be furnished to the claimant by the Named Fiduciary or his designee within a reasonable period of time, not to exceed 90 days time after receipt of the claim by Companythe Plan, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension which notice shall indicate include the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: following information:
(ia) The specific reasons reason(s) for the denial; ;
(iib) specific Specific reference to the pertinent Plan provisions upon which the denial is based; ;
(iiic) a 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 and
(ivd) an An explanation of the Agreement’s claims Plan's claim review procedure as set forth belowprocedures. The In order that a claimant may appeal the a denial of his claim to Company for a full and fair review. A claim, a claimant (or his duly authorized representative:
(a) may May request a review by filing a written application for review with to the Administrator at any time within 60 Named Fiduciary or his designee not later than sixty (60) days after receipt by the claimant of written notice notification of the denial of his a claim. The claimant or his duly authorized representative may request, upon written application to Company, to ;
(b) May review pertinent documents, and ; and
(c) May submit issues and comments in writing. The A decision on review of a denied claim shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives the Plan's receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possiblewithin a reasonable period of time, but not later than 120 one hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons the specific reason(s) for the decision, written in a manner calculated to be understood by decision and the claimant, and specific references reference(s) to the pertinent Plan provisions in the relevant documents on which the decision is based. Notwithstanding anything contained in this Paragraph to the contrary, any claim for a death benefit under an insurance policy under this Plan shall be filed with the Insurer by the claimant or his authorized representative on the form or forms prescribed for such purpose by the Insurer. The Insurer shall have sole authority for determining whether a death claim shall or shall not be paid, either in whole or in part, in accordance with the terms of such insurance contract which may have been purchased on the life of the Executive.
Appears in 3 contracts
Sources: Split Dollar Life Insurance Agreement (Miix Group Inc), Split Dollar Life Insurance Agreement (Miix Group Inc), Split Dollar Life Insurance Agreement (Miix Group Inc)
Claims Procedure. Any The Consultant or his designated beneficiary or beneficiaries may make a claim for benefits under this Agreement shall be made in writing to Companyby filing a written request with the Committee. If any a claim for benefits under this Agreement is wholly or partially denied, notice of the decision Committee shall be furnished to furnish the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits with written notice setting forth, forth in a manner calculated to be understood by the claimant, ;
(a) the following: (i) specific reason or reasons for the denial; ;
(iib) specific reference to the pertinent provisions upon of this Agreement on which the denial is based; ;
(iiic) a description of any additional material or information necessary for the claimant to perfect the his claim and an explanation of why such material or information is necessary; and and
(ivd) appropriate information as to the steps to be taken if the claimant wishes to submit his claim for review. Such notice shall be furnished to the claimant within ninety (90) days after the receipt of his claim, unless special circumstances require an explanation extension of time for processing his claim. If an extension of time for processing is required, the Committee shall, prior to the termination of the Agreement’s claims review procedure as set forth belowinitial ninety (90) day period, furnish the claimant with written notice indicating the special circumstances requiring an extension and the date by which the Committee expects to render its decision. The claimant may appeal In no event shall an extension exceed a period of ninety (90) days from the denial end of his claim to Company for a full and fair reviewthe initial ninety (90) day period. A claimant (or his duly authorized representative) may request the Committee to review a review by filing a written application for review with denied claim. Such request shall be in writing and must be delivered to the Administrator at any time Committee within 60 sixty (60) days after receipt by the claimant of written notice notification of the denial of his claim. The A claimant or his duly authorized representative may request, upon written application to Company, to may:
(a) review pertinent documents, and and
(b) submit issues and comments in writing. The Committee shall notify the claimant of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives the receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is requiredrequired because of special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) shall must be furnished to the claimant prior to the commencement of the extension. In the event that the The Committee’s decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and as well as specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based.
Appears in 3 contracts
Sources: Assumption of Amended and Restated Transition, Consulting, Noncompetition and Retirement Agreement (Bryn Mawr Bank Corp), Transition, Consulting, Noncompetition and Retirement Agreement (First Keystone Financial Inc), Transition, Consulting, Noncompetition and Retirement Agreement (First Keystone Financial Inc)
Claims Procedure. (a) The Company shall make all decisions and determinations respecting the right of any person to a payment under this Agreement.
(b) The following procedure shall be followed with respect to claims under this Agreement:
(i) Any claim for benefits claimant who believes he or she is entitled to a benefit under this Agreement shall be made submit a claim for such benefit in writing to Company. If any the Board.
(ii) Any decision by the Board denying a claim for benefits under this Agreement is wholly in whole or partially denied, notice of the decision in part shall be furnished stated in writing by the Board and delivered or the mailed to the claimant within a reasonable period of time, not to exceed 90 ninety (90) days after receipt of the claim by Company, the Board unless special circumstances require an extension of time for processing the claimprocessing, but in any event within one hundred eighty (180) days after such receipt. If such an extension of time is requiredtaken, written notice the Board shall inform the claimant of the extension shall be furnished to delay in writing before the claimant prior to the termination expiration of the initial ninety (90-) day period. In no event shall such extension exceed , including the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time reasons therefor and the date on by which the administrator Board expects to render a decision. Company shall provide every claimant who is denied Any decision denying a claim shall be in writing and set forth the specific reasons for benefits the denial with specific references to the Agreement provisions on which the denial is based, a description of any additional material or information necessary to perfect the claim and the reasons therefor, and an explanation of the Agreement’s claim review procedure, all written notice setting forth, in a manner calculated to be understood by the claimant. If the Board does not notify the claimant of denial of the claim or the need for an extension of time within the initial ninety (90) day period, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent provisions upon which the denial is based; claim shall be deemed denied.
(iii) If a description of any additional material claim is denied in whole or information necessary for in part, the claimant to perfect the claim and an explanation of why such material or information is necessary; and (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) representative may request a review by filing a the Board of the decision upon written application for review with to the Administrator at any time Board within 60 sixty (60) days after receipt by the claimant of written notice notification of the denial of his claimdecision. The claimant or his a duly authorized representative may request, upon written application to Company, to review pertinent documents, documents and submit issues and comments in writing. The Board shall make its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives receipt of the request for review, review unless special circumstances require an extension of time for processing, in which case a its decision shall be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the request for review. If such an extension of time for review is requiredtaken, written notice the Board shall inform the claimant of the extension (including delay in writing before the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement expiration of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on reviewinitial sixty (60) day period. The decision on review shall be in writing and shall include set forth the specific reasons for the decision, shall make specific references to the pertinent Agreement provisions on which the decision is based, and shall be written in a manner calculated to be understood by the claimant. If the Board does not notify the claimant of its decision on review within the period herein provided for, the claim shall be deemed denied on review.
(c) The Board may adopt such rules as it deems necessary, desirable, or appropriate to carry out its duties under this Section 7. Any action or determination or decision whatsoever taken or made by the Board under this Section 7 shall be final, conclusive, and specific references binding upon all persons concerned.
(d) The procedure provided for in this Section 7 shall be the sole, exclusive and mandatory procedure for resolving any dispute under this Agreement; provided, however, that if the Executive wishes to make a valid legal challenge to the pertinent provisions Board’s determination and he has entered into an agreement with the Board to arbitrate disputes arising from his employment with the Company, such legal challenge shall be resolved pursuant to the arbitration procedures in that agreement and the relevant documents Executive’s burden of proof in any arbitration shall be the same as if the dispute were tried in a court proceeding.
(e) In any arbitration or litigation to enforce rights and obligations hereunder, except as required by law or separate contract between the parties, the unsuccessful party shall pay the successful party an amount equal to all reasonable out-of-pocket expenses (including reasonable legal expenses and court costs) incurred by the successful party.
(f) In the event of the death of the Executive or any beneficiary, the Board need not make any payment provided for by this Agreement until it shall have received proof satisfactory to it of such death and of the identity, existence and location of the party thereafter entitled to receive payments under this Agreement.
(g) In making any payment or taking any action under this Agreement the Board shall be absolutely protected in relying upon any finding or statement of facts believed to be true, and on which any written instrument believed to have been signed by the decision is basedproper party.
Appears in 2 contracts
Sources: Supplemental Executive Retirement Agreement (Legacy Bancorp, Inc.), Supplemental Executive Retirement Agreement (Legacy Bancorp, Inc.)
Claims Procedure. Any claim In accordance with Section 503 of ERISA and the regulations of the Secretary of Labor prescribed thereunder:
A. All claims for benefits under this Agreement shall be made filed in writing with the Company in accordance with such procedures as the Company shall reasonably establish.
B. The Company shall, within ninety (90) days of submission of a claim, provide adequate notice in writing to Company. If any claimant whose claim for benefits under this the Agreement has been denied. Such notice shall contain the specific reason or reasons for the denial and references to specific Agreement provisions on which the denial is wholly or partially denied, notice of the decision shall be furnished to based. It will also provide the claimant within with a reasonable period description of time, not any material or information which is necessary in order for the claimant to exceed 90 days after receipt perfect his claim and an explanation of the claim by Company, unless why such information is necessary. If special circumstances require an extension of time for processing the claim. If such an extension of time is required, the Company shall furnish the claimant a written notice of the such extension shall be furnished to the claimant prior to the termination expiration of the initial ninety (90-) day period. In no event shall such extension exceed the period of 90 days from the end of such initial perioddescribed above. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; extension and the expected date for a final decision, which date shall not be more than one hundred eighty (ii180) specific reference to pertinent provisions days from the initial claim.
C. The Company shall, upon which the denial is based; written request by a claimant within sixty (iii60) 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 (iv) an explanation days of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of notice that his claim has been denied, afford a reasonable opportunity to Company such claimant for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice Company of the denial of his decision denying the claim. The Company will afford the claimant or his duly authorized representative may request, upon written application to Company, an opportunity to review pertinent documents, documents and submit issues and comments in writing. The claimant shall have the right to be represented by counsel.
D. The Company shall, within sixty (60) days of a request for a review, render a written decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless . If special circumstances require extension of extra time for processingthe Company to review its decision, in which case a the Company will attempt to make its decision shall be rendered as soon as possiblepracticable, but not later and in no event will the Company take more than 120 one hundred twenty (120) days after receipt of the request for review. If such an extension of time for review is required, to send a claimant a written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the its decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 2 contracts
Sources: Survivor Benefit Deferred Compensation Agreement (Corning Natural Gas Corp), Survivor Benefit Deferred Compensation Agreement (Corning Natural Gas Corp)
Claims Procedure. Any controversy or claim for benefits under arising out of or relating to this Agreement shall be made filed with the Fiduciary which shall make all determinations concerning such claim. Any decision by the Fiduciary denying such claim shall be in writing and shall be delivered to Companyall parties in interest in accordance with the notice provisions of Article 5.3 hereof. Such decision shall set forth the reasons for denial in plain language. Pertinent provisions of the Agreement shall be cited and, where appropriate, an explanation as to how the Employee can perfect the claim will be provided. This notice of denial of benefits will be provided within ninety (90) days of the Fiduciary’s receipt of the Employee’s claim for benefits. If any the Fiduciary fails to notify the Employee of his decision regarding his claim, the claim for benefits under shall be considered denied, and the Employee shall then be permitted to proceed with his appeal as provided in this Agreement is wholly Article. An Employee who has been completely or partially denied, notice of the decision denied a benefit shall be furnished entitled to appeal this denial of his claim by filing a written statement of his position with the claimant within a reasonable period of time, not to exceed 90 Fiduciary no later than sixty (60) days after receipt of the written notification of such claim denial. The Fiduciary shall schedule an opportunity for a full and fair review of the issue within thirty (30) days of receipt of the appeal. The decision on review shall set forth specific reasons for the decision, and shall cite specific references to the pertinent Agreement provisions on which the decision is based. Following his review of any additional information submitted by Companythe Employee, unless either through the hearing process or otherwise, the Fiduciary shall render a decision on his review of the denied claim in the following manner:
(a) the Fiduciary shall make his decision regarding the merits of the denied claim within sixty (60) days following his receipt of the request for review (or within 120 days after such receipt, in a case where there are special circumstances require requiring extension of time for reviewing the appealed claim). He shall deliver the decision to the claimant in writing. If an extension of time for processing reviewing the claim. If such an extension appealed claim is required because of time is requiredspecial circumstances, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent provisions upon which the denial is based; (iii) 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 (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant Employee prior to the commencement of the extension. In the event that If the decision on review is not furnished within the time period set forth in this paragraphprescribed time, the claim shall be deemed denied on review. The ; and
(b) the decision on review shall be in writing and shall include set forth specific reasons for the decision, written in a manner calculated to be understood by the claimant, and shall cite specific references to the pertinent Agreement provisions in the relevant documents on which the decision is based.
Appears in 2 contracts
Sources: Collateral Assignment Split Dollar Insurance Agreement, Collateral Assignment Split Dollar Insurance Agreement (Dana Corp)
Claims Procedure. Any (i) Benefits will be provided to each Designated Employee as specified in this Plan. If a Designated Employee believes that he has not been provided with benefits due under the Plan, then the Designated Employee (who is hereafter referred to as the “Claimant”) has the right to make a written claim for benefits under this Agreement the Plan. Written claims for severance pay benefits shall be made in writing to Companygoverned by the following procedures; any written claims for health or welfare benefits shall be governed by the claims procedures of the applicable health or welfare plan. If any such a written claim for benefits under this Agreement is made, and the Administrator wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing denies the claim. If such an extension of time is required, the Administrator shall provide the Claimant with written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice denial, setting forth, in a manner calculated to be understood by the claimant, Claimant:
(A) the following: (i) specific reason or reasons for the such denial; ;
(iiB) specific reference to pertinent Plan provisions upon on which the denial is based; ;
(iiiC) a description of any additional material or information necessary for the claimant Claimant to perfect the claim and an explanation of why such material or information is necessary; and and
(ivD) an explanation of the AgreementPlan’s claims review procedure as set forth below. and time limits applicable to those procedures, including a statement of the Claimant’s right to bring a civil action under ERISA Section 502(a) if the claim is denied on appeal.
(ii) The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the any claim denial of his claim. The claimant or his duly authorized representative may request, upon written application pursuant to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review Section 6(a)(i) shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and given not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 thirty (30) days after receipt of the request for review. If such claim by the Administrator, unless the Administrator determines that special circumstances require an extension of time for review is requiredprocessing the claim, in which event:
(A) written notice of the extension shall be given by the Administrator to the Claimant prior to thirty (including 30) days after receipt of the claim;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day period for giving notice of a claim denial; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Administrator expects to render the benefit determination.
(iii) The decision of the Administrator shall be final unless the Claimant, within sixty (60) days after receipt of notice of the claims denial from the Administrator, submits a written request to the Board of Directors of Perspecta, or its delegate, for an appeal of the denial. During that sixty (60) day period, the Claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claim for benefits. The Claimant shall be provided the opportunity to submit written comments, documents, records, and other information relating to the claim for benefits as part of the Claimant’s appeal. The Claimant may act in these matters individually, or through his or her authorized representative.
(iv) After receiving the written appeal, if the Board of Directors of Perspecta, or its delegate, shall issue a written decision notifying the Claimant of its decision on review, not later than thirty (30) days after receipt of the written appeal, unless the Board of Directors of Perspecta or its delegate determines that special circumstances require an extension of time for reviewing the appeal, in which event:
(A) written notice of the extension of time) shall be furnished to given by the claimant Board of Directors of Perspecta or its delegate prior to the commencement thirty (30) days after receipt of the extensionwritten appeal;
(B) the extension shall not exceed a period of thirty (30) days from the end of the initial thirty (30) day review period; and
(C) the extension notice shall indicate (1) the special circumstances requiring an extension of time and (2) the date by which the Board of Directors of Perspecta or its delegate expects to render the appeal decision. In the event that the decision The period of time within which a benefit determination on review is not furnished within required to be made shall begin at the time an appeal is received by the Board of Directors of Perspecta or its delegate, without regard to whether all the information necessary to make a benefit determination on review accompanies the filing of the appeal. If the period set forth in this paragraphof time for reviewing the appeal is extended as permitted above, due to a claimant’s failure to submit information necessary to decide the claim shall be deemed denied on review. The decision appeal, then the period for making the benefit determination on review shall be tolled from the date on which the notification of the extension is sent to the claimant until the date on which the claimant responds to the request for additional information.
(v) In conducting the review on appeal, the Board of Directors of Perspecta or its delegate shall take into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in writing and the initial benefit determination. If the Board of Directors of Perspecta or its delegate upholds the denial, the written notice of decision from the Board of Directors of Perspecta or its delegate shall include reasons for the decisionset forth, written in a manner calculated to be understood by the claimant, and Claimant:
(A) the specific references reason or reasons for the denial;
(B) specific reference to the pertinent Plan provisions in the relevant documents on which the decision denial is based;
(C) a statement that the Claimant is entitled to be 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 Claimant’s right to bring a civil action under ▇▇▇▇▇ 502(a).
(vi) If the Plan or any of its representatives fail to follow any of the above claims procedures, the Claimant shall be deemed to have duly exhausted the administrative remedies available under the plan and shall be entitled to pursue any available remedies under ERISA Section 502(a), including but not limited to the filing of an action for immediate declaratory relief regarding benefits due under the Plan.
(vii) If the Board of Directors of Perspecta or its delegate upholds the denial on review of a severance pay claim, or if a health or welfare benefit claim is denied on review under the applicable health or welfare plan and/or the administrative remedies thereunder have been exhausted, then the Claimant shall have the right to bring a civil action under ERISA Section 502(a).
Appears in 2 contracts
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company (“Administrator”), whose address is 4▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, and whose telephone number is (▇▇▇) ▇▇▇-▇▇▇▇. The “Named Fiduciary” as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (the ‘Claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant Claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant Claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant Claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims review procedure as set forth below. The claimant ability in a manner that may appeal the denial of his be understood without legal or actuarial counsel.
(c) A Claimant whose claim to Company for a full and fair review. A claimant (benefits has been wholly or his duly authorized representative) may request a review partially denied by filing a written application for review with the Administrator at any time may request, within 60 days after following the date of such denial, in a writing addressed to the Administrator, a review of such denial. The Claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant shall consider relevant to a determination of the claim, and the Claimant may include a request for a hearing in person before the Administrator. Prior to submitting the request, the Claimant shall be entitled to review such documents as are pertinent to the claim. The Claimant may, at all stages of review, be represented by counsel, legal or otherwise, of the Claimant’s choice. All requests for review shall be promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Claimant not later than 10 days following receipt by the claimant of written notice Administrator of the denial of his claim. The claimant or his duly authorized representative may requestClaimant’s request unless special circumstances, upon written application such as the need to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptlyhearing, and not later than 60 days after Company receives the request for review, unless special circumstances require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A Claimant who has followed the request procedure in paragraphs (b) and (c) of this Section, but who has not obtained full relief on the claim for benefits, may, within 60 days following the Claimant’s receipt of the Administrator’s written decision on review, apply in writing to the Administrator for binding arbitration of the claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Plymouth, Michigan, in accordance with the arbitration rules of the American Arbitration Association, Commercial Disputes Resolution Procedures, as then in effect. If such the parties are unable to mutually agree upon an extension arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of time for review is requiredwhich shall be designated by the Company, written notice one of which shall be designated by the Claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the arbitration rules referenced above. The arbitrator(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of the extension (including Agreement’s provisions. The arbitrator(s) shall have the special circumstances requiring power to compel attendance of witnesses at the extension hearing. Any court having jurisdiction may enter a judgment based upon such arbitration. All decisions of timethe arbitrator(s) shall be furnished final and binding on the Claimant and the Company without appeal to any court. The Executive and the claimant prior Company hereby acknowledge that as arbitration is the exclusive remedy with respect to any grievance hereunder, neither party has the commencement right to resort to any federal, state or local court or administrative agency concerning breaches of this Agreement, and the decision of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim arbitrator shall be deemed denied on review. The decision on review shall be a complete defense to any suit, action or proceeding instituted in writing and shall include reasons for the decisionany federal, written in a manner calculated state or local court or before any administrative agency with respect to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on any dispute which the decision is basedarbitrable as herein set forth.
Appears in 2 contracts
Sources: Severance Agreement (Perceptron Inc/Mi), Severance Agreement (Perceptron Inc/Mi)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made ProAssurance (“Administrator”), whose address is 1▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇; Telephone: (▇▇▇) ▇▇▇-▇▇▇▇. The “Named Fiduciary” as defined in writing Section 402(a) (2) or ERISA, also shall be ProAssurance. ProAssurance shall have the right to Companydesignate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. If ProAssurance shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (“the claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 ten (10) days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 ten (10) days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (10) days following the receipt of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the claimant shall consider relevant to a determination of the claim, and the claimant may appeal the denial of his claim to Company include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting the request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by shall agree are pertinent to the claimant of written notice of the denial of his claim. The claimant may, at all stages of review, be represented by counsel, legal or his duly authorized representative may requestotherwise, upon written application to Company, to review pertinent documents, and submit issues and comments in writingof the claimant’s choice. The decision on All requests for review shall be made by promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 ten (10) days after Company receives following receipt by the Administrator of the claimant’s request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 twenty (20) days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedrequest.
Appears in 2 contracts
Sources: Release and Severance Compensation Agreement (Proassurance Corp), Release and Severance Compensation Agreement (Proassurance Corp)
Claims Procedure. Any claim for benefits under this Agreement (a) All claims shall be made filed in writing to Companyby the Participant, his or her beneficiary or authorized representative of the claimant, by completing such procedures as the Administrative Committee shall require. Such procedures shall be reasonable and may include the completion of forms and the submission of documents and additional information.
(b) If any a claim for benefits under this Agreement is wholly or partially denied, notice of the decision denial shall be furnished by the Administrative Committee to the claimant within a reasonable period of time, not to exceed 90 ninety (90) days after receipt of the claim by Companythe Administrative Committee, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice in which event notification of the extension shall be furnished provided to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time Participant or Beneficiary and the date on which the administrator expects to render a decision. Company extension shall not exceed ninety (90) days.
(c) The Administrative Committee shall provide every claimant who is denied a claim for benefits written notice setting forthadequate notice, in a manner calculated writing, to be understood by any claimant whose claim has been denied, setting forth the claimant, the following: (i) specific reasons for the such denial; (ii) , specific reference to pertinent provisions upon which the denial is based; (iii) Plan provisions, a description of any additional material or information necessary for the claimant to perfect the his or her claim and an any explanation of why such material or information is necessary; and (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim , all written in a manner calculated to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt be understood by the claimant. Such notice shall include appropriate information as to the steps to be taken if the claimant of written notice of the denial of wishes to submit his claimor her claim for review. The claimant or his duly the claimant’s authorized representative may request, upon written application to Company, to must request such review pertinent documents, and submit issues and comments in writingwithin the reasonable period of time prescribed by the Administrative Committee. The In no event shall such period of time be less than sixty (60) days. A decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives the Bank’s receipt of the request for review, unless . If special circumstances require further extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after following the Bank’s receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be furnished to the claimant. Such decision shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and as well as specific references to the pertinent Plan provisions in the relevant documents on which the decision is based.
Appears in 2 contracts
Sources: Nonqualified Deferred Compensation Plan (Federal Home Loan Bank of Dallas), Nonqualified Deferred Compensation Plan (Federal Home Loan Bank of Dallas)
Claims Procedure. The Company shall determine the rights of any claimant to any Severance Compensation hereunder. Any claim for benefits claimant who believes that he has not received any benefit under this Agreement shall be made to which he believes he is entitled, may file a claim in writing to Companywith the Senior Vice President Human Resources. If any claim for benefits under this Agreement is wholly or partially deniedThe Company shall, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed no later than 90 days after the receipt of a claim, either allow or deny the claim by Company, unless special circumstances require an extension of time for processing written notice to the claimclaimant. If such an extension of time is required, a claimant does not receive written notice of the extension shall be furnished to the claimant prior to the termination of the initial Company’s decision on his claim within such 90-day period, the claim shall be deemed to have been denied in full. In no event shall such extension exceed the period A denial of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits by the Company, wholly or partially, shall be written notice setting forth, in a manner calculated to be understood by the claimant, the following: claimant and shall include:
(i) the specific reason or reasons for the denial; ;
(ii) specific reference to pertinent provisions upon of this Agreement on which the denial is based; ;
(iii) 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 and
(iv) an explanation of the Agreement’s claims claim review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair reviewprocedure. A claimant whose claim is denied (or his duly authorized representative) may may, within 30 days after receipt of denial of his claim, request a review of such denial by the Company by filing with the Secretary of the Company a written application request for review of his claim. If the claimant does not file a request for review with the Administrator at any time Company within 60 days after receipt by such 30-day period, the claimant of written notice shall be deemed to have acquiesced in the original decision of the denial of Company on his claim. The If a written request for review is so filed within such 30-day period, the Company shall conduct a full and fair review of such claim. During such full review, the claimant or his duly authorized representative may request, upon written application to Company, shall be given the opportunity to review documents that are pertinent documents, to his claim and to submit issues and comments in writing. The Company shall notify the claimant of its decision on review within 60 days after receipt of a request for review. Notice of the decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for reviewwriting. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished to the claimant within the time period set forth in this paragraphsuch 60-day period, the claim shall be deemed to have been denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 2 contracts
Sources: Change in Control Severance Agreement (Cliffs Natural Resources Inc.), Change in Control Severance Agreement (Cliffs Natural Resources Inc.)
Claims Procedure. Any claim a. The Company will be the "named fiduciary" and "plan administrator" of the arrangement contemplated herein. The claims procedure set forth herein may be changed by Company from time to time by written notice to the Executive, provided no such change shall limit the protections herein provided to the claimant except as such limitations are imposed by applicable law, regulation, or case law. The Company may establish reasonable administrative procedures for applying the Claims Procedures.
b. The Executive or any beneficiary of his may file a request for benefits under this Agreement shall be made with the Company in writing delivered to Companythe Company at its address provided in Section 12 hereof. If any a claim for benefits under this Agreement request is wholly or partially denied, notice of the decision shall be furnished Company will furnish to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial its decision within ninety (90-day period. In no event shall such extension exceed the period of 90 ) days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time in writing, and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, which notice will contain the following: (i) following information:
i. the specific reason or reasons for the denial; (;
ii) . specific reference to pertinent provisions of this Agreement upon which the denial is based; (;
iii) . a description of any additional material or information necessary for the claimant to perfect the claim and an explanation of as to why such material or information is necessary; and (and
iv) . an explanation of the Agreement’s claims applicable claim-review procedure as set forth below. The describing the steps to be taken by a claimant may appeal the denial of who wishes to submit his claim to Company for a full and fair review. .
c. A claimant (or his duly authorized representative) may representative may, with respect to any denied claim:
i. request a review by filing a upon written application for review with the Administrator at any time filed within 60 sixty (60) days after receipt by the claimant of written notice of the denial of his claim;
ii. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and ; and
iii. submit issues and comments in writing.
d. Any request or submission will be in writing and will be directed to the Company. The Company will have the sole responsibility for the review of any denied claim and will take all appropriate steps in light of its findings. The Company will render a decision on upon review shall be made by the Administrator, who may, in its or his/her discretion, hold of a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 claim within sixty (60) days after Company receives the receipt of a request for review, unless . If special circumstances require extension of time for processingwarrant additional time, in which case a the decision shall will be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the request for review. If such an extension of time for review is required, written Written notice of the any such extension (including the special circumstances requiring the extension of time) shall will be furnished to the claimant prior to the commencement of the extension. In The decision on review will be in writing and will include specific reasons for the event that decision written in a manner to be understood by the claimant, as well as the specific references of the pertinent provisions on which the decision is based. If the decision on review is not furnished to the claimant within the time period set forth in this paragraphlimits described above, the claim shall will be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 2 contracts
Sources: Executive Supplemental Compensation Agreement (First Ipswich Bancorp /Ma), Executive Supplemental Compensation Agreement (First Ipswich Bancorp /Ma)
Claims Procedure. Any claim for benefits under this Agreement shall be made in writing to CompanyEmployer. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by CompanyEmployer, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company Employer shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent provisions upon which the denial is based; (iii) 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 (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company Employer for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with Employer or its designee (the Administrator "Reviewer") at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to CompanyEmployer, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the AdministratorReviewer, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator Reviewer shall make this decision promptly, and not later than 60 days after Company Employer receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including an explanation of the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 2 contracts
Sources: Employee Consultation, Post Retirement Non Competition and Death Benefit Agreement (First Citizens Bancshares Inc /De/), Employee Consultation, Post Retirement Non Competition and Death Benefit Agreement (First Citizens Bancshares Inc /De/)
Claims Procedure. Any claim for benefits under this Agreement 8.2.1 Benefits shall be made paid in writing to Companyaccordance with the provisions of this Agreement. If any claim A Claimant shall send a written request for benefits under this Agreement is wholly or partially deniedsuch benefit, notice of setting forth the decision shall be furnished claim, to the claimant Company at its principal place of business. The claim will be forwarded to the Plan Administrator.
8.2.2 Upon proper delivery and receipt of a claim, the Plan Administrator shall advise the Claimant that a reply will be forthcoming within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If and shall deliver such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall reply within such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate Plan Administrator may, however, extend the special circumstances requiring reply period for an extension of time and additional 90 days for reasonable cause. If the date on which claim is denied in whole or in part, the administrator expects to render a decision. Company Plan Administrator shall provide every claimant who is denied a claim for benefits written notice notice, setting forth, in a manner calculated to be understood by the claimant, the following: (i) the specific reason or reasons for the such denial; (ii) the specific reference to pertinent provisions upon of this Agreement on which the such denial is based; (iii) a description of any additional material or information necessary for the claimant Claimant to perfect the claim and an explanation of why such material or such information is necessary; and (iv) an explanation of appropriate information as to the Agreement’s claims review procedure as set forth below. The claimant may appeal steps to be taken if the denial of his Claimant wishes to submit the claim to Company for a full review; and fair review. A claimant (or his duly authorized representativev) may request the time limits for requesting a review by filing a written application under Section 8.2.3 and for review with under Section 8.2.4.
8.2.3 If the Administrator at any time claim is denied and a review is desired, the Claimant must, within 60 days after receipt by the claimant of written notice Claimant of the written denial of his claim, as described above, request in writing that the Plan Administrator reconsider the determination of the Company. Such request must be addressed to the Plan Administrator at the Company’s principal place of business. The claimant Claimant or his or her duly authorized representative may request, upon written application to Company, to review the pertinent documents, documents and submit issues and comments in writingwriting for consideration of the Plan Administrator. The decision on review If the Claimant does not request a reconsideration of the Plan Administrator’s determination within such 60 day period, then the Claimant shall be made by barred and stopped from challenging the Plan Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than ’s determination.
8.2.4 Within 60 days after Company receives the Plan Administrator’s receipt of a timely and properly delivered request for review, unless the Plan Administrator shall review the Company’s determination, and after considering all materials presented by the Claimant, shall render a written option, setting forth the specific reasons for the decision and containing specific references to the pertinent provisions of this Agreement on which the decision is based. If special circumstances require extension of that the 60-day time for processingperiod be extended, in which case a the Plan Administrator will notify the Claimant and the Plan Administrator will render the decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 2 contracts
Sources: Executive Nonqualified Deferred Compensation Agreement (Lithia Motors Inc), Outside Director Nonqualified Deferred Compensation Agreement (Lithia Motors Inc)
Claims Procedure. Any claim for benefits (a) In the event the Executive (or his beneficiary in the case of the Executive’s death) or their authorized representative (hereinafter the “Claimant”) asserts a right to a benefit under this Agreement shall be made in writing to which has not been received, the Claimant must file a claim for such benefit with the Company on forms provided by the Company. If any The Company shall render its decision on the claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after its receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such special circumstances apply, the 90-day period may be extended by an extension of time is requiredadditional 90 days; provided, written notice of the extension shall be furnished is provided to the claimant prior to the termination of Claimant during the initial 90-day period. In no event shall period and such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate indicates the special circumstances requiring an extension of time and the date on by which the administrator Company expects to render a decisionits decision on the claim. If the Company wholly or partially denies the claim, the Company shall provide every claimant who is denied a claim for benefits written notice setting to the Claimant within the time limitations of the immediately preceding paragraph. Such notice shall set forth, in a manner calculated to be understood by the claimant, the following: :
(i) the specific reasons for the denial; denial of the claim;
(ii) specific reference to pertinent provisions upon of the Agreement on which the denial is based; ;
(iii) 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 ;
(iv) an explanation a description of the Agreement’s claims review procedure procedures, and the time limitations applicable to such procedures; and
(v) a statement of the Claimant’s right to bring a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974, as set forth below. The claimant amended (“ERISA”), if the claim denial is appealed to the Company and the Company fully or partially denies the claim.
(b) A Claimant whose application for benefits is denied may appeal the denial of his claim to Company for request a full and fair review. A claimant (or his duly authorized representative) review of the decision denying the claim by filing, in accordance with such procedures as the Company may request a review by filing establish, a written application for review with appeal which sets forth the Administrator at any time documents, records and other information relating to the claim within 60 days after receipt by of the claimant of written notice of the denial of his from the Company. In connection with such appeal and upon request by the Claimant, a Claimant may review (or receive free copies of) all documents, records or other information relevant to the Claimant’s claim for benefit, all in accordance with such procedures as the Company may establish. If a Claimant fails to file an appeal within such 60-day period, he shall have no further right to appeal.
(c) A decision on the appeal by the Company shall include a review by the Company that takes into account all comments, documents, records and other information submitted by the Claimant relating to the claim, without regard to whether such information was submitted or considered in the initial claim determination. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The Company shall render its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and appeal not later than 60 days after the receipt by the Company receives of the request for review, unless appeal. If special circumstances require extension of time for processingapply, in which case a decision shall the 60-day period may be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such extended by an extension of time for review is requiredadditional 60 days; provided, written notice of the extension (including is provided to the Claimant during the initial 60-day period and such notice indicates the special circumstances requiring the an extension of time) time and the date by which the Company expects to render its decision on the claim on appeal. If the Company wholly or partly denies the claim on appeal, the Company shall be furnished provide written notice to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished Claimant within the time period limitations of the immediately preceding paragraph. Such notice shall set forth in this paragraph, forth:
(i) the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated denial of the claim;
(ii) specific reference to be understood by the claimant, and specific references to the pertinent provisions in of the relevant documents Agreement on which the decision denial is based;
(iii) a statement of the Claimant’s right to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Claimant’s claim for benefits; and
(iv) a statement of the Claimant’s right to bring a civil action under Section 502(a) of ERISA.
Appears in 2 contracts
Sources: Supplemental Executive Retirement Agreement (Meridian Bancorp, Inc.), Supplemental Executive Retirement Agreement (Meridian Interstate Bancorp Inc)
Claims Procedure. Any claim a. The Company will be the "named fiduciary" and "plan administrator" of the arrangement contemplated herein. The claims procedure set forth herein may be changed by Company from time to time by written notice to the Executive, provided no such change shall limit the protections herein provided to the claimant except as such limitations are imposed by applicable law, regulation, or case law. The Company may establish reasonable administrative procedures for applying the Claims Procedures.
b. The Executive or any beneficiary of his may file a request for benefits under this Agreement shall be made with the Company in writing delivered to Companythe Company at its address provided in Section 13 hereof. If any a claim for benefits under this Agreement request is wholly or partially denied, notice of the decision shall be furnished Company will furnish to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial its decision within ninety (90-day period. In no event shall such extension exceed the period of 90 ) days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time in writing, and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, which notice will contain the following: (i) following information:
i. the specific reason or reasons for the denial; (;
ii) . specific reference to pertinent provisions of this Agreement upon which the denial is based; (;
iii) . a description of any additional material or information necessary for the claimant to perfect the claim and an explanation of as to why such material or information is necessary; and (and
iv) . an explanation of the Agreement’s claims applicable claim-review procedure as set forth below. The describing the steps to be taken by a claimant may appeal the denial of who wishes to submit his claim to Company for a full and fair review. .
c. A claimant (or his duly authorized representative) may representative may, with respect to any denied claim:
i. request a review by filing a upon written application for review with the Administrator at any time filed within 60 sixty (60) days after receipt by the claimant of written notice of the denial of his claim;
ii. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and ; and
iii. submit issues and comments in writing.
d. Any request or submission will be in writing and will be directed to the Company. The Company will have the sole responsibility for the review of any denied claim and will take all appropriate steps in light of its findings. The Company will render a decision on upon review shall be made by the Administrator, who may, in its or his/her discretion, hold of a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 claim within sixty (60) days after Company receives the receipt of a request for review, unless . If special circumstances require extension of time for processingwarrant additional time, in which case a the decision shall will be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the request for review. If such an extension of time for review is required, written Written notice of the any such extension (including the special circumstances requiring the extension of time) shall will be furnished to the claimant prior to the commencement of the extension. In The decision on review will be in writing and will include specific reasons for the event that decision written in a manner to be understood by the claimant, as well as the specific references of the pertinent provisions on which the decision is based. If the decision on review is not furnished to the claimant within the time period set forth in this paragraphlimits described above, the claim shall will be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 2 contracts
Sources: Executive Supplemental Compensation Agreement (First Ipswich Bancorp /Ma), Executive Supplemental Compensation Agreement (First Ipswich Bancorp /Ma)
Claims Procedure. Any person claiming a benefit under the Agreement (a "Claimant") shall present the claim, in writing, to the Bank, and the Bank shall respond in writing. If the claim is denied, the written notice of denial shall state, in a manner calculated to be understood by the Claimant:
(i) The specific reason or reasons for benefits under this denial, with specific references to the Agreement provisions on which the denial is based;
(ii) A description of any additional material or information necessary for the Claimant to perfect his, her or its claim and an explanation of why such material or information is necessary; and
(iii) An explanation of the Agreement's claims review procedure. The written notice denying or granting the Claimant's claim shall be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished provided to the claimant Claimant within a reasonable period of time, not to exceed 90 ninety (90) days after the Bank's receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished by the Bank to the claimant prior to the termination of Claimant within the initial ninety (90-) day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The Any extension notice shall indicate the special circumstances requiring an the extension of time and the date on which the administrator Bank expects to render a decisiondecision on the claim. Company Any claim not granted or denied within the period noted above shall provide every claimant who be deemed to have been denied. Any Claimant whose claim is denied a claim for benefits written notice setting forthdenied, in a manner calculated or deemed to be understood by denied under the claimantpreceding sentence, or such Claimant's authorized representative, may, within sixty (60) days after the following: (i) specific reasons for Claimant's receipt of notice of the denial; (ii) specific reference to pertinent provisions upon which , or after the denial is based; (iii) 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 (iv) an explanation date of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may deemed denial, request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may requestby notice given, upon written application to Companyin writing, to review the Bank. Upon such a request for review, the claim shall be reviewed by the Bank (or its designated representative). In connection with the review, the Claimant may have representation, may examine pertinent documents, and may submit issues and comments in writing. The decision on review normally shall be made by within sixty (60) days of the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after Bank's receipt of the request for review. If such an extension of time for review is requiredrequired due to special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) Claimant shall be furnished to notified, in writing, by the claimant prior to Bank, and the commencement of the extension. In the event that time limit for the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on reviewextended to one hundred twenty (120) days. The decision on review shall be in writing and shall include reasons for the decisionstate, written in a manner calculated to be understood by the claimantClaimant, the specific reasons for the decision and specific shall include references to the pertinent relevant Agreement provisions in the relevant documents on which the decision is based. The written decision on review shall be given to the Claimant within the sixty (60) day (or, if applicable, the one hundred twenty (120) day) time limit discussed above. If the decision on review is not communicated to the Claimant within the sixty (60) day (or, if applicable, the one hundred twenty (120) day) period described above, the claim shall be deemed to have been denied upon review. All decisions on review shall be final and binding with respect to all concerned parties.
Appears in 2 contracts
Sources: Endorsement Split Dollar Insurance Agreement (Florida Business Bancgroup Inc), Endorsement Split Dollar Insurance Agreement (Florida Business Bancgroup Inc)
Claims Procedure. Any The Executive or his designated beneficiary or beneficiaries may make a claim for benefits under this Agreement shall be made in writing to Companyby filing a written request with the Committee. If any a claim for benefits under this Agreement is wholly or partially denied, the Committee shall furnish the claimant with written notice of:
(a) the specific reason or reasons for the denial; and
(b) specific reference to the pertinent provisions of this Agreement on which the decision denial is based. Such notice shall be furnished to the claimant within a reasonable period of time, not to exceed 90 ninety (90) days after the receipt of the claim by Companyhis claim, unless special circumstances require an extension of time for processing the his claim. If such an extension of time for processing is required, written notice of the extension shall be furnished to the claimant Committee shall, prior to the termination of the initial ninety (90-) day period. In no event shall such extension exceed , furnish the period of 90 days from the end of such initial period. The extension claimant with written notice shall indicate indicating the special circumstances requiring an extension of time and the date on by which the administrator Committee expects to render a its decision. Company In no event shall provide every claimant who is denied an extension exceed a claim for benefits written notice setting forth, in a manner calculated to be understood by period of ninety (90) days from the claimant, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent provisions upon which the denial is based; (iii) 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 (iv) an explanation end of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair reviewinitial ninety (90) day period. A claimant (or his duly authorized representative) may request the Committee to review a review by filing a written application for review with denied claim. Such request shall be in writing and must be delivered to the Administrator at any time Committee within 60 sixty (60) days after receipt by the claimant of written notice notification of the denial of his claim. The A claimant or his duly authorized representative may request, upon written application to Company, to may:
(a) review pertinent documents, and and
(b) submit issues and comments in writing. The Committee shall notify the claimant of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives the receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is requiredrequired because of special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) shall must be furnished to the claimant prior to the commencement of the extension. In the event that the The Committee’s decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and as well as specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based.
Appears in 2 contracts
Sources: Retention and Non Competition Agreement (Poage Bankshares, Inc.), Retention and Non Competition Agreement (Poage Bankshares, Inc.)
Claims Procedure. (a) Benefits shall be payable in accordance with the plan provisions. Should the designated beneficiary fail to receive benefits to which such beneficiary believes he or she is entitled, a claim may be filed. Any claim for benefits under this Agreement a plan benefit hereunder shall be filed by the beneficiary (claimant) of this plan by written communication which is made in writing by the claimant or the claimant’s authorized representative which is reasonably calculated to Company. bring the claim to the attention of the Named Fiduciary.
(b) If any a claim for benefits under this Agreement a plan benefit is wholly or partially denied, a written notice of the decision shall be furnished to the claimant by the Named Fiduciary or his designee within a reasonable period of time, not to exceed 90 days time after receipt of the claim by Companythe plan, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension which notice shall indicate include the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: following information:
(i) The specific reason or reasons for the denial; ;
(ii) specific Specific reference to the pertinent plan provisions upon which the denial is based; ;
(iii) a 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 and
(iv) an An explanation of the Agreementplan’s claims claim review procedure as set forth below. The procedures.
(c) In order that a claimant may appeal the a denial of his claim to Company for a full and fair review. A claim, a claimant (or his duly authorized representative:
(i) may May request a review by filing a written application for review with to the Administrator at any time within Named Fiduciary or his designee not later than 60 days after receipt by the claimant of written notice notification of the denial of his a claim. The claimant or his duly authorized representative may request, upon written application to Company, to ;
(ii) May review pertinent documents, and ; and
(iii) May submit issues and comments in writing. The .
(d) A decision on review of a denied claim shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the Named Fiduciary’s receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possiblewithin a reasonable period of time, but not later than 120 days after receipt of the a request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons the specific reason(s) for the decision, written in a manner calculated to be understood by decision and the claimant, and specific references reference(s) to the pertinent plan provisions in the relevant documents on which the decision is based.
(e) Notwithstanding anything contained in this paragraph to the contrary, any claim for a death benefit under an insurance policy under this plan shall be filed with the Insurer by the claimant or his authorized representative on the form or forms prescribed for such purpose by the Insurer. The Insurer shall have sole authority for determining whether a death claim shall or shall not be paid, either in whole or in part, in accordance with the terms of such annuity or insurance contract which may have been purchased on the life of the Employee.
Appears in 2 contracts
Sources: Split Dollar Life Insurance Agreement (First Horizon National Corp), Split Dollar Life Insurance Agreement (First Horizon National Corp)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company ("Administrator"), whose address is Champion Enterprises, Inc., ▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇, ▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇ ▇▇▇▇▇ and whose telephone number is (▇▇▇) ▇▇▇-▇▇▇▇. The "Named Fiduciary" as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive ("the claimant") shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and his claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreement’s claims best of the Administrator's ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within 10 days following the date of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant may appeal the denial shall be entitled to submit such issues or comments in writing or otherwise, as he shall consider relevant to a determination of his claim to Company claim, and he may include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting his request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of shall agree are pertinent to his claim. The claimant may, at all stages of review, be represented by counsel, legal or otherwise, of his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writingchoice. The decision on All requests for review shall be made by promptly resolved. The Administrator's decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 10 days after Company receives following receipt by the Administrator of the claimant's request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator's decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this section, but who has not obtained full relief on his claim for benefits, may, within 60 days following his receipt of the Administrator's written decision on review, apply in writing to the Administrator for binding arbitration of his claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Detroit, Michigan, in accordance with the commercial arbitration rules of the American Arbitration Association, as then in effect. If the parties are unable to mutually agree upon an arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of which shall be designated by the Company, one of which shall be designated by the claimant and the third of which shall be designated by the first two arbitrators in accordance with the commercial arbitration rules referenced above. The arbitrator
(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of its provisions. The arbitrator(s) shall have the power to compel attendance of witnesses at the hearing. Any court having jurisdiction may enter a judgment based upon such an extension of time for review is required, written notice arbitration. All decisions of the extension (including the special circumstances requiring the extension of timearbitrator(s) shall be furnished to final and binding on the claimant prior and the Company without appeal to the commencement any court. Upon execution of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraphAgreement, the claim Executive shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for to have waived his right to commence litigation proceedings outside of arbitration without the decision, express written in a manner calculated to be understood by consent of the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedCompany.
Appears in 2 contracts
Sources: Change in Control Severance Agreement (Champion Enterprises Inc), Change in Control Severance Agreement (Champion Enterprises Inc)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company ("Administrator"), whose address is Champion Enterprises, Inc., 2701 ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇, ▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇ ▇▇▇▇▇ ▇▇▇ whose telephone number is (248) 340-9090. The "Named Fiduciary" as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive ("the claimant") shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and his claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreement’s claims best of the Administrator's ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within 10 days following the date of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant may appeal the denial shall be entitled to submit such issues or comments in writing or otherwise, as he shall consider relevant to a determination of his claim to Company claim, and he may include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting his request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of shall agree are pertinent to his claim. The claimant may, at all stages of review, be represented by counsel, legal or otherwise, of his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writingchoice. The decision on All requests for review shall be made by promptly resolved. The Administrator's decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 10 days after Company receives following receipt by the Administrator of the claimant's request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator's decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this section, but who has not obtained full relief on his claim for benefits, may, within 60 days following his receipt of the Administrator's written decision on review, apply in writing to the Administrator for binding arbitration of his claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Detroit, Michigan, in accordance with the commercial arbitration rules of the American Arbitration Association, as then in effect. If the parties are unable to mutually agree upon an arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of which shall be designated by the Company, one of which shall be designated by the claimant and the third of which shall be designated
(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of its provisions. The arbitrator(s) shall have the power to compel attendance of witnesses at the hearing. Any court having jurisdiction may enter a judgment based upon such an extension of time for review is required, written notice arbitration. All decisions of the extension (including the special circumstances requiring the extension of timearbitrator(s) shall be furnished to final and binding on the claimant prior and the Company without appeal to the commencement any court. Upon execution of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraphAgreement, the claim Executive shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for to have waived his right to commence litigation proceedings outside of arbitration without the decision, express written in a manner calculated to be understood by consent of the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedCompany.
Appears in 2 contracts
Sources: Change in Control Agreement (Champion Enterprises Inc), Change in Control Agreement (Champion Enterprises Inc)
Claims Procedure. Any claim for If Executive believes that she is entitled to receive severance benefits under this Agreement shall be made Agreement, she may file a claim in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of with the decision shall be furnished to the claimant Committee within a reasonable period of time, not to exceed 90 ninety (90) days after the date such Executive believes she should have received such benefits. No later than ninety (90) days after the receipt of the claim, the Committee shall either allow or deny the claim by Companyin writing. A denial of a claim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is requiredin whole or in part, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by Executive and shall include the claimant, the following: (i) specific reason or reasons for the denial; (ii) specific reference to the pertinent provisions upon of this Agreement on which the denial is based; (iii) a description of any additional material or information necessary for the claimant Executive to perfect the claim and an explanation of why such material or information is necessary; and (iv) an explanation of the Agreement’s claims claim review procedure as set forth belowprocedure. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant Executive (or his her duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within sixty 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, her claim request a review upon written application to Company, to the Committee; review pertinent documents, ; and submit issues and comments in writing. The Committee shall notify Executive of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 within sixty (60) days after Company receives the receipt of a request for review, review unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one-hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is required, written notice Notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing writing. The Committee’s decision on review shall be final and shall include reasons for binding on Executive and any successor in interest. If Executive subsequently wishes to file a claim under Section 502(a) of ERISA, any legal action must be filed within ninety (90) days of the Committee’s final decision, written . Executive must exhaust the claims procedure provided in this section 6 before filing a manner calculated claim under ERISA with respect to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedany benefits provided under section 2 of this Agreement.
Appears in 2 contracts
Sources: Severance/Change in Control Agreement (CASA International, LLC), Severance/Change in Control Agreement (Hanesbrands Inc.)
Claims Procedure. Any claim for In the event that benefits under this Agreement are not paid to the Executive (or his beneficiary in the case of the Executive’s death), and such person feels entitled to receive them under the terms of this Agreement, a claim shall be made in writing to Company. If any claim for benefits the Bank within sixty (60) days after written notice from the Bank to the Executive or his beneficiary or personal representative that payments are not being made or are not to be made under this Agreement, or, within sixty (60) days after the date such benefit should have been paid under this Agreement according to such claimant. Such claim shall be reviewed by the Bank. If the claim is wholly approved or partially denied, notice of in full or in part, the decision Bank shall be furnished to the claimant within provide a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of approval or denial within sixty (60) days setting forth the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim specific reason for benefits written notice setting forthdenial, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent the provisions of this Agreement upon which the denial is based; (iii) a description of , and any additional material or information necessary for the claimant to perfect the claim and an explanation of why claim, if any. Also, such material or information is necessary; and (iv) an explanation of written notice shall indicate the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim steps to Company for a full and fair review. A claimant (or his duly authorized representative) may request be taken if a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for reviewis desired. If such an extension of time for review a claim is required, written notice of the extension denied (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the a claim shall be deemed denied on review. The decision on if the Bank does not take action within the aforesaid sixty (60) day period) and a review is desired, the Executive (or beneficiary or personal representative in the case of the Executive’s death) shall be notify the Bank in writing within twenty (20) business days from the earlier of the date of the denial or the end of such sixty (60) day period. In requesting a review, the Executive or his beneficiary or personal representative may review this Agreement or any document relating to it and submit any written issues and comments he or she may feel appropriate. In its sole discretion the Bank shall then review the claim and provide a written decision within sixty (60) days after receiving the request for review of the denial. This decision likewise shall state the specific reasons for the decision and shall include reasons for the decision, written in a manner calculated reference to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based. Any decision of the Bank shall not be binding on the Executive, his personal representative, or any beneficiary without consent, nor shall it preclude further action by the Executive, his personal representative or beneficiary.
Appears in 2 contracts
Sources: Supplemental Compensation Agreement (Campello Bancorp, Inc.), Supplemental Compensation Agreement (Campello Bancorp, Inc.)
Claims Procedure. (a) The Administrator shall be the Company, whose address is SEMCO Energy, Inc., 4▇▇ ▇▇▇▇▇ ▇▇., ▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇. The Company shall have the right to designate one or more employees as Administrator at any time. The Company shall give Executive written notice of any change. All notices shall be in writing, and delivered to Executive in person or sent by certified mail to Executive's last known address.
(b) The Administrator shall make all determinations as to Benefits. Any denial of a claim for benefits under this Agreement shall be made stated in writing to Company. If any claim for benefits under this Agreement is wholly and delivered or partially denied, notice of the decision shall be furnished to the claimant mailed within a reasonable period of time, not to exceed 90 ten (10) business days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claimtime. If such an extension of time is required, written Written notice of the an extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event Such extension may not exceed ten (10) business days. Failure to provide any notice within ten (10) business days constitutes acceptance of the claim. Notice of denial shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific set forth reasons for the denial; (ii) specific , reference to pertinent provisions upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an explanation of the Agreement’s claims claim review procedure as set forth belowprocedures, written in a manner that may be understood without legal counsel.
(c) A claimant whose claim has been wholly or partially denied may request, within ten (10) days following such denial in writing a review of such denial. The claimant may appeal the denial of his claim to Company submit comments in writing and may include a request for a full and fair reviewhearing in person before the administrator. A Prior to submitting a request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by agrees are pertinent to the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writingbe represented by counsel. The Administrator's decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished with respect to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on any review shall be in writing and shall include reasons be mailed not later than ten (10) days following receipt of the request for review unless special circumstances, such as the decisionneed to hold a hearing, written require an extension of time, in which case the Administrator's decision shall be delivered in person, or mailed by certified mail, not later than twenty (20) days after receipt of such request.
(d) A claimant who has followed the procedure in paragraphs (b) and (c) of this section, but who has not obtained full relief on Executive's claim may, within sixty (60) days following receipt of the decision on review, apply in writing to the Administrator for binding arbitration of Executive's claim before three arbitrators in St. Clair County, Michigan, in accordance with the commercial arbitration rules of the American Arbitration Association. The Company shall designate one arbitrator, the Executive shall choose an arbitrator and the two arbitrators jointly shall designate a manner calculated third arbitrator. The arbitrators' sole authority shall be to interpret and apply the provisions of this Agreement; they shall not change, add to, or subtract from, any of its provisions. The arbitrators shall have the power to compel attendance of witnesses at the hearing. Once a claimant commences arbitration proceedings, any right to commence litigation shall be understood by the claimantwaived, and specific references the arbitration proceedings shall continue to conclusion. Any court having jurisdiction may enter a judgment based upon such arbitration. All decisions of the pertinent provisions in the relevant documents on which the decision is basedarbitrators shall be final and binding without appeal to any court.
Appears in 2 contracts
Sources: Change in Control Agreement (Semco Energy Inc), Change in Control Agreement (Semco Energy Inc)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made ProAssurance (“Administrator”), whose address is ▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇; Telephone: (▇▇▇) ▇▇▇-▇▇▇▇. The “Named Fiduciary” as defined in writing Section 402(a) (2) or ERISA, also shall be ProAssurance. ProAssurance shall have the right to Companydesignate one or more employees of the Companies as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. If ProAssurance shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (“the claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 ten (10) days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 ten (10) days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (10) days following the receipt of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the claimant shall consider relevant to a determination of the claim, and the claimant may appeal the denial of his claim to Company include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting the request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by shall agree are pertinent to the claimant of written notice of the denial of his claim. The claimant may, at all stages of review, be represented by counsel, legal or his duly authorized representative may requestotherwise, upon written application to Company, to review pertinent documents, and submit issues and comments in writingof the claimant’s choice. The decision on All requests for review shall be made by promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 ten (10) days after Company receives following receipt by the Administrator of the claimant’s request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 twenty (20) days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedrequest.
Appears in 2 contracts
Sources: Release and Severance Compensation Agreement (Proassurance Corp), Employment Agreement (Proassurance Corp)
Claims Procedure. Any claim (a) The administrator for benefits under this Agreement shall be made in writing to Company. If any claim for benefits purposes of the claims procedure under this Agreement is the Chief Financial Officer of the Company. The business address and telephone number of the claims administrator is: ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇, Buffalo, New York 14225; telephone: (▇▇▇) ▇▇▇-▇▇▇▇.
(b) The Company shall have the right to change the claims administrator. The Company shall also have the right to change the address and telephone number of the claims administrator. The Company shall give the Employee written notice of any of the foregoing changes.
(c) Benefits shall be paid in accordance with the provisions of this Agreement.
(d) The claims administrator shall present any disputed claim for benefits to the Compensation Committee for review. The Compensation Committee in conjunction with the Board of Directors shall determine the disposition of the disputed claim.
(e) If the claim is denied, either wholly or partially deniedpartially, notice of the decision shall be furnished mailed to the claimant within a reasonable period of time, not to exceed 90 days after the receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, claims administrator.
(f) The claims administrator shall provide a written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every any claimant who is denied a claim for benefits written under this Agreement. The notice setting forth, in a manner calculated to be understood by shall set forth the claimant, the following: following information:
(i) the specific reasons for the denial; ;
(ii) the specific reference to pertinent provisions upon of the Agreement on which the denial is based; ;
(iii) 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 and
(iv) appropriate information and an explanation of the Agreement’s claims review procedure as under this Agreement to permit the claimant to submit his claim for review. All of this information shall be set forth below. in the notice in a manner calculated to be understood by the claimant.
(g) The claims procedure under this Agreement shall allow the claimant may a reasonable opportunity to appeal the denial of his a denied claim and to Company for get a full and fair reviewreview of that decision from the claims administrator. A The claimant (or shall exercise his duly authorized representative) may right of appeal by submitting a written request for a review by filing a of the denied claim to the claims administrator. This written application request for review with must be submitted to the Administrator at any time claims administrator within 60 sixty days after receipt by the claimant of the written notice of the denial of his claimdenial. The claimant or his duly authorized representative may request, shall have the following rights under this appeal procedure:
(i) to request a review upon written application to Company, the claims administrator;
(ii) to review pertinent documents, and documents with regard to this Agreement;
(iii) to submit issues and comments in writing. ;
(iv) to request an extension of time to make a written submission of issues and comments; and
(v) to request that a hearing be held to consider claimant's appeal.
(h) The claims administrator shall notify the claimant in writing of the decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on of the denied claim; the Administrator shall make this decision promptly, and not later than claim within 60 days after Company receives the receipt of the request for reviewreview if no hearing was held, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than or within 120 days after the receipt of the request for review. If such , if an extension of time for review is requirednecessary in order to hold a hearing. If an extension of time is necessary in order to hold a hearing, the claims administrator shall give the claimant written notice of the extension (including of time and of the special circumstances requiring the hearing. This notice shall be given prior to any extension. The written notice of extension shall indicate that an extension of time) time will occur in order to hold a hearing on the claimant's appeal. The notice shall also specify the place, date, and time of that hearing and the claimant's opportunity to participate in the hearing. It may also include any other information the claims administrator believes may be furnished important or useful to the claimant prior in connection with the appeal.
(i) The decision to hold a hearing to consider the commencement claimant's appeal of the extension. In denied claim shall be within the event that sole discretion of the claims administrator, whether or not the claimant requests such a hearing.
(j) The written decision on review is not furnished within required by Paragraph (h) above shall contain the time period set forth in this paragraph, following information:
(i) the claim shall be deemed denied on review. The decision on review shall be in writing and shall include decisions;
(ii) the reasons for the decision, decisions; and
(iii) specific references to the provisions of the Agreement on which the decisions are based. All of this information shall be written in a manner calculated to be understood by the claimant, .
(k) The claims administrator shall be entitled to retain and specific references rely on the advice of experts (including without limitation attorneys and accountants retained by the Company) in taking or refraining from taking any action or making any decision pursuant to this Section 9. All fees and expenses of such experts shall be paid by the pertinent provisions in the relevant documents on which the decision is basedCompany.
Appears in 2 contracts
Sources: Executive Supplemental Retirement Plan (American Precision Industries Inc), Executive Supplemental Retirement Plan (American Precision Industries Inc)
Claims Procedure. Any claim for In the event that benefits under this Agreement are not paid to the Executive (or his beneficiary in the case of the Executive’s death), and such person feels entitled to receive them, a claim shall be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant Plan Administrator within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial ninety (90-day period. In no event shall such extension exceed the period of 90 ) days from the end of such initial perioddate payments are not made. The extension notice Such claim shall indicate be reviewed by the special circumstances requiring an extension of time Plan Administrator and the date on which Bank. If the administrator expects to render a decision. Company claim is denied, in full or in part, the Plan Administrator shall provide every claimant who is denied a claim for benefits written notice within ninety (90) days setting forth, in a manner calculated to be understood by forth the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent the provisions of this Agreement upon which the denial is based; (iii) a description of , and any additional material or information necessary for the claimant to perfect the claim and an explanation of why claim, if any. Also, such material or information is necessary; and (iv) an explanation written notice shall indicate the steps to be taken if a review of the Agreement’s claims denial is desired. If a claim is denied and a review procedure as set forth below. The claimant may appeal is desired, the denial of his claim to Company for a full and fair review. A claimant Executive (or his duly authorized representative) may request a review by filing a written application for review with beneficiary in the Administrator at any time within 60 days after receipt by the claimant of written notice case of the denial of his claim. The claimant or his duly authorized representative may requestExecutive’s death), upon written application to Company, to review pertinent documents, shall notify the Plan Administrator in writing within ninety (90) days [and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on if the Plan Administrator does not take any action within the aforesaid ninety (90) day period]. In requesting a review, the Executive or his beneficiary may review this Agreement or any documents relating to it and submit any written issues and comments he or she may feel appropriate. The In its sole discretion the Plan Administrator shall then review the claim and provide a written decision on review within ninety (90) days. This decision likewise shall be in writing and shall include reasons for state the decision, written in a manner calculated to be understood by specific provisions of the claimant, and specific references to the pertinent provisions in the relevant documents Agreement on which the decision is based. If claimants continue to dispute the benefit denial based upon completed performance of this Agreement or the meaning and effect of the terms and conditions thereof, then claimants may submit the dispute to a Board of Arbitration for final arbitration. Said Board shall consist of one member selected by the claimant, one member selected by the Bank, and the third member selected by the first two members. The Board shall operate under any generally recognized set of arbitration rules. The parties hereto agree that they and their heirs, personal representatives, successors and assigns shall be bound by the decision of such Board with respect to any controversy properly submitted to it for determination. Where a dispute arises as to the Bank’s discharge of the Executive “for cause,” such dispute shall likewise be submitted to arbitration as above described and the parties hereto agree to be bound by the decision thereunder.
Appears in 2 contracts
Sources: Executive Salary Continuation Agreement (Lyons Bancorp Inc), Executive Salary Continuation Agreement (Lyons Bancorp Inc)
Claims Procedure. Any The Executive or his designated beneficiary or beneficiaries may make a claim for benefits under this Agreement shall be made in writing to Companyby filing a written request with the Committee. If any a claim for benefits under this Agreement is wholly or partially denied, notice of the decision Committee shall be furnished to furnish the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits with written notice setting forth, forth in a manner calculated to be understood by the claimant, :
(a) the following: (i) specific reason or reasons for the denial; ;
(iib) specific reference to the pertinent provisions upon of this Agreement on which the denial is based; ;
(iiic) a description of any additional material or information necessary for the claimant to perfect the his claim and an explanation of why such material or information is necessary; and and
(ivd) appropriate information as to the steps to be taken if the claimant wishes to submit his claim for review. Such notice shall be furnished to the claimant within ninety (90) days after the receipt of his claim, unless special circumstances require an explanation extension of time for processing his claim. If an extension of time for processing is required, the Committee shall, prior to the termination of the Agreement’s claims review procedure as set forth belowinitial ninety (90) day period, furnish the claimant with written notice indicating the special circumstances requiring an extension and the date by which the Committee expects to render its decision. The claimant may appeal In no event shall an extension exceed a period of ninety (90) days from the denial end of his claim to Company for a full and fair reviewthe initial ninety (90) day period. A claimant (or his duly authorized representative) may request the Committee to review a review by filing a written application for review with denied claim. Such request shall be in writing and must be delivered to the Administrator at any time Committee within 60 sixty (60) days after receipt by the claimant of written notice notification of the denial of his claim. The A claimant or his duly authorized representative may request, upon written application to Company, to may:
(a) review pertinent documents, and and
(b) submit issues and comments in writing. The Committee shall notify the claimant of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives the receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is requiredrequired because of special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) shall must be furnished to the claimant prior to the commencement of the extension. In the event that the The Committee's decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and as well as specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based.
Appears in 1 contract
Sources: Supplemental Executive Retirement Agreement (Home Federal Bancorp, Inc. Of Louisiana)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company or, following a Change in writing to Control, the Survivor ("Administrator"), whose current address is 5555 ▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇▇▇, ▇▇d whose telephone number is (512) ▇▇▇-▇▇▇▇. ▇▇e "Named Fiduciary" as defined in Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive ("the claimant") shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 ten (10) days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 ten (10) days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreement’s claims best of the Administrator's ability in a manner that is intended to be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within ten (10) days following the date of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant shall be entitled to submit such issues or comments in writing or otherwise, as the claimant shall consider relevant to a determination of the claim, and the claimant may appeal the denial of his claim to Company include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting the request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by shall agree are pertinent to the claimant of written notice of the denial of his claim. The claimant may, at all stages of review, be represented by counsel, legal or his duly authorized representative may requestotherwise, upon written application to Company, to review pertinent documents, and submit issues and comments in writingof the claimant's choice. The decision on All requests for review shall be made by promptly resolved. The Administrator's decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 ten (10) days after Company receives following receipt by the Administrator of the claimant's request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator's decision shall be rendered as soon as possible, but so mailed not later than 120 twenty (20) days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedrequest.
Appears in 1 contract
Sources: Executive Change in Control Bonus and Severance Agreement (American Dental Technologies Inc)
Claims Procedure. Benefits shall be payable in accordance with the Plan provisions. Should the Executive or any beneficiary fail to receive benefits to which the Executive or any beneficiary believes he or she is entitled, a claim may be filed. Any claim for benefits under this Agreement a Plan benefit hereunder shall be made in writing filed by the Executive or any beneficiary ("Claimant") or a duly authorized representative of the Claimant of the Plan by written communication delivered to Companythe Employer (or its assignee) which is reasonably calculated to bring the claim to the attention of the Employer. If any a claim for a Plan benefits under this Agreement is wholly or partially denieddenied by the Employer or its assignee, a written notice of the decision shall be furnished to the claimant Claimant or his or her duly authorized representative by the Employer or its assignee within a reasonable period of time, not to exceed 90 days time after receipt of the claim by Companythe Plan, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension which notice shall indicate include the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: following information;
(ia) The specific reasons reason(s) for the denial; ;
(iib) specific Special reference to the pertinent Plan provisions upon which the denial is based; ;
(iiic) a A description of any additional material or information necessary for the claimant Claimant to perfect the claim and an explanation of why such material or information is necessary; and and
(ivd) an An explanation of the Agreement’s claims Plan's claim review procedure as set forth belowprocedures. The claimant In order that a Claimant may appeal the a denial of his claim to Company for a full and fair review. A claimant (claim, a Claimant or his or her duly authorized representative:
(a) may May request a review by filing a written application for review with to the Administrator at any time within 60 Employer or its assignee not later than sixty (60) days after receipt by the claimant Claimant of written notice notification of the denial of his a claim. The claimant or his duly authorized representative may request, upon written application to Company, to ;
(b) May review pertinent documents, and ; and
(c) May submit issues and comments in writing. The A decision on review of a denied claim shall be made by the Administrator, who may, in Employer or its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and assignee not later than 60 sixty (60) days after Company receives the Plan's receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possibleby the Employer or its assignee within a reasonable period of time, but not later than 120 one hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons the specific reason(s) for the decision, written in a manner calculated to be understood by decision and the claimant, and specific references reference(s) to the pertinent Plan provisions in the relevant documents on which the decision is based. Notwithstanding anything contained in this section to the contrary, any claim for a death benefit under a Policy shall be filed with the Insurer by the Claimant or his or her duly authorized representative on the form or forms prescribed for such purpose by the Insurer. The Insurer shall have sole authority for determining whether a death claim shall or shall not be paid, either in whole or in part, in accordance with the terms of such Policy.
Appears in 1 contract
Sources: Executive Split Dollar Life Insurance Agreement (Filenes Basement Corp)
Claims Procedure. Any The Executive or her designated beneficiary or beneficiaries may make a claim for benefits under this Agreement shall be made in writing to Companyby filing a written request with the Committee. If any a claim for benefits under this Agreement is wholly or partially denied, notice of the decision Committee shall be furnished to furnish the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits with written notice setting forth, forth in a manner calculated to be understood by the claimant, :
(a) the following: (i) specific reason or reasons for the denial; ;
(iib) specific reference to the pertinent provisions upon of this Agreement on which the denial is based; ;
(iiic) a description of any additional material or information necessary for the claimant to perfect the her claim and an explanation of why such material or information is necessary; and and
(ivd) appropriate information as to the steps to be taken if the claimant wishes to submit her claim for review. Such notice shall be furnished to the claimant within ninety (90) days after the receipt of her claim, unless special circumstances require an explanation extension of time for processing her claim. If an extension of time for processing is required, the Committee shall, prior to the termination of the Agreement’s claims review procedure as set forth belowinitial ninety (90) day period, furnish the claimant with written notice indicating the special circumstances requiring an extension and the date by which the Committee expects to render its decision. The claimant may appeal In no event shall an extension exceed a period of ninety (90) days from the denial end of his claim to Company for a full and fair reviewthe initial ninety (90) day period. A claimant (or his duly authorized representative) may request the Committee to review a review by filing a written application for review with denied claim. Such request shall be in writing and must be delivered to the Administrator at any time Committee within 60 sixty (60) days after receipt by the claimant of written notice notification of the denial of his claim. The A claimant or his her duly authorized representative may request, upon written application to Company, to may:
(a) review pertinent documents, and and
(b) submit issues and comments in writing. The Committee shall notify the claimant of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives the receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is requiredrequired because of special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) shall must be furnished to the claimant prior to the commencement of the extension. In the event that the The Committee’s decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and as well as specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based.
Appears in 1 contract
Sources: Supplemental Retirement Agreement (Minden Bancorp, Inc.)
Claims Procedure. Any If an Executive or the Executive's beneficiary (or qualified executor or administrator) fails to receive benefits to which such Executive or beneficiary (or qualified executor or administrator) feels entitled under this Agreement, such Executive or beneficiary (or qualified executor or administrator) shall submit a claim for such benefits under this Agreement shall be made in writing to Companythe Corporation within 60 days of the date the Executive or beneficiary (or qualified executor or administrator) would have received such benefits if so entitled. Such claim shall be reviewed by the Corporation. If any the claim for benefits under this Agreement is wholly or partially denied, notice of in full or in part, the decision Corporation shall be furnished to the claimant within provide a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, claimant within 90 days setting forth the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent the provisions of this Agreement upon which the denial is based; (iii) a description of , and any additional material or information necessary for the claimant to perfect the claim claim, if any, and an explanation of why such material or information is necessary; and (iv) an explanation . Also, such written notice shall indicate the steps to be taken if a review of the Agreement’s claims denial is desired. If a claim is denied in full or inpart and a review procedure as set forth below. The claimant may appeal is desired, the Executive or his beneficiary (or qualified executor or administrator) shall so notify the Corporation in writing within 60 days after receiving a denial of claim and a claim shall be deemed denied if the Corporation does not take any action within the aforesaid 90-day period. In requesting a review, the Executive or his claim to Company for a full and fair review. A claimant beneficiary (or his duly authorized representativequalified executor or administrator) may request a review by filing this Agreement or any documents relating to it and submit any written issues and comments he may feel appropriate. In its sole discretion, the Corporation shall then review the claim and provide a written application for review with the Administrator at any time decision within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, review unless special circumstances require an extension of time for processing, processing in which case a decision shall be rendered as soon as possible, but not no later than 120 days after receipt of the a request for review. If such an extension of time This decision shall state the specific reasons for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for reference to specific provisions of this Agreement on which the decision, decision is based and be written in a manner calculated to be understood by the claimant. All determinations made by the Corporation shall be conclusive upon the Executive, and specific references his beneficiary (or qualified executor or administrator) or any other person claiming benefits pursuant to the pertinent provisions in the relevant documents on which the decision is basedthis Agreement.
Appears in 1 contract
Sources: Executive Supplemental Defined Contribution Benefit Agreement (Elco Industries Inc)
Claims Procedure. Any person claiming a benefit under the Agreement (a “Claimant”) shall present the claim, in writing, to the Bank, and the Bank shall respond in writing. If the claim is denied, the written notice of denial shall state, in a manner calculated to be understood by the Claimant:
(i) The specific reason or reasons for benefits under this denial, with specific references to the Agreement provisions on which the denial is based;
(ii) A description of any additional material or information necessary for the Claimant to perfect his, her or its claim and an explanation of why such material or information is necessary; and
(iii) An explanation of the Agreement’s claims review procedure. The written notice denying or granting the Claimant’s claim shall be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished provided to the claimant Claimant within a reasonable period of time, not to exceed 90 ninety (90) days after the Bank’s receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished by the Bank to the claimant prior to the termination of Claimant within the initial ninety (90-) day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The Any extension notice shall indicate the special circumstances requiring an the extension of time and the date on which the administrator Bank expects to render a decisiondecision on the claim. Company Any claim not granted or denied within the period noted above shall provide every claimant who be deemed to have been denied. Any Claimant whose claim is denied a claim for benefits written notice setting forthdenied, in a manner calculated or deemed to be understood by denied under the claimantpreceding sentence, or such Claimant’s authorized representative, may, within sixty (60) days after the following: (i) specific reasons for Claimant’s receipt of notice of the denial; (ii) specific reference to pertinent provisions upon which , or after the denial is based; (iii) 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 (iv) an explanation date of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may deemed denial, request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may requestby notice given, upon written application to Companyin writing, to review the Bank. Upon such a request for review, the claim shall be reviewed by the Bank (or its designated representative). In connection with the review, the Claimant may have representation, may examine pertinent documents, and may submit issues and comments in writing. The decision on review normally shall be made by within sixty (60) days of the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after Bank’s receipt of the request for review. If such an extension of time for review is requiredrequired due to special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) Claimant shall be furnished to notified, in writing, by the claimant prior to Bank, and the commencement of the extension. In the event that time limit for the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on reviewextended to one hundred twenty (120) days. The decision on review shall be in writing and shall include reasons for the decisionstate, written in a manner calculated to be understood by the claimantClaimant, the specific reasons for the decision and specific shall include references to the pertinent relevant Agreement provisions in the relevant documents on which the decision is based. The written decision on review shall be given to the Claimant within the sixty (60) day (or, if applicable, the one hundred twenty (120) day) time limit discussed above. If the decision on review is not communicated to the Claimant with the sixty (60) day (or, if applicable, the one hundred twenty (120) day) period discussed above, the claim shall be deemed to have been denied upon review. All decisions on review shall be final and binding with respect to all concerned parties.
Appears in 1 contract
Sources: Endorsement Split Dollar Insurance Agreement (Alliance Bancorp Inc of Pennsylvania)
Claims Procedure. Any claim for If any person believes he is being denied any rights or benefits under this Agreement shall be made the Plan, such person or his duly authorized representative (the “Claimant”) may file a claim in writing to Companywith the Administrator. If any such claim for benefits under this Agreement is wholly or partially denied, notice the Administrator will notify the Claimant of its decision in writing. Such notification (the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: “Initial Notification”) will contain (i) specific reasons for the denial; , (ii) specific reference to pertinent Plan provisions upon on which the denial is decision was based; , (iii) a description of any additional material or information necessary for the claimant Claimant to perfect the such claim and an explanation of why such material or information is necessary; and , (iv) an explanation a description of the AgreementPlan’s claims review procedure as set forth belowprocedures and the time limits applicable to such procedures, including a statement of the person’s right to bring a civil action under ERISA Section 502(a) following an adverse decision on review, and (v) in the case of a denial of a claim regarding Disability (a “Disability Claim”), a statement that the Administrator will provide to the Claimant, upon request and free of charge, a copy of any internal rule, guideline, protocol or other similar criterion that was relied upon in making the decision. The claimant may appeal Initial Notification will be given within 90 days (45 days in the denial case of his a Disability Claim) after the claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made is received by the Administrator. However, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 may extend the period for providing such notification by up to 90 additional days after Company receives in the request for review, unless case of a non-Disability Claim if special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review processing the claim and if written notice of such extension and circumstances, and the date by which the Administrator expects to render a decision, is requiredgiven to the Claimant within the initial 90 day period. In the case of a Disability Claim, written the Administrator may extend the period for providing the Initial Notification by up to 30 additional days if the Administrator determines that it needs additional time to process such claim due to matters beyond the control of the Administrator. In such event, the Administrator will provide the Claimant with a notice of the extension (including before the special end of the initial 45-day period. If the Administrator determines that a decision cannot be made within the first extension period due to matters beyond the control of the Administrator, the time period for making a decision may be further extended by an additional 30 days. If such an additional extension is necessary, the Administrator shall notify the Claimant before the expiration of the initial 30-day extension. Any such notice of extension shall indicate the circumstances requiring necessitating the extension of time) shall , the date by which the Administrator expects to furnish a notice of decision, the specific standards on which such entitlement to a benefit is based, any unresolved issues that prevent a decision on the Disability Claim and any additional information needed to resolve those issues. A Claimant will be furnished provided a minimum of 45 days to submit any such additional information to the claimant prior to the commencement of the extensionAdministrator. In the event that a 30-day extension is necessary due to the decision on review is not furnished within Claimant’s failure to submit information necessary to decide the time period set forth in this paragraphDisability Claim, the claim period for furnishing a notice of decision shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for tolled from the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents date on which the decision extension notice is basedprovided to the Claimant until the earlier of the date the Claimant responds to the request for additional information or the response deadline.
Appears in 1 contract
Claims Procedure. Any The Executive or her designated beneficiary or beneficiaries may make a claim for benefits under this Agreement shall be made in writing to Companyby filing a written request with the Committee. If any a claim for benefits under this Agreement is wholly or partially denied, notice of the decision Committee shall be furnished to furnish the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits with written notice setting forth, forth in a manner calculated to be understood by the claimant, ;
(a) the following: (i) specific reason or reasons for the denial; ;
(iib) specific reference to the pertinent provisions upon of this Agreement on which the denial is based; ;
(iiic) a description of any additional material or information necessary for the claimant to perfect the her claim and an explanation of why such material or information is necessary; and and
(ivd) appropriate information as to the steps to be taken if the claimant wishes to submit her claim for review. Such notice shall be furnished to the claimant within ninety (90) days after the receipt of her claim, unless special circumstances require an explanation extension of time for processing her claim. If an extension of time for processing is required, the Committee shall, prior to the termination of the Agreement’s claims review procedure as set forth belowinitial ninety (90) day period, furnish the claimant with written notice indicating the special circumstances requiring an extension and the date by which the Committee expects to render its decision. The claimant may appeal In no event shall an extension exceed a period of ninety (90) days from the denial end of his claim to Company for a full and fair reviewthe initial ninety (90) day period. A claimant (or his duly authorized representative) may request the Committee to review a review by filing a written application for review with denied claim. Such request shall be in writing and must be delivered to the Administrator at any time Committee within 60 sixty (60) days after receipt by the claimant of written notice notification of the denial of his claim. The A claimant or his her duly authorized representative may request, upon written application to Company, to may:
(a) review pertinent documents, and and
(b) submit issues and comments in writing. The Committee shall notify the claimant of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 sixty (60) days after Company receives the receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 one hundred twenty (120) days after receipt of the a request for review. If such an extension of time for review is requiredrequired because of special circumstances, written notice of the extension (including the special circumstances requiring the extension of time) shall must be furnished to the claimant prior to the commencement of the extension. In the event that the The Committee's decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and as well as specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based.
Appears in 1 contract
Sources: Supplemental Executive Retirement Agreement (Meridian Interstate Bancorp Inc)
Claims Procedure. Any Claim forms or claim for benefits information as to the subject policy can be obtained by contacting: Kaeding, Ernst & Company, 21 McGrath Highway, Suite 503, Quincy Cent▇▇, ▇▇ ▇▇▇▇▇.
(a) Claims ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇--When the Named Fiduciary has a claim which may be covered under this Agreement shall the provisions described in the Policy, he or she should contact the office or the person named above who will either complete a claim form and forward it to an authorized representative of the Insurer or advise the Named Fiduciary what further requirements are necessary. The Insurer will evaluate the claim and make a decision as to payment within 90 days of the date the claim is received by the Insurer. If the claim is payable, a benefit check will be issued to the Named Fiduciary or other party or parties entitled to payment under the Policy and forwarded through the office or person named above. In the event that a claim is not eligible under the Policy, the Insurer will notify the Named Fiduciary of the denial. Such notification will be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice within 90 days of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of date the claim by Company, unless special circumstances require an extension of time for processing is received and will be transmitted through the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial periodoffice or person named above. The extension notice shall indicate notification will include the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) denial as well as specific reference to pertinent the policy provisions upon which the denial is based; . The Named Fiduciary will also be informed as to the steps which may be taken to have the claim denial reviewed. A decision as to the validity of a claim will ordinarily be made within 10 working days of the date the claim is received by the Insurer. Occasionally, however, certain questions may prevent the Insurer from rendering a decision on the validity of the claim within the specific 90-day period. If this occurs, the Named Fiduciary will be notified of the reasons for the delay as well as the anticipated length of the delay, in writing and through the office or person named above. If further information or other material is required, the Named Fiduciary will be so informed. If the Named Fiduciary is dissatisfied with the denial of the claim or the amount paid, he or she has 60 days from the date he or she receives notice of a claim denial to file his or her objections to the action taken by the Insurer. If the Named Fiduciary wishes to contest a claim denial, he or she should notify the person or office named above who will assist in making inquiry to the insurer. All objections to the Insurer's actions should be in writing and submitted to the person or office named above for transmittal to the Insurer. The Insurer will review the claim denial and render a decision on such objections. The Named Fiduciary will be informed in writing of the decision of the Insurer within 60 days of the date the claim request is received by the Insurer.
(iiib) Claims Under the Plan--Claims for any benefits due under the plan or the surrender of the Policy may be made in writing by the Corporation or the Corporation's designated beneficiary and Employee or his designated beneficiary, as the case may be, to the Named Fiduciary. In the event a claim for benefits is wholly or party denied or disputed, the Named Fiduciary shall, within a reasonable period of time after receipt of the claim, notify the Corporation or the designated beneficiary and Employee or his designated beneficiary, as the case may be, of such total or partial denial or dispute listing:
(a) The specific reason or reasons for the denial of dispute;
(b) Specific reference to pertinent plan provisions upon which the denial or dispute 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 and,
(ivd) an An explanation of the Agreement’s claims plan's review procedure as set forth belowprocedure. The Within 60 days of denial or notice of claim under the plan, a claimant may appeal request that the denial of his claim to Company for be reviewed by the Named Fiduciary in a full and fair reviewhearing. A claimant (or his duly authorized representative) may request a review final decision shall be rendered by filing a written application for review with the Administrator at any time Named Fiduciary within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 1 contract
Claims Procedure. Any (a) A claim for benefits by a Participant, former Participant, Spouse, beneficiary, or any other person shall be presented to the Plan Administrator in writing within the maximum time permitted by law or under this Agreement Regulations promulgated by the Secretary of Labor or his delegate.
(b) The Plan Administrator shall, within a reasonable time, consider the claim and shall issue its determination thereon in writing.
(c) If the claim is granted, the appropriate distribution or payment shall be made in writing to Company. from the Trust Fund as soon as is administratively practicable following such grant.
(d) If any the claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to Plan Administrator shall, within 90 days provide the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, with written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice denial, setting forth, in a manner calculated to be understood by the claimant, :
(1) the following: specific reason or reasons for such denial;
(i2) specific reasons for the denial; (ii) specific reference references to pertinent Plan provisions upon on which the denial is based; ,
(iii3) a description of any additional material or information Information necessary for the claimant to perfect the claim claim~ and an explanation of why such material or information is necessary; and , and
(iv4) an explanation of the Agreement’s claims Plan's claim review procedure as set forth belowprocedure. The 90-day period described in the preceding sentence may be extended in special circumstances for up to an additional 90 days if the claimant may is given written notice of the extension that specifies the reason(s) for the extension.
(e) Each claimant shall have the opportunity to appeal the Plan Administrator's denial of his a claim to Company the Employer in writing for a full and fair review. A The claimant (or his duly authorized representative:
(1) may request a review by filing a written application for review with the Employer,
(2) may review pertinent documents, and
(3) may submit issues and comments in writing.
(f) The Plan Administrator at any may establish such time limits within which a claimant may request review of a denied claim as are reasonable in relation to the nature of the benefit which is the subject of the claim and to other attendant circumstances, but which shall not be less than 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. .
(g) The decision by the Plan Administrator on review of a claim shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives its receipt of the request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possiblepracticable, but not in no event later than 120 days after receipt of the request for review. If such an extension of time for review is required, written Written notice of the extension (including the special circumstances requiring the extension of time) shall must be furnished sent to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. .
(h) The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and claimant with specific references to the pertinent Plan provisions in the relevant documents on which the decision is based.
(i) To the extent permitted by law, the decision of the Plan Administrator, if no review is properly requested, the decision at the Employer on review, as the case may be, shall be final and Binding on all parties. No legal action for benefits under the Plan shall be brought unless and until the claimant has exhausted his remedies under the Plan.
(j) If for any reason the written notice at denial described above is not furnished within 90 days at the Plan Administrator's receipt of a claim for benefits, the lain shall be deemed to be denied. Likewise, if for any reason the written decision on review described above Is not furnished within the time prescribed, the claim shall be deemed to be denied on review.
(k) Notwithstanding any other provision of this Section, any controversy or claim arising out of or relating to a claim for benefits payable by this Plan may, at the option of the claimant, be submitted for settlement by arbitration in accordance with the Employee Benefit Plan Claims Arbitration Rules of the American Arbitration Association, and such rules are incorporated herein by reference. The decision of the arbitrator shall be final and binding on all parties thereto and judgment upon the award may be entered in any court having competent jurisdiction.
Appears in 1 contract
Sources: Savings and Protection Plan Joinder Agreement (Petroleum Development Corp)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company (“Administrator”), whose address is ▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, and whose telephone number is (▇▇▇) ▇▇▇-▇▇▇▇. The “Named Fiduciary” as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (“the Claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant Claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant Claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant Claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims review procedure as set forth below. The claimant ability in a manner that may appeal be understood without legal or actuarial counsel.
(c) If the Administrator wholly or partially denies the Claimant’s claim for benefits, within 60 days following the date of such denial of his claim the Claimant, in a writing addressed to Company for a full and fair review. A claimant (or his duly authorized representative) the Administrator, may request a review of such denial. The Claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant shall consider relevant to a determination of the claim, and the Claimant may include a request for a hearing in person before the Administrator. Prior to submitting the request, the Claimant shall be entitled to review such documents as are pertinent to the claim. The Claimant may, at all stages of review, be represented by filing a written application counsel, legal or otherwise, of the Claimant’s choice. All requests for review shall be promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator at any time within 60 Claimant not later than 10 days after following receipt by the claimant of written notice Administrator of the denial of his claim. The claimant or his duly authorized representative may requestClaimant’s request unless special circumstances, upon written application such as the need to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptlyhearing, and not later than 60 days after Company receives the request for review, unless special circumstances require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) If the request Claimant has followed the procedure in paragraphs (b) and (c) of this Section, but has not obtained full relief on the claim for benefits, may, within 60 days following the Claimant’s receipt of the Administrator’s written decision on review, apply in writing to the Administrator for binding arbitration of the claim before an arbitrator mutually acceptable to both parties, with the arbitration to be held in Plymouth, Michigan, in accordance with the arbitration rules of the American Arbitration Association, Commercial Disputes Resolution Procedures, as then in effect. If such the parties are unable to mutually agree upon an extension arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of time for review is requiredwhich shall be designated by the Company, written notice one of which shall be designated by the Claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the arbitration rules referenced above. The arbitrator(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of the extension (including Agreement’s provisions. The arbitrator(s) shall have the special circumstances requiring power to compel attendance of witnesses at the extension hearing. Any court having jurisdiction may enter a judgment based upon such arbitration. All decisions of timethe arbitrator(s) shall be furnished final and binding on the Claimant and the Company without appeal to any court. The Executive and the claimant prior Company hereby acknowledge that as arbitration is the exclusive remedy with respect to any grievance hereunder, neither party has the commencement right to resort to any federal, state or local court or administrative agency concerning breaches of this Agreement, and the decision of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim arbitrator shall be deemed denied on review. The decision on review shall be a complete defense to any suit, action or proceeding instituted in writing and shall include reasons for the decisionany federal, written in a manner calculated state or local court or before any administrative agency with respect to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on any dispute which the decision is basedarbitrable as herein set forth.
Appears in 1 contract
Claims Procedure. Any claim (a) Claim - The Employee or other person who believes that he is being denied a benefit to which he is entitled (hereinafter referred to as "Claimant") may file a written request for benefits under this Agreement such benefit with the Employer setting forth his claim. The Employer shall advise the Claimant that a reply will be made in writing to Companyforthcoming within thirty (30) days and deliver a reply within thirty (30) days. However, the Employer may extend the reply period for an additional fifteen (15) days for reasonable cause. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied in whole or in part, the Employer will adopt a claim for benefits written notice setting forth, in a manner opinion using language calculated to be understood by the claimant, the following: Claimant setting forth:
(i) the specific reason or reasons for the denial; ;
(ii) the specific reference references to pertinent Agreement provisions upon on which the denial is based; ;
(iii) a description of any additional material or information necessary for the claimant Claimant to perfect the claim and an explanation of why such material or such information is necessary; and ;
(iv) an explanation of appropriate information as to the Agreement’s claims review procedure as set forth below. The claimant may appeal steps to be taken if the denial of his Claimant wishes to submit the claim to Company for a full and fair review. A claimant ; and
(or his duly authorized representativev) may request a review by filing a written application the time limits for review with the Administrator at any time within 60 under Subparagraph (b), below.
(b) Review - Within sixty (60) days after the receipt by the claimant of written notice Claimant of the denial of his claimwritten opinion described above, the Claimant may request in writing that the previous determination be reviewed by the Employees' Benefit Committee (hereinafter referred to as the "Committee"). The claimant Claimant or his duly authorized representative may requestmay, upon written application to Companybut need not, to review the pertinent documents, documents and submit issues and comments in writing. The decision on review shall be made writing for consideration by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 Committee. Within thirty (30) days after Company receives the Committee's receipt of a request for review, unless it will render a written opinion setting forth the specific reasons for the decision and containing specific references to the pertinent Agreement provisions on which the decision is based. If special circumstances require extension of that the thirty (30) day time for processingperiod be extended, in which case a the Committee will so notify the Claimant and will render the decision shall be rendered as soon as possible, possible but not later than 120 sixty (60) days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 1 contract
Claims Procedure. Any claim for benefits under this Agreement shall be made in writing to Company1. If any claim for benefits under this Agreement the Plan is wholly or partially denied, notice of the decision claimant shall be furnished to the claimant given notice in writing within a reasonable period of time, time after receipt of the claim by the Plan (not to exceed 90 days after receipt of the claim by Companyclaim, unless or if special circumstances require an extension of time for processing the claim. If such an extension of time is requiredtime, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of and an additional 90 days from the end will be considered reasonable) by registered or certified mail of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits denial, written notice setting forth, in a manner calculated to be understood by the claimant, setting forth the following: following information:
(ia) the specific reasons for the such denial; ;
(iib) specific reference to pertinent Plan provisions upon on which the denial is based; ;
(iiic) 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 and
(ivd) an explanation of the Agreement’s claims Plan's claim review procedure as set forth belowprocedure.
2. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant also shall be advised that he or his duly authorized representative may requestrequest a review by the Plan Administrator of the decision denying the claim by filing with the Plan Administrator, upon within 60 days after such notice has been received by the claimant, a written application to Companyrequest for such review, to and that he may review pertinent documents, and submit issues and comments in writingwriting within the same 60-day period. The decision on If such request is so filed, such review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Plan Administrator shall make this decision promptly, and not later than within 60 days after Company receives the request for reviewreceipt of such request, unless special circumstances require an extension of time for processing, in which case the claimant shall be so notified and a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review.
3. If such an extension of time for review is required, The claimant shall be given written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraphresulting from such review, the claim shall be deemed denied on review. The decision on review shall be in writing and which notice shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent Plan provisions in the relevant documents on which the decision is based.
Appears in 1 contract
Sources: Profit Sharing/401(k) Plan Amendment (Winn Dixie Stores Inc)
Claims Procedure. Any If a claim is filed by a Participant or a Beneficiary, the following provisions shall apply:
(a) A claim shall mean a request for benefits the grant or enforcement of rights under this Agreement shall be Plan to which a Participant or a Beneficiary is entitled. A claim is deemed filed when a written communication is made in writing by a Participant, a Beneficiary, or a duly authorized representative of either, to Company. If any claim the Committee or to the Committee's representative designated for benefits under this Agreement is wholly or partially denied, notice such purpose.
(b) The recipient of the decision communication shall be furnished to notify the claimant Committee that a claim has been filed and the Committee shall within a reasonable period of time, time not to exceed 90 60 days after receipt of grant or deny the claim.
(c) If the claim by Companyis denied in whole or in part, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension such decision shall be furnished given to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial periodParticipant or Beneficiary. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, set forth in a manner calculated to be understood by the claimant, Participant or Beneficiary the following: :
(i1) the specific reason or reasons for the denial; ;
(ii2) a specific reference to pertinent Plan provisions upon on which the denial is was based; ;
(iii3) a description of any additional material or information necessary for the claimant Participant or Beneficiary to perfect the claim and an explanation of why such material or information is necessary; and and
(iv4) an explanation of the Agreement’s claims Plan's claim review procedure as set forth below. procedure.
(d) The claimant may appeal the denial of his claim shall have up to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 90 days after receipt by of the claimant of written notice of denial to file with the denial Committee a request for review of his a denied claim. The claimant In connection with the review of the denied claim, the Participant, Beneficiary, or his duly authorized representative may request, upon written application shall be entitled to Company, to review inspect pertinent documents, documents and submit issues and comments in writing. The review of the decision on shall be a full and fair review by the Committee and shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, promptly and not later than 60 days after Company receives the receipt of a request for review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered as soon as possible, possible but not later than 120 days after receipt of the a request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be made in writing and writing, shall include specific reasons for the decision, decision written in a manner calculated to be understood by the claimantParticipant or Beneficiary, and shall set forth specific references to the pertinent Plan provisions in the relevant documents on which the decision is based.
Appears in 1 contract
Sources: Employee Stock Ownership Plan and Trust Agreement (Scotts Liquid Gold Inc)
Claims Procedure. Any If an Executive or the Executive's beneficiary (or qualified executor or administrator) fails to receive benefits to which such Executive or beneficiary (or qualified executor or administrator) feels entitled under this Agreement, such Executive or beneficiary (or qualified executor or administrator) shall submit a claim for such benefits under this Agreement shall be made in writing to Companythe Corporation within 60 days of the date the Executive or beneficiary (or qualified executor or administrator) would have received such benefits if so entitled. Such claim shall be reviewed by the Corporation. If any the claim for benefits under this Agreement is wholly or partially denied, notice of in full or in part, the decision Corporation shall be furnished to the claimant within provide a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, claimant within 90 days setting forth the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent the provisions of this Agreement upon which the denial is based; (iii) a description of , and any additional material or information necessary for the claimant to perfect the claim claim, if any, and an explanation of why such material or information is necessary; and (iv) an explanation . Also, such written notice shall indicate the steps to be taken if a review of the Agreement’s claims denial is desired. If a claim is denied in full or in part and a review procedure as set forth below. The claimant may appeal is desired, the Executive or his beneficiary (or qualified executor or administrator) shall so notify the Corporation in writing within 60 days after receiving a denial of his claim to Company for and a full and fair claim shall be deemed denied if the Corporation does not take any action within the aforesaid 90-day period. In requesting a review. A claimant (, the Executive or his duly authorized representative) beneficiary may request a review by filing this Agreement or any documents relating to it and submit any written issues and comments he may feel appropriate. In its sole discretion, the Corporation shall then review the claim and provide a written application for review with the Administrator at any time decision within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, review unless special circumstances require an extension of time for processing, processing in which case a decision shall be rendered as soon as possible, but not no later than 120 days after receipt of the a request for review. If such an extension of time This decision shall state the specific reasons for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for reference to specific provisions of this Agreement on which the decision, decision is based and be written in a manner calculated to be understood by the claimant. All determinations made by the Corporation shall be conclusive upon the Executive, and specific references his beneficiary (or qualified executor or administrator) or any other person claiming benefits pursuant to the pertinent provisions in the relevant documents on which the decision is basedthis Agreement.
Appears in 1 contract
Sources: Executive Supplemental Benefit Agreement (Elco Industries Inc)
Claims Procedure. Any If an Executive or the Executive's beneficiary fails to receive benefits to which such Executive or beneficiary feels entitled under this Plan, such Executive or beneficiary shall submit a claim for such benefits under this Agreement shall be made in writing to Companythe Corporation within 60 days of the date the Executive or beneficiary would have received such benefits if so entitled. Such claim shall be reviewed by the Corporation. If any the claim for benefits under this Agreement is wholly or partially denied, notice of in full or in part, the decision Corporation shall be furnished to the claimant within provide a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, claimant within 90 days setting forth the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent the provisions of this Agreement upon which the denial is based; (iii) a description of , and any additional material or information necessary for the claimant to perfect the claim claim, if any, and an explanation of why such material or information is necessary; and (iv) an explanation . Also, such written notice shall indicate the steps to be taken if a review of the Agreement’s claims denial is desired. If a claim is denied in full or in part and a review procedure as set forth below. The claimant may appeal is desired, the Executive or his beneficiary shall so notify the Corporation in writing within 60 days after receiving a denial of his claim to Company for and a full and fair claim shall be deemed denied if the Corporation does not take any action within the aforesaid 90-day period. In requesting a review. A claimant (, the Executive or his duly authorized representative) beneficiary may request a review by filing this Plan Agreement or any documents relating to it and submit any written issues and comments he or she may feel appropriate. In its sole discretion, the Corporation shall then review the claim and provide a written application for review with the Administrator at any time decision within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, review unless special circumstances require an extension of time for processing, processing in which case a decision shall be rendered as soon as possible, but not no later than 120 days after receipt of the a request for review. If such an extension of time This decision shall state the specific reasons for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for reference to specific provisions of this Plan Agreement on which the decision, decision is based and be written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 1 contract
Sources: Executive Supplemental Benefit Agreement (Elco Industries Inc)
Claims Procedure. Any claim for In the event that benefits under this Agreement are not paid to the Executive (or his legal representative or beneficiary in the case of the Executive's death or legal incapacity), and the Executive or such person feels entitled to receive said benefits, a claim shall be made in writing therefor to Companythe Compensation Committee. Such claim shall be reviewed by the Compensation Committee. If any the claim for benefits under this Agreement is wholly approved or partially denied, in full or in part, the Compensation Committee shall provide a written notice of the decision shall be furnished to the claimant approval or denial within a reasonable period sixty (60) days of time, not to exceed 90 days after receipt of the claim by Companysetting forth the specific reason for denial, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) citing specific reference to pertinent the provisions of this Agreement upon which the denial is based; (iii) a description of , and any additional material or information necessary for to properly inform the claimant Executive, his legal representative or beneficiary. Such written notice from the Compensation Committee shall indicate the steps to perfect be taken if a review of the denial is desired. A claim shall be deemed denied if the Compensation Committee does not take action within the aforesaid sixty (60) day period. If a claim is denied and a review is desired, the Executive (or his aforesaid legal representative or beneficiary), shall notify the Compensation Committee in writing within twenty (20) days of the receipt of said denial or within twenty (20) days after the expiration of the 60 days of filing the claim, if there is no action taken by the Compensation Committee requesting such further review. In requesting such review, the Executive (or his legal representative or beneficiary), may refer to this Agreement or any document or documents relating to it and submit any written issues and comments he or she may feel appropriate. The Compensation Committee shall again review the claim and an explanation of why such material or information is necessary; and provide a written decision within sixty (iv60) an explanation days of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for subsequent review is required, written notice of stating the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated decision and which shall include reference to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based. (The claim shall be deemed denied again if the Compensation Committee does not take such action within the aforesaid sixty (60) day period).
Appears in 1 contract
Sources: Executive Salary Continuation Agreement (First Essex Bancorp Inc)
Claims Procedure. In the event a dispute arises over the benefits under this Executive Plan and benefits are not paid to the Executive (or to the Executive’s beneficiary[ies] in the case of Executive’s death) and such claimants feel they are entitled to receive such benefits, then a written claim must be made to the Named Fiduciary and Plan Administrator named above within forty-five (45) days from the date payments are refused. The Named Fiduciary and Plan Administrator shall review the written claim and if the claim is denied, in whole or in part, they shall provide in writing within forty-five (45) days of receipt of such claim the specific reasons for such denial, reference to the provision of the Executive Plan upon which the denial is based and any additional material or information necessary to perfect the claim. Such written notice shall further indicate the additional steps to be taken by claimants if further review of the claim denial is desired. Any decision by the Employer denying a claim by the Executive for benefits under this Agreement shall be made stated in writing to Company. If any claim for benefits under this Agreement is wholly and delivered or partially deniedmailed, notice of the decision shall be furnished via registered or certified mail, to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimantExecutive, the following: (i) specific reasons for Executive’s spouse or the denial; (ii) specific reference to pertinent provisions upon which Executive’s beneficiaries, as the denial is based; (iii) case may be. Furthermore, 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 (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on if the Named Fiduciary and Plan Administrator fail to take any action within the aforesaid forty-five (45) day period. If claimants desire a second review. The decision on review , they shall be notify the Named Fiduciary and Plan Administrator in writing within forty-five (45) days of the first claim denial. Claimants may review this Executive Plan or any documents relating thereto and submit any written issues and comments they may feel appropriate. In their sole discretion, the Named Fiduciary and Plan Administrator shall then review the second claim and provide a written decision within forty-five (45) days of receipt of such claim. This decision shall likewise state the specific reasons for the decision and shall include reasons for reference to specific provisions of the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on Plan Agreement upon which the decision is based.
Appears in 1 contract
Sources: Executive Supplemental Compensation Agreement (Americanwest Bancorporation)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company (“Administrator”), whose address is Champion Enterprises, Inc., 2▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇, ▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇ ▇▇▇▇▇ and whose telephone number is (▇▇▇) ▇▇▇-▇▇▇▇. The “Named Fiduciary” as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (“the claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and his claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within 10 days following the date of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant may appeal the denial shall be entitled to submit such issues or comments in writing or otherwise, as he shall consider relevant to a determination of his claim to Company claim, and he may include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting his request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of shall agree are pertinent to his claim. The claimant may, at all stages of review, be represented by counsel, legal or otherwise, of his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writingchoice. The decision on All requests for review shall be made by promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 10 days after Company receives following receipt by the Administrator of the claimant’s request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this section, but who has not obtained full relief on his claim for benefits, may, within 90 days following his receipt of the Administrator’s written decision on review, apply in writing to the Administrator for binding arbitration of his claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Detroit, Michigan, in accordance with the commercial arbitration rules of the American Arbitration Association, as then in effect. If the parties are unable to mutually agree upon an arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of which shall be designated by the Company, one of which shall be designated by the claimant and the third of which shall be designated by the first two arbitrators in accordance with the commercial arbitration rules referenced above. The arbitrator(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of its provisions. The arbitrator(s) shall have the power to compel attendance of witnesses at the hearing. Any court having jurisdiction may enter a judgment based upon such an extension of time for review is required, written notice arbitration. All decisions of the extension (including the special circumstances requiring the extension of timearbitrator(s) shall be furnished to final and binding on the claimant prior and the Company without appeal to the commencement any court. Upon execution of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraphAgreement, the claim Executive shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for to have waived his right to commence litigation proceedings outside of arbitration without the decision, express written in a manner calculated to be understood by consent of the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedCompany.
Appears in 1 contract
Sources: Change in Control Severance Agreement (Champion Enterprises Inc)
Claims Procedure. Any In general, Benefit distributions are automatic and no claim for benefits under this Agreement shall the Benefit needs to be made in writing to Company. If any filed; however, the Executive or a designated beneficiary may submit a claim for benefits under this Agreement the Benefit to the Administrator in writing. The following procedure shall apply in such a case:
(a) If such claim for the Benefit is wholly or partially denied, notice the Administrator shall notify the claimant of the decision shall be furnished to denial of the claimant claim within a reasonable period of time, not to exceed 90 but no later than ninety (90) days after receipt of the claim by Companywritten claim, unless special circumstances require an extension of time for processing the claim. If In such an extension of time is requiredevent, written notice of the extension shall be furnished to the claimant prior to the termination end of the initial ninety (90-) day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice and shall indicate the special circumstances requiring an the extension of time and the date on by which a final decision is expected. In no event shall the administrator expects to render a decisionextension period exceed ninety (90) days from the end of the initial ninety (90) day period. Company The notice of denial shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the followinginclude: (i) the specific reasons for the denial; (ii) specific reference to pertinent the Benefit provisions upon which the denial is based; (iii) a description of any additional material materials or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessaryclaim; and (iv) an explanation of the Agreement’s Benefit claims review procedure as set forth below. The claimant may appeal procedure.
(b) Within sixty (60) days of the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of the written notice of denial, or if the claim has not been granted within the applicable time period, the claimant may file a written request with the Administrator that it conduct a review of the denial of his the claim. The In connection with the claimant’s appeal, the claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, documents and may submit issues and comments in writing. .
(c) The Administrator shall deliver to the claimant a written decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision claim promptly, and but not later than 60 sixty (60) days after Company receives receipt of the claimant’s request for review, unless except that if there are special circumstances which require an extension of time for processing, the sixty (60) day period shall be extended to a maximum of one hundred and twenty (120) days, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement end of the extensionsixty (60) day period. In The Administrator’s decision shall include (i) the event that specific reasons for its decision and (ii) reference to the Benefit provisions on which its decision on review is based. If a decision is not furnished given to the claimant within the time period set forth in this paragraphreview period, the claim shall be is deemed denied on review. The decision on the last day of the review shall be in writing period.
(d) In all cases, the Executive or a designated beneficiary must submit any and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references all claims relating to the pertinent provisions in Benefit and exhaust all administrative remedies relating to any such claims with the relevant documents Administrator before serving a Demand for Arbitration on which the decision is basedany party.
Appears in 1 contract
Claims Procedure. Any claim for benefits under Article 5 of this Agreement by Employee shall be made in writing and sent to CompanyEmployer at its principal offices in Mechanicsburg, Pennsylvania, or such other place as Employer shall hereafter designate in writing. If Employee, or any claim for beneficiary following Employee’s death (collectively, the “Claimant”), believes he has been denied any benefits or payments under Article 5 of this Agreement is wholly Agreement, either in total or partially deniedin an amount less than the full benefit or payment to which the Claimant would normally be entitled, notice Employer shall advise the Claimant in writing of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt amount of the claim by Companybenefit, unless special circumstances require an extension of time for processing the claim. If such an extension of time is requiredor payment, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time if any, and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; denial within thirty (ii30) days of the receipt of the Claimant’s claim. Employer shall also furnish the Claimant at that time with a written notice containing:
(a) A specific reference to pertinent provisions upon which the denial is based; of this Agreement;
(iiib) a A description of any additional material or information necessary for the claimant Claimant to perfect the claim if possible, and an explanation of why such material or information is necessaryneeded; and and
(ivc) an An explanation of the Agreement’s claims claim review procedure as set forth belowin this Section 5.03. Within sixty (60) days of receipt of the information described above, the Claimant shall, if further review is desired, file a written request of reconsideration of Employer’s decision with the Appeal Committee. The claimant Appeal Committee shall consist of those individuals who were serving as the Compensation Committee of the Board of Directors of Employer immediately prior to the Change of Control. The Appeal Committee shall select from its membership a chairperson and a secretary and may appeal adopt such rules and procedures as it deems necessary to carry out its functions. In the denial event any individual is unable to serve on the Appeal Committee, then the chairperson of his claim the Appeal Committee shall appoint a successor provided such successor must have been a member of the Board of Directors of Employer prior to Company the Change of Control (“Prior Board Member”). So long as the Claimant’s request for a full and fair review. A claimant review is pending with the Appeal Committee (including such 60-day period), the Claimant, or his duly authorized representative) , may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, documents and may submit issues and comments in writingwriting to the Appeal Committee. The A final and binding decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on Appeal Committee within thirty (30) days of the denied claim; filing by the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt Claimant of the request for reviewreconsideration. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) The Appeal Committee’s decision shall be furnished conveyed to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be Claimant in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimant, decision and specific references to the pertinent provisions in the relevant documents of this Agreement on which the decision is based. The Appeal Committee shall discharge its duties under this claims procedure in accordance with the fiduciary standards of Employee Retirement Income Security Act of 1974, as amended (“ERISA”), and in doing so, to the extent permitted by law, shall be indemnified and held harmless by Employer (to the extent not indemnified or saved harmless under any liability insurance or other indemnification arrangement with Employer) for or against all liability to which the Appeal Committee may be subjected by reason of any act done in good faith with respect to the adjudication of any claim under Article 5 of this Agreement, including reasonable expenses. Notwithstanding anything to the contrary herein contained, the Claimant shall be entitled to submit his claim for determination to any court having competent jurisdiction regardless of whether he has first exercised his right to have Employer’s decision reconsidered by the Appeal Committee.
Appears in 1 contract
Claims Procedure. Any claim (a) The administrator for benefits under this Agreement shall be made in writing to Company. If any claim for benefits purposes of the claims procedure under this Agreement is the Chief Financial Officer of the Company. The business address and telephone number of the claims administrator is: ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇, Buffalo, New York 14225; telephone: (▇▇▇) ▇▇▇-▇▇▇▇.
(b) The Company shall have the right to change the claims administrator. The Company shall also have the right to change the address and telephone number of the claims administrator. The Company shall give the Employee written notice of any of the foregoing changes.
(c) Benefits shall be paid in accordance with the provisions of this Agreement .
(d) The claims administrator shall present any disputed claim for benefits to the Compensation Committee for review. The Compensation Committee in conjunction with the Board of Directors shall determine the disposition of the disputed claim.
(e) If the claim is denied, either wholly or partially deniedpartially, notice of the decision shall be furnished mailed to the claimant within a reasonable period of time, not to exceed 90 days after the receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, claims administrator.
(f) The claims administrator shall provide a written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every any claimant who is denied a claim for benefits written under this Agreement. The notice setting forth, in a manner calculated to be understood by shall set forth the claimant, the following: following information:
(i) the specific reasons for the denial; ;
(ii) the specific reference to pertinent provisions upon of the Agreement on which the denial is based; ;
(iii) 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 and
(iv) appropriate information and an explanation of the Agreement’s claims review procedure as under this Agreement to permit the claimant to submit his claim for review. All of this information shall be set forth below. in the notice in a manner calculated to be understood by the claimant.
(g) The claims procedure under this Agreement shall allow the claimant may a reasonable opportunity to appeal the denial of his a denied claim and to Company for get a full and fair reviewreview of that decision from the claims administrator. A The claimant (or shall exercise his duly authorized representative) may right of appeal by submitting a written request for a review by filing a of the denied claim to the claims administrator. This written application request for review with must be submitted to the Administrator at any time claims administrator within 60 sixty days after receipt by the claimant of the written notice of the denial of his claimdenial. The claimant or his duly authorized representative may request, shall have the following rights under this appeal procedure:
(i) to request a review upon written application to Company, the claims administrator;
(ii) to review pertinent documents, and documents with regard to this Agreement;
(iii) to submit issues and comments in writing. ;
(iv) to request an extension of time to make a written submission of issues and comments; and
(v) to request that a hearing be held to consider claimant's appeal.
(h) The claims administrator shall notify the claimant in writing of the decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on of the denied claim; the Administrator shall make this decision promptly, and not later than claim within 60 days after Company receives the receipt of the request for reviewreview if no hearing was held, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than or within 120 days after the receipt of the request for review. If such , if an extension of time for review is requirednecessary in order to hold a hearing. If an extension of time is necessary in order to hold a hearing, the claims administrator shall give the claimant written notice of the extension (including of time and of the special circumstances requiring the hearing. This notice shall be given prior to any extension. The written notice of extension shall indicate that an extension of time) time will occur in order to hold a hearing on the claimant's appeal. The notice shall also specify the place, date, and time of that hearing and the claimant's opportunity to participate in the hearing. It may also include any other information the claims administrator believes may be furnished important or useful to the claimant prior in connection with the appeal.
(i) The decision to hold a hearing to consider the commencement claimant's appeal of the extension. In denied claim shall be within the event that sole discretion of the claims administrator, whether or not the claimant requests such a hearing.
(j) The written decision on review is not furnished within required by Paragraph (h) above shall contain the time period set forth in this paragraph, following information:
(i) the claim shall be deemed denied on review. The decision on review shall be in writing and shall include decisions;
(ii) the reasons for the decision, decisions; and
(iii) specific references to the provisions of the Agreement on which the decisions are based. All of this information shall be written in a manner calculated to be understood by the claimant, .
(k) The claims administrator shall be entitled to retain and specific references rely on the advice of experts (including without limitation attorneys and accountants retained by the Company) in taking or refraining from taking any action or making any decision pursuant to this Section 9. All fees and expenses of such experts shall be paid by the pertinent provisions in the relevant documents on which the decision is basedCompany.
Appears in 1 contract
Sources: Executive Supplemental Retirement Plan (American Precision Industries Inc)
Claims Procedure. Any claim for (a) If the payment of benefits under this Agreement shall be made in writing disputed by the Corporation, the Executive, or other person claiming through the Executive, must file a written claim with the Board as a prerequisite to Companythe payment of such benefits. If The Board shall make all determinations as to the right of any person to receive benefits under subsections (a) and (b) of this Section 12. Any denial by the Board of a claim for benefits under this Agreement is wholly by the Executive, his heirs or partially denied, notice of personal representative (“the decision claimant”) shall be furnished stated in writing by the Board and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 ten (10) days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day ten (10)-day period. In no event shall such extension exceed the a period of 90 ten (10) days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and his claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Board’s claims ability in a manner that may be understood without legal or actuarial counsel.
(b) A claimant whose claim for benefits has been wholly or partially denied by the Board may request, within ten (10) days following the date of such denial, in a writing addressed to the Board, a review procedure as set forth belowof such denial. The claimant may appeal the denial shall be entitled to submit such issues or comments in writing or otherwise as he shall consider relevant to a determination of his claim to Company claim, and he may include a request for a full and fair reviewhearing in person before the Board. A claimant (or Prior to submitting his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by request, the claimant of written notice of shall be entitled to review such documents as the denial of Board shall agree are pertinent to his claim. The claimant may, at all stages of review, be represented by counsel, legal or otherwise, of his duly authorized representative may requestchoice, upon written application to Company, to review pertinent documents, provided that such fees and submit issues and comments in writingexpenses shall be borne by the Corporation. The decision on All requests for review shall be made by promptly resolved. The Board’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 ten (10) days after Company receives following receipt by the Board of the claimant’s request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Board’s decision shall be rendered as soon as possible, but so mailed not later than 120 twenty (20) days after receipt of such request.
(c) A claimant who has followed the request procedure in subsections (a) and (b) of this Section, but who has not obtained full relief on his claim for review. If benefits, may submit such claim for expedited and binding arbitration of his claim before an extension of time for review is requiredarbitrator in Hennepin County, written notice Minnesota, in accordance with the commercial arbitration rules of the extension American Arbitration Association, as then in effect, or pursuant to such other form of alternative dispute resolution as the parties may agree (including collectively, the special circumstances requiring the extension of time) “arbitration”). The arbitrator’s sole authority shall be furnished to interpret and apply the provisions of this Agreement; the arbitrator shall not change, add to, or subtract from, any of its provisions. The arbitrator shall have the power to compel attendance of witnesses at the hearing. Any court having competent jurisdiction may enter a judgment based upon such arbitration. The arbitrator shall be appointed by mutual agreement of the Corporation and the claimant pursuant to the applicable commercial arbitration rules. The arbitrator shall be a professional person with a national reputation for expertise in employee benefit matters and who is unrelated to the claimant prior to the commencement and any employees of the extensionCorporation. In All decisions of the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim arbitrator shall be deemed denied final and binding on review. The decision on review shall be in writing the claimant and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedCorporation.
Appears in 1 contract
Sources: Employment Agreement (Regis Corp)
Claims Procedure. Any A Participant or any designated beneficiary who disputes the Administrator's determination of the benefits due to him or her under the Plan may file a claim for benefits under this Agreement shall with the Administrator. A claim must be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially deniedwriting, in a form which gives the Administrator reasonable notice of the decision shall be furnished claim, sets forth the basis of the claim, and authorizes the Administrator to take all steps reasonably necessary to determine the claimant within a reasonable period of time, not to exceed 90 days after receipt validity of the claim by Companyand to facilitate the payment of any benefits to which the claimant is entitled. The Administrator will, unless special circumstances require an extension of time for processing the claimif reasonably possible, decide whether to grant or deny a claim within ninety (90) days after it is filed. If such an extension of time a longer period is requiredneeded, written notice the Administrator will, no later than the last day of the extension shall be furnished to ninety (90) day period, notify the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decisionreasons why it is needed. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to A decision must then be understood by the claimant, the following: rendered within ninety (i90) specific reasons for the denial; (ii) specific reference to pertinent provisions upon which the denial is based; (iii) a description of any additional material or information necessary for days after the claimant to perfect the claim and an explanation of why such material or information is necessary; and (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement was notified of the extension. In If the event that the decision on review is Administrator does not furnished act within the time period set forth in specified by this paragraphparagraph C, the claim shall is automatically denied, and the claimant may appeal in accordance with this paragraph C. If the Administrator determines that a claim should be deemed denied on reviewdenied, it will give the claimant written notice of denial. The decision on review shall This notice must be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and state specific references to reasons for denying the pertinent claim, citing the provisions in of the relevant documents Plan on which the decision denial is based, explain the procedure for reviewing the Administrator's decision, and if the claim is denied because the Administrator lacks adequate information to reach a decision, state what information is needed to make a decision possible and why it is needed. If a claim is denied, the claimant may appeal to the Board. The claimant's appeal must be submitted in writing to the Board no later than sixty (60) days after the earlier of the date on which he receives notice of denial or the expiration of the period within which the Board is required to render a decision. The claimant or his representative may submit any documents or written arguments that he desires in support of his claim, and the Board may, but is not required to, hold a hearing on the claim. The Board will, if reasonably possible, decide the claimant's appeal within sixty (60) days after it is filed. If a longer period is needed, the Board will, no later than the last day of the sixty (60) day period, notify the claimant of the extension of time and the reasons why it is needed. A decision must then be rendered within sixty (60) days after the claimant was notified of the extension. If the Board does not act within the time specified by this paragraph C, the appeal is automatically denied. If the Board determines that an appeal should be denied, it must give the claimant written notice of the denial in the same manner as required on initial denial of the claim by the Board.
Appears in 1 contract
Claims Procedure. Any claim The Company shall notify ▇▇▇▇▇▇▇▇ in writing within ninety (90) days of the Participant's written application for benefits of his eligibility or noneligibility for benefits under this Agreement shall be made in writing to CompanyAgreement. If any claim the Company determines that ▇▇▇▇▇▇▇▇ is not eligible for benefits under this Agreement is wholly or partially deniedfull benefits, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate set forth (a) the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the such denial; , (iib) a specific reference to pertinent provisions upon the provision of this Agreement on which the denial is based; , (iiic) a description of any additional information or material or information necessary for the claimant ▇▇▇▇▇▇▇▇ to perfect the claim his claim, and an explanation a description of why such material or information it is necessary; needed, and (ivd) an explanation of the this Agreement’s 's claims review procedure and other appropriate information as set forth below. The claimant may appeal to the denial of steps to be taken if ▇▇▇▇▇▇▇▇ wishes to have his claim reviewed. If the Company determines that there are special circumstances requiring additional time to make a decision, the Company shall notify ▇▇▇▇▇▇▇▇ of the special circumstances and the date by which a decision is expected to be made, and may extend the time for a full and fair reviewup to an additional 90-day period. A claimant (If ▇▇▇▇▇▇▇▇ is determined by the Company to be not eligible for benefits, or if ▇▇▇▇▇▇▇▇ believes that he is entitled to greater or different benefits, he shall have the opportunity to have his duly authorized representative) may request a review claim reviewed by the Company by filing a written application petition for review with the Administrator at any time Company within 60 sixty (60) days after receipt by him of the notice issued by the Company. Said petition shall state the specific reasons ▇▇▇▇▇▇▇▇ believes he is entitled to benefits or greater or different benefits. Within sixty (60) days after receipt by the claimant Company of written notice of said petition, the denial of Company shall afford ▇▇▇▇▇▇▇▇ (and his claim. The claimant counsel, if any) an opportunity to present his position to the Company orally or in writing, and ▇▇▇▇▇▇▇▇ (or his duly authorized representative may request, upon written application to Company, counsel) shall have the right to review the pertinent documents, and submit issues and comments in writing. The the Company shall notify ▇▇▇▇▇▇▇▇ of its decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for within said sixty (60) day period, stating specifically the decision, basis of said decision written in a manner calculated to be understood by ▇▇▇▇▇▇▇▇ and the claimant, and specific references to provisions of the pertinent provisions in the relevant documents Plan on which the decision is based. If, because of the need for a hearing, the sixty (60) day period is not sufficient, the decision may be deferred for up to another sixty (60) day period at the election of the Company, but notice of this deferral shall be given to ▇▇▇▇▇▇▇▇.
Appears in 1 contract
Claims Procedure. Any Participant or Beneficiary, or any other person asserting the right to receive a benefit under this Plan by virtue of his relationship to a Participant or Beneficiary (the “Applicant”), who believes that he has the right to a benefit that has not been paid, must file a written claim for such benefit in accordance with the procedures established by the Plan Administrator. All such claims shall be filed not more than one year after the Applicant knows, or with the exercise of reasonable diligence should have known, of the basis for such claim. The preceding sentence shall not be construed to require a Participant or Beneficiary to file a formal claim for the payment of undisputed benefits in the normal course, but any claim that relates to the amount of any benefit shall in any event be filed not more than one year after payment of such benefit commences. The Plan Administrator may retain third party Plan Administrators and recordkeepers for the purpose of processing routine matters relating to the payment of benefits, but correspondence between a Participant, Beneficiary or other person and such third parties shall not be considered claims for purposes of this Section, and a person shall not be considered a Applicant until he has filed a written claim for benefits under this Agreement with the Plan Administrator. All claims for benefits shall be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially deniedprocessed by the Plan Administrator, notice of and the decision Plan Administrator shall be furnished to furnish the claimant Applicant within a reasonable period of time, not to exceed 90 days after receipt of the such claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, a written notice of that specifies the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons reason for the denial; (ii) specific reference , refers to the pertinent provisions upon of the Plan on which the denial is based; (iii) a description of , describes any additional material or information necessary for the claimant to perfect properly completing the claim and an explanation of explains why such material or information is necessary; , and (ivexplains the claim review procedures of this Section 3.8, and the Applicant’s right to bring an action under Section 502 of ERISA, subject to the restrictions of paragraph 502(e) if the request for review is unsuccessful. The 90 day period may be extended by up to an additional 90 days if the Plan Administrator so notifies the Applicant prior to the end of the initial 90 day period, which notice shall include an explanation of the Agreement’s claims review procedure as set forth belowreason for the extension and an estimate of when the processing of the claim will be complete. The claimant may appeal If the denial Plan Administrator determines that additional information is necessary to process the claim, the Applicant shall be given a period not less than 45 days to furnish the information, and the time for responding to the claim shall be tolled during the period of his claim to Company time beginning on the date on which the Applicant is notified of the need for a full the additional information and fair review. A claimant the day on which the information is furnished (or his duly authorized representative) may request a review by filing a written application if earlier the end of the period for review with furnishing the Administrator at any time information). If the claim is denied in whole or in part, or if the decision on the claim is otherwise adverse, the Applicant may, within 60 days after receipt by the claimant of written notice such notice, request a review of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments decision in writing. The decision on review shall be made by If the Administrator, who may, in its or his/her discretion, hold Applicant requests a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time the Compensation Committee (or such other fiduciary as the Compensation Committee may appoint for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of timepurpose) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on reviewsuch decision. The Compensation Committee’s decision on review shall be in writing and furnished not more than five days after the meeting at which the review is completed, and shall include specific reasons for the decision, written in a manner calculated to be understood by the claimantApplicant, and shall include specific references to the pertinent provisions in of the relevant documents Plan on which the decision is based, and shall advise the Applicant of his right to bring an action under Section 502 of ERISA, subject to the limitations set forth below. The Compensation Committee’s decision on review shall be delivered to the Applicant not more than 60 days after the request for review is received, which may be extended to not more than 120 days if special circumstances require and Applicant is notified of the extension by the end of the initial 60 day period, which notice shall explain the reason for the delay and include an estimate of the time at which the review will be complete As additional consideration for receipt of benefits hereunder, each Participant agrees and covenants, on behalf of himself, his Beneficiaries, and all persons claiming through him, not to initiate any action before any court, under Section 502 of ERISA or otherwise, or before any administrative agency or quasi-judicial tribunal, for any benefit under the Plan, without having first filed a claim for such benefit and requested review of any adverse decision on such claim in accordance with this Section and the procedures established by the Plan Administrator pursuant to this Section, and in any event not more than 180 days after receipt of the decision on review of the adverse claim decision.
Appears in 1 contract
Sources: Executive Deferred Compensation Plan (Alberto Culver Co)
Claims Procedure. Any All claims for benefits hereunder will be ---------------- directed to the Committee or to a member of the Committee designated for that purpose. Within 90 days following receipt of a claim for benefits, the Committee will determine whether the claimant is entitled to benefits under this Agreement shall be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by CompanyPlan, unless special circumstances require an extension of additional time is required for processing the claim. If such an extension of time is requiredIn this event, written notice of the extension shall be furnished to the claimant prior to the termination of Committee will, within the initial 90-day period. In no event shall such extension exceed , notify the period claimant that additional time is needed, explain the reason for the extension, and indicate when a decision on the claim will be made, which must be within 180 days of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decisionclaim is filed. Company shall provide every claimant who is denied A denial by the Committee of a claim for benefits will be stated in writing and delivered or mailed to the claimant. The notice will set forth the specific reasons for the denial, written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) claimant without benefit of legal or actuarial counsel. The notice will include specific reference to pertinent the Plan provisions upon on which the denial is based; (iii) based and a description of any additional material or information necessary for the claimant to perfect the claim and claim, an explanation of why such this material or information is necessary; , and (iv) an explanation the steps to be taken if the claimant wishes to submit his or her claim for review. The Committee will afford a reasonable opportunity to any claimant whose request for benefits has been denied for a review of the Agreement’s claims review procedure as set forth belowdecision denying the claim. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review must be requested by filing a written application for review with to the Administrator at any time Committee within 60 days after following receipt by the claimant of written notice notification of the denial of his or her claim. The Pursuant to this review, the claimant or his or her duly authorized representative may request, upon written application review any documents which are pertinent to Company, to review pertinent documents, the denied claim and submit issues and comments in writing. The A decision on review shall the claimant's appeal of the denial of benefits will ordinarily be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than Committee within 60 days after Company receives of the receipt of the request for review, unless special circumstances require extension of additional time is required for processinga decision on review, in which case a event the decision shall will be rendered as soon as possible, but reviewed not later than 120 days after receipt of the request for reviewruling. If such an extension of time for review is required, written Written notice of the need for an extension (including the special circumstances requiring the extension of time) shall will be furnished given to the claimant prior to the commencement within 60 days of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on his or her request for review. The decision on review shall will be in writing and shall will include specific reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references reference to the pertinent Plan provisions in the relevant documents on which the decision is based.
Appears in 1 contract
Sources: Qualified Stock Ownership Plan and Trust Agreement (United Parcel Service of America Inc)
Claims Procedure. Any claim (a) All claims for benefits or for determination of the qualified status of a domestic relations order under this Agreement Plan shall be made filed in writing with the Plan Administrator in accordance with such procedures as the Plan Administrator shall reasonably establish.
(b) The Plan Administrator shall, within ninety (90) days of submission of a claim, provide adequate notice in writing to Companyany claimant whose claim has been denied. If any claim for benefits under this Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension Such notice shall indicate contain the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reason or reasons for the denial; (ii) denial and references to specific reference to pertinent Plan provisions upon on which the denial is based; (iii) . The Plan Administrator will also provide the claimant with a description of any additional material or information which is necessary in order for the claimant to perfect the his claim and an explanation of why such material or information is necessary; and (iv) . If special circumstances require an explanation extension of time for processing the claim, the Plan Administrator shall furnish the claimant a written notice of such extension prior to the expiration of the Agreement’s claims review procedure as set forth belowninety (90) day period. The extension notice shall indicate the reasons for the extension and the expected date for a final decision, which date shall not be more than one hundred and eighty (180) days from the initial claim.
(c) The Plan Administrator shall, upon written request by a claimant may appeal submitted to the denial Plan Administrator within sixty (60) days of the claimant's receipt of the notice that his claim had been denied, afford a reasonable opportunity to Company such claimant, for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Plan Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his decision denying the claim. The Plan Administrator will afford the claimant or his duly authorized representative may request, upon written application to Company, the opportunity to review pertinent documents, documents and to submit issues and comments in writing. The claimant shall have the right to be represented.
(d) The Plan Administrator shall, within sixty (60) days of receipt of a request for a review, render a written decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless . If special circumstances require extension of extra time for processingthe Plan Administrator to review the decision, in which case a decision shall be rendered the Plan Administrator will attempt to complete the review as soon as possiblepracticable, but not later and in no event will the Plan Administrator take more than 120 one hundred and twenty (120) days after receipt of to send the request for review. If such an extension of time for review is required, claimant a written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 1 contract
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company (“Administrator”), whose address is 4▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, and whose telephone number is (▇▇▇) ▇▇▇-▇▇▇▇. The “Named Fiduciary” as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive (“the Claimant”) shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant Claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant Claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant Claimant to perfect the claim and claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Administrator’s claims review procedure as set forth below. The claimant ability in a manner that may appeal the denial of his be understood without legal or actuarial counsel.
(c) A Claimant whose claim to Company for a full and fair review. A claimant (benefits has been wholly or his duly authorized representative) may request a review partially denied by filing a written application for review with the Administrator at any time may request, within 60 days after following the date of such denial, in a writing addressed to the Administrator, a review of such denial. The Claimant shall be entitled to submit such issues or comments in writing or otherwise, as the Claimant shall consider relevant to a determination of the claim, and the Claimant may include a request for a hearing in person before the Administrator. Prior to submitting the request, the Claimant shall be entitled to review such documents as are pertinent to the claim. The Claimant may, at all stages of review, be represented by counsel, legal or otherwise, of the Claimant’s choice. All requests for review shall be promptly resolved. The Administrator’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Claimant not later than 10 days following receipt by the claimant of written notice Administrator of the denial of his claim. The claimant or his duly authorized representative may requestClaimant’s request unless special circumstances, upon written application such as the need to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptlyhearing, and not later than 60 days after Company receives the request for review, unless special circumstances require an extension of time for processing, in which case a the Administrator’s decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A Claimant who has followed the request procedure in paragraphs (b) and (c) of this Section, but who has not obtained full relief on the claim for benefits, may, within 60 days following the Claimant’s receipt of the Administrator’s written decision on review, apply in writing to the Administrator for binding arbitration of the claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Plymouth, Michigan, in accordance with the arbitration rules of the American Arbitration Association, Commercial Disputes Resolution Procedures, as then in effect. If such the parties are unable to mutually agree upon an extension arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of time for review is requiredwhich shall be designated by the Company, written notice one of which shall be designated by the Claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the arbitration rules referenced above. The arbitrator(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of the extension (including Agreement’s provisions. The arbitrator(s) shall have the special circumstances requiring power to compel attendance of witnesses at the extension hearing. Any court having jurisdiction may enter a judgment based upon such arbitration. All decisions of timethe arbitrator(s) shall be furnished final and binding on the Claimant and the Company without appeal to any court. The Executive and the claimant prior Company hereby acknowledge that as arbitration is the exclusive remedy with respect to any grievance hereunder, neither party has the commencement right to resort to any federal, state or local court or administrative agency concerning breaches of this Agreement, and the decision of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim arbitrator shall be deemed denied on review. The decision on review shall be a complete defense to any suit, action or proceeding instituted in writing and shall include reasons for the decisionany federal, written in a manner calculated state or local court or before any administrative agency with respect to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on any dispute which the decision is basedarbitrable as herein set forth.
Appears in 1 contract
Claims Procedure. Any Claim forms or claim for benefits information as to the subject Policy can be obtained by contacting: ▇▇▇▇▇▇ & ▇▇▇▇▇▇▇ Financial Services, Inc. ---------------------------------------------------------------------- . -------- (Agent or Agency) When the Named Fiduciary has a claim which may be covered under this Agreement shall the provisions described in an insurance Policy, he or she should contact the office or the person named above who will either complete a claim form and forward it to an authorized representative of the Insurer or advise the Named Fiduciary what further requirements are necessary. The Insurer will evaluate the claim and make a decision as to payment within 90 days of the date the claim is received by the Insurer. If the claim is payable, a benefit check will be issued to the Named Fiduciary and forwarded through the office or person named above. In the event that a claim is not eligible under a Policy, the Insurer will notify the Named Fiduciary of the denial. Such notification will be made in writing to Company. If any claim for benefits under this Agreement is wholly or partially denied, notice within 90 days of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of date the claim by Company, unless special circumstances require an extension of time for processing is received and will be transmitted through the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial periodoffice or person named above. The extension notice shall indicate notification will include the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) denial as well as specific reference to pertinent the policy provisions upon which the denial is based; (iii) . The Named Fiduciary will also be informed as to the steps which may be taken to have the claim denial reviewed. A decision as to the validity of a claim will ordinarily be made within 10 working days of the date the claim is received by the Insurer. Occasionally, however, certain questions may prevent the Insurer from rendering a decision on the validity of the claim within the specific 90-day period. If this occurs, the Named Fiduciary will be notified of the reasons for the delay as well as the anticipated length of the delay, in writing and through the office or person named above. If further information or other material is required, the Named Fiduciary will be so informed. If the Named Fiduciary is dissatisfied with the denial of the claim or the amount paid, he or she has 60 days from the date he or she receives notice of a claim denial to file his or her objections to the action taken by the Insurer. If the `Named Fiduciary wishes to contest a claim denial, he or she should notify the person or office named above who will assist in making inquiry to the Insurer. All objections to the Insurer's actions should be in writing and submitted to the person or office named above for transmittal to the Insurer. The Insurer will review the claim denial and render a decision on such objections. The Named Fiduciary will be informed in writing of the decision of the Insurer within 60 days of the date the claim request is received by the Insurer. This decision will be final. Once a decision has been rendered as to the distribution of Policy proceeds under the claim procedure described above, claims for any benefits due under the Plan or the surrender of a Policy may be made in writing by the Bank or the Bank's designated representative and Employee or his designated beneficiary, as the case may be, to the Named Fiduciary. In the event a claim for benefits is wholly or partly denied or disputed, the Named Fiduciary shall, within a reasonable period of time after receipt of the claim, notify the Bank or the Bank's designated representative and Insured or his designated beneficiary, as the case may be, of such total or partial denial or dispute listing:
A. The specific reason or reasons for the denial or dispute;
B. Specific reference to pertinent plan provisions upon which the denial or dispute 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 (iv) an and,
D. An explanation of the Agreement’s claims Plan's review procedure as set forth belowprocedure. The Within 60 days of denial or notice of claim under the Plan, a claimant may appeal request that the denial of his claim to Company for be reviewed by the Named Fiduciary in a full and fair reviewhearing. A claimant (or his duly authorized representative) may request a review final decision shall be rendered by filing a written application for review with the Administrator at any time Named Fiduciary within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 1 contract
Claims Procedure. Any A. A Participant or Beneficiary ("claimant") with an interest in the Plan shall have the right to file a claim for benefits under this Agreement 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 made considered to be a claim. An authorized representative of the claimant may act on behalf of the claimant in writing 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 Companyprovide reasonable written proof that the representative has in fact been authorized to act on behalf of the claimant. If any 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 plan administrator. A claim must be submitted in writing on such form or forms as required by the plan administrator; provided, that the plan administrator, in its discretion, may accept a written claim submitted otherwise than on the Plan's form or forms. The claim may be delivered personally during normal business hours or mailed to the plan administrator.
C. The plan administrator, acting through such agent or agents as it may appoint, will determine whether, or to what extent, the claim may be allowed or denied under this Agreement the terms of the Plan. In the case of a claim for disability benefits, such agent or agents must be someone other than a Claims Appeal Committee member and may not be any person to whom any member of the Claims Appeal Committee is subordinate. If the claim is wholly or partially denied, notice the plan administrator shall notify the claimant of the decision shall be furnished to the claimant Plan's adverse benefit determination within a reasonable period of time, but not to exceed later than 90 days (not later than 45 days in the case of a claim for disability benefits) after receipt of the claim by CompanyPlan receives the claim, unless the plan administrator determines that special circumstances require an extension of time for processing the claim. Extensions for claims other than a claim for disability benefits. 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. In no event shall such Such extension may not exceed the period of an additional 90 days from the end of such the initial 90-day period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on by which the Plan expects to render the final decision. Extensions for claims for disability benefits. The 45-day period may be extended by the Plan for up to 30 days, provided that the plan administrator both determines that such an extension is necessary due to matters beyond the control of the Plan and notifies the claimant, prior to the expiration of the initial 45-day period, of the circumstances requiring the extension of time and the date by which the Plan expects to render a final decision. If, prior to the end of the first 30-day extension period, the plan administrator determines that, due to matters beyond the control of the Plan, a decision cannot be reached within the extension period, the period for making the determination may be extended for up to an additional 30 days, provided that the plan administrator notifies the claimant prior to the expiration of the first 30-day extension period, of the circumstances requiring an extension and the date as of which the Plan expects to render a decision. Company The notice of any extension shall provide every claimant who specifically explain the standards on which entitlement to a benefit is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimantbased, the following: (i) specific reasons for unresolved issues that present a decision on the denial; (ii) specific reference claim, and the additional information needed to pertinent provisions upon which the denial is based; (iii) 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 (iv) an explanation of the Agreement’s claims review procedure as set forth belowresolve those issues. The claimant may appeal the denial of his claim to Company for a full and fair review. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by afforded at least 45 days within which to provide the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedspecified information.
Appears in 1 contract
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company ("Administrator"), whose address is Champion Enterprises, Inc., 2701 ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇, ▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇ ▇▇▇▇▇ ▇▇▇ whose telephone number is (248) 340-9090. The "Named Fiduciary" as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive ("the claimant") shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and his claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreement’s claims best of the Administrator's ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within 10 days following the date of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant may appeal the denial shall be entitled to submit such issues or comments in writing or otherwise, as he shall consider relevant to a determination of his claim to Company claim, and he may include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting his request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of shall agree are pertinent to his claim. The claimant may, at all stages of review, be represented by counsel, legal or otherwise, of his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writingchoice. The decision on All requests for review shall be made by promptly resolved. The Administrator's decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 10 days after Company receives following receipt by the Administrator of the claimant's request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator's decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this section, but who has not obtained full relief on his claim for benefits, may, within 60 days following his receipt of the Administrator's written decision on review, apply in writing to the Administrator for binding arbitration of his claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Detroit, Michigan, in accordance with the commercial arbitration rules of the American Arbitration Association, as then in effect. If the parties are unable to mutually agree upon an arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of which shall be designated by the Company, one of which shall be designated by the claimant and the third of which shall be designated mutually by the first two arbitrators in accordance with the commercial arbitration rules referenced above. The arbitrator(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of its provisions. The arbitrator(s) shall have the power to compel attendance of witnesses at the hearing. Any court having jurisdiction may enter a judgment based upon such an extension of time for review is required, written notice arbitration. All decisions of the extension (including the special circumstances requiring the extension of timearbitrator(s) shall be furnished to final and binding on the claimant prior and the Company without appeal to the commencement any court. Upon execution of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraphAgreement, the claim Executive shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for to have waived his right to commence litigation proceedings outside of arbitration without the decision, express written in a manner calculated to be understood by consent of the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedCompany.
Appears in 1 contract
Sources: Change in Control Agreement (Champion Enterprises Inc)
Claims Procedure. Any (a) The Committee shall prescribe a form for the presentation of claims under the terms of this Agreement.
(b) Upon presentation to the Committee of the claim for benefits under this Agreement on the prescribed form, the Committee shall be made in writing to Companymake the determination of the validity thereof. If any claim for benefits under this Agreement the determination is wholly or partially deniedadverse to the claimant, notice of the decision Committee shall be furnished furnish to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 90-day period. In no event shall such extension exceed the period of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, forth the following: :
(i) The specific reason or reasons for the denial; ;
(ii) specific reference Specific references to pertinent provisions upon of the Agreement on which the denial is based; ;
(iii) a A description of any additional material materials or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; and and
(iv) an explanation Appropriate information as to the steps to be taken if the claimant wishes to submit his or her claim for review.
(c) In the event of a denial of a claim, the Agreement’s claims review procedure as set forth below. The claimant or his or her duly authorized representative may appeal such denial to the denial of his claim to Company Committee for a full and fair reviewreview of the adverse determination. A claimant (or his duly authorized representative) may The claimant’s request for a review by filing a written application for review with must be in writing and made to the Administrator at any time Committee within 60 days after receipt by the claimant of the written notice of notification required under paragraph (b) above; provided, however, such 60-day period shall be extended if the denial of his claimcircumstances so warrant. The claimant or his or her duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall writing which will be made given full consideration by the Administrator, who Committee in its review.
(d) The Committee may, in its or his/her sole discretion, hold conduct a hearing. A request for a hearing on made by the denied claim; claimant will be given full consideration. At such hearing, the Administrator claimant shall be entitled to appear and present evidence and to be represented by counsel.
(e) The Committee shall make this a decision promptly, and on a request for review not later than 60 days after Company receives receipt of the request for reviewrequest; provided, unless special circumstances require extension of time for processinghowever, in which case the event of a hearing or other special circumstances, such decision shall be rendered as soon as possible, but made not later than 120 days after receipt of the request for reviewsuch request. If such an it is necessary to extend the period of time for making a decision beyond 60 days after the receipt of the request, the claimant shall be notified in writing of the extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement beginning of such extension.
(f) The Committee’s decision on review shall state in writing the specific reasons and references to the provisions of the extensionAgreement upon which it is based. In Such decision shall be promptly provided to the event that claimant. If the decision on review is not furnished within in accordance with the time period set forth in this paragraphforegoing, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 1 contract
Sources: Supplemental Executive Retirement Plan Agreement (Tasty Baking Co)
Claims Procedure. Any claim for benefits under this Agreement the Plan shall be made in writing and submitted to Company. If any claim for benefits the Plan Administrator, who shall reach a decision as soon as reasonable under this Agreement is wholly the circumstances and notify the claimant, or partially deniedhis duly authorized representative, notice thereof promptly (and, except as provided herein, within ninety (90) days of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim claim) in writing by Companymail addressed to the last known address of the claimant or such representative, unless as the case may be, appearing on the records of the Plan Administrator. If the Plan Administrator determines that special circumstances require an extension of time for processing the claim. If such , the Plan Administrator shall have up to an extension of time is required, written additional 90 days to respond provided he gives notice of the extension shall be furnished extension, the reasons therefor, and the expected date of response to the claimant prior to the termination end of the initial 90-day period. In no event If the claim shall such extension exceed be denied, in whole or in part, the period of 90 days from the end of such initial period. The extension notice thereof shall indicate the special circumstances requiring an extension of time be by certified mail, return receipt requested, and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting set forth, in a manner reasonably calculated to be understood by understood:
(a) the claimant, the following: (i) specific reason or reasons for the denial; ;
(iib) specific reference to pertinent Plan provisions upon on which the denial is based; ;
(iiic) a description of any additional material or information necessary for to be submitted by the claimant in order to perfect the claim his claim, and an explanation of why such material or information is necessary; and and
(ivd) an explanation of the AgreementPlan’s claims claim review procedure as set forth belowand time limits, and a statement of the claimant’s right to bring a civil lawsuit. The claimant may appeal Upon denial, in whole or in part, of a claim by the denial of his claim to Company for a full and fair review. A claimant (Plan Administrator, the claimant, or his duly authorized representative, as the case may be, may, within the period ending ninety (90) may days from the date of receipt of the denial as aforesaid:
(e) request a review thereof, by filing a written application for review with the Administrator at any time within 60 days after receipt Trustees or a committee thereof;
(f) upon request, review pertinent documents, records, and other information and obtain copies free of charge; and
(g) submit comments, documents, records, and other information relating to the claim in writing. Documents, records, and other information are “pertinent” if they were relied upon in making the determination on the claim or if they were submitted, considered, or generated in the course of making the benefit determination. The Trustees, or a committee thereof shall constitute the review board, which shall fully review such request, review all comments, documents, records, and other information submitted by the claimant of written notice of relating to the denial of his claim. The , without regard to whether such information was submitted or considered in the initial benefit determination, hold any hearing deemed appropriate by such review board, and notify the claimant or his duly authorized representative representative, as the case may requestbe, upon written application to Companyof the decision in writing as soon as practicable, to review pertinent documents, and submit issues and comments but in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not no event later than 60 sixty (60) days after Company receives receipt of the written request for review; provided, unless however, if a hearing is requested or if the Trustees determine that special circumstances require extension exist, the Trustees shall have up to an additional sixty (60) days to respond provided they give notice of time for processingthe extension, in which case a decision the reasons therefor, and the expected date of response to the claimant prior to the end of the initial 60-day period; provided further, if the Trustees have regularly scheduled quarterly meetings, their response date shall be rendered as soon as possible, but not later than 120 up to five (5) days after the next regularly scheduled meeting which comes at least thirty (30) days after their receipt of the request for review. If such an extension In no event, however, shall the Trustees respond later than five (5) days following the third regularly scheduled meeting after the receipt of time the request for review is required, written review. Such notice of the extension (including the special circumstances requiring the extension of time) decision on appeal shall be furnished written in a manner reasonably calculated to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraphbe understood, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include the specific reasons for the decision, written in a manner calculated to be understood by the claimant, and shall set forth specific references to the pertinent Plan provisions in the relevant documents on which the decision rests. The use of the claims procedure of this Subsection is basedmandatory in pursuing claims for benefits. Except as otherwise provided, failure to file a claim by the end of the Plan Year following the Plan Year in which the individual knew or should have known of the claim shall constitute an irrevocable waiver of the claim unless it shall be shown not to have been reasonably possible to furnish proof within the specified time period, and that proof was furnished as soon as was reasonably possible, in which case failure to furnish proof within the time provided shall not invalidate nor reduce the claim. Failure to raise issues or present evidence at any stage in the claims procedure shall preclude those issues or evidence from being presented in a judicial review of the claim. If any time limitation of the Plan with respect to furnishing proof of loss or bringing of an action at law or in equity is less than that permitted by ERISA, such limitation is hereby extended to agree with the minimum period permitted by such law. In the event the Plan Administrator or the Trustees extend the time for response due to the claimant’s failure to provide information necessary to decide the claim, the period for the benefit determination shall be tolled from the date notice of the extension is sent to the claimant until the claimant responds to the request for additional information. The Plan Administrator may implement reasonable procedures for ensuring that an individual has been authorized to act on behalf of a claimant.
Appears in 1 contract
Claims Procedure. The Company shall determine the rights of any claimant to any Severance Compensation hereunder. Any claim for benefits claimant who believes that he has not received any benefit under this Agreement shall be made to which he believes he is entitled, may file a claim in writing to Companywith the Executive Vice President, Human Resources. If any claim for benefits under this Agreement is wholly or partially deniedThe Company shall, notice of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed no later than 90 days after the receipt of a claim, either allow or deny the claim by Company, unless special circumstances require an extension of time for processing written notice to the claimclaimant. If such an extension of time is required, a claimant does not receive written notice of the extension shall be furnished to the claimant prior to the termination of the initial Company’s decision on his claim within such 90-day period, the claim shall be deemed to have been denied in full. In no event shall such extension exceed the period A denial of 90 days from the end of such initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits by the Company, wholly or partially, shall be written notice setting forth, in a manner calculated to be understood by the claimant, the following: claimant and shall include:
(i) the specific reason or reasons for the denial; ;
(ii) specific reference to pertinent provisions upon of this Agreement on which the denial is based; ;
(iii) 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 and
(iv) an explanation of the Agreement’s claims claim review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair reviewprocedure. A claimant whose claim is denied (or his duly authorized representative) may may, within 30 days after receipt of denial of his claim, request a review of such denial by the Company by filing with the Secretary of the Company a written application request for review of his claim. If the claimant does not file a request for review with the Administrator at any time Company within such 30-day period, the claimant shall be deemed to have acquiesced in the original decision of the Company on his claim. If a written request for review is so filed within such 30-day period, the Company shall conduct a full and fair review of such claim. During such full review, the claimant shall be given the opportunity to review documents that are pertinent to his claim and to submit issues and 2015 Form A&R CIC Agrt -13- comments in writing. The Company shall notify the claimant of its decision on review within 60 days after receipt by the claimant of written notice a request for review. Notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writing. The decision on review shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than 60 days after Company receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than 120 days after receipt of the request for reviewwriting. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished to the claimant within the time period set forth in this paragraphsuch 60-day period, the claim shall be deemed to have been denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.
Appears in 1 contract
Sources: Change in Control Severance Agreement (Cliffs Natural Resources Inc.)
Claims Procedure. Any (a) Executive, or other person claiming through Executive, must file a written claim for benefits with the Board as a prerequisite to the payment of benefits under this Agreement Agreement. The Board shall be made in writing make all determinations as to Companythe right of any person to receive benefits under subsections (a) and (b) of this Section 10. If any Any denial by the Board of a claim for benefits under this Agreement is wholly by Executive, his heirs or partially denied, notice of personal representative (“the decision claimant”) shall be furnished stated in writing by the Board and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and his claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreementbest of the Board’s claims ability in a manner that may be understood without legal or actuarial counsel.
(b) A claimant whose claim for benefits has been wholly or partially denied by the Board may request, within 10 days following the date of such denial, in a writing addressed to the Board, a review procedure as set forth belowof such denial. The claimant may appeal the denial shall be entitled to submit such issues or comments in writing or otherwise as he shall consider relevant to a determination of his claim to Company claim, and he may include a request for a full and fair reviewhearing in person before the Board. A claimant (or Prior to submitting his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by request, the claimant of written notice of shall be entitled to review such documents as the denial of Board shall agree are pertinent to his claim. The claimant may, at all stages of review, be represented by counsel, legal or otherwise, of his duly authorized representative may requestchoice, upon written application to Company, to review pertinent documents, provided that such fees and submit issues and comments in writingexpenses shall be borne by the Corporation. The decision on All requests for review shall be made by promptly resolved. The Board’s decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 10 days after Company receives following receipt by the Board of the claimant’s request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Board’s decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(c) A claimant who has followed the request procedure in subsections (a) and (b) of this section, but who has not obtained full relief on his claim for review. If benefits, may submit such claim for expedited and binding arbitration of his claim before an extension of time for review is requiredarbitrator in Hennepin County, written notice Minnesota, in accordance with the commercial arbitration rules of the extension American Arbitration Association, as then in effect, or pursuant to such other form of alternative dispute resolution as the parties may agree (including collectively, the special circumstances requiring “arbitration”). The Corporation shall advance the extension filing fees, arbitrator fees and other costs required to conduct the arbitration, as well as Executive’s attorney fees (which fees and costs shall not be recoverable by the Corporation). The Corporation shall reimburse all of time) Executive’s remaining reasonable fees and expenses. The arbitrator’s sole authority shall be furnished to interpret and apply the provisions of this Agreement; the arbitrator shall not change, add to, or subtract from, any of its provisions. The arbitrator shall have the power to compel attendance of witnesses at the hearing. Any court having competent jurisdiction may enter a judgment based upon such arbitration. The arbitrator shall be appointed by mutual agreement of the Corporation and the claimant pursuant to the applicable commercial arbitration rules. The arbitrator shall be a professional person with a national reputation for expertise in employee benefit matters and who is unrelated to the claimant prior to the commencement and any employees of the extensionCorporation. In All decisions of the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim arbitrator shall be deemed denied final and binding on review. The decision on review shall be in writing the claimant and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedCorporation.
Appears in 1 contract
Sources: Employment Agreement (Regis Corp)
Claims Procedure. Any claim (a) The administrator for benefits under purposes of this Agreement shall be made the Company ("Administrator"), whose address is Champion Enterprises, Inc., ▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇, ▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇ ▇▇▇▇▇ and whose telephone number is (▇▇▇) ▇▇▇-▇▇▇▇. The "Named Fiduciary" as defined in writing to Section 402(a)(2) of ERISA, also shall be the Company. If The Company shall have the right to designate one or more Company employees as the Administrator and the Named Fiduciary at any time, and to change the address and telephone number of the same. The Company shall give the Executive written notice of any change in the Administrator and Named Fiduciary, or in the address or telephone number of the same.
(b) The Administrator shall make all determinations as to the right of any person to receive benefits under the Agreement. Any denial by the Administrator of a claim for benefits under this Agreement is wholly or partially denied, notice of by the decision Executive ("the claimant") shall be furnished stated in writing by the Administrator and delivered or mailed to the claimant within a reasonable period of time, not to exceed 90 10 days after receipt of the claim by Companyclaim, unless special circumstances require an extension of time for processing the claim. If such an extension of time is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 9010-day period. In no event shall such extension exceed the a period of 90 10 days from the end of such the initial period. The extension Any notice of denial shall indicate set forth the special circumstances requiring an extension of time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) , specific reference to pertinent provisions of this Agreement upon which the denial is based; (iii) , a description of any additional material or information necessary for the claimant to perfect the claim and his claim, with an explanation of why such material or information is necessary; , and (iv) an any explanation of claim review procedures, written to the Agreement’s claims best of the Administrator's ability in a manner that may be understood without legal or actuarial counsel.
(c) A claimant whose claim for benefits has been wholly or partially denied by the Administrator may request, within 10 days following the date of such denial, in a writing addressed to the Administrator, a review procedure as set forth belowof such denial. The claimant may appeal the denial shall be entitled to submit such issues or comments in writing or otherwise, as he shall consider relevant to a determination of his claim to Company claim, and he may include a request for a full and fair reviewhearing in person before the Administrator. A Prior to submitting his request, the claimant (or his duly authorized representative) may request a shall be entitled to review by filing a written application for review with such documents as the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of shall agree are pertinent to his claim. The claimant may, at all stages of review, be represented by counsel, legal or otherwise, of his duly authorized representative may request, upon written application to Company, to review pertinent documents, and submit issues and comments in writingchoice. The decision on All requests for review shall be made by promptly resolved. The Administrator's decision with respect to any such review shall be set forth in writing and shall be mailed to the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and claimant not later than 60 10 days after Company receives following receipt by the Administrator of the claimant's request for review, unless special circumstances circumstances, such as the need to hold a hearing, require an extension of time for processing, in which case a the Administrator's decision shall be rendered as soon as possible, but so mailed not later than 120 20 days after receipt of such request.
(d) A claimant who has followed the request procedure in paragraphs (b) and (c) of this section, but who has not obtained full relief on his claim for benefits, may, within 60 days following his receipt of the Administrator's written decision on review, apply in writing to the Administrator for binding arbitration of his claim before an arbitrator mutually acceptable to both parties, the arbitration to be held in Detroit, Michigan, in accordance with the commercial arbitration rules of the American Arbitration Association, as then in effect. If the parties are unable to mutually agree upon an arbitrator, then the arbitration proceedings shall be held before three arbitrators, one of which shall be designated by the Company, one of which shall be designated by the claimant and the third of which shall be designated by the first two arbitrators in accordance with the commercial arbitration rules referenced above. The arbitrator
(s) sole authority shall be to interpret and apply the provisions of this Agreement; the arbitrator(s) shall not change, add to, or subtract from, any of its provisions. The arbitrator(s) shall have the power to compel attendance of witnesses at the hearing. Any court having jurisdiction may enter a judgment based upon such an extension of time for review is required, written notice arbitration. All decisions of the extension (including the special circumstances requiring the extension of timearbitrator(s) shall be furnished to final and binding on the claimant prior and the Company without appeal to the commencement any court. Upon execution of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraphAgreement, the claim Executive shall be deemed denied on reviewto have waived his right to commence litigation proceedings outside of arbitration without the express written consent of the Company. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is based.Exhibit 10.40
Appears in 1 contract
Sources: Change in Control Severance Agreement (Champion Enterprises Inc)
Claims Procedure. Any claim for In the event that any Participant or Beneficiary claims to be entitled to benefits under this Agreement the Plan and the Administrative Committee determines that such claim should be denied in whole or in part, the Administrative Committee shall, in writing, notify such claimant within 90 days of receipt of such claim that his claim has been denied, setting forth the specific reasons for such denial. Such notification shall be made written in writing a manner reasonably expected to Companybe understood by such Participant or Beneficiary and shall set forth the pertinent sections of the Plan relied on, and where appropriate, an explanation of how the claimant can obtain review of such denial. If any claim for benefits under this Agreement is wholly Within 60 days after the mailing or partially denieddelivery by the Administrative Committee of such notice, such claimant may request, by mailing or delivery of written notice to the Administrative Committee, a review and/or hearing by the Administrative Committee of the decision shall be furnished to the claimant within a reasonable period of time, not to exceed 90 days after receipt of the claim by Company, unless special circumstances require an extension of time for processing denying the claim. If the claimant fails to request such an extension of time is requireda review and/or hearing within such 60 day period, written notice of the extension it shall be furnished to conclusively determined for all purposes of this Plan that the denial of such claim by the Administrative Committee is correct. If such claimant prior to the termination of the initial 90-requests a hearing within such 60 day period. In no event , the Administrative Committee shall such extension exceed the period of 90 designate a time (which time shall not be less than 7 nor more than 60 days from the end date of such initial period. The extension claimant’s notice to the Administrative Committee) and a place for such hearing, and shall indicate the special circumstances requiring an extension promptly notify such claimant of such time and the date on which the administrator expects to render a decision. Company shall provide every claimant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: (i) specific reasons for the denial; (ii) specific reference to pertinent provisions upon which the denial is based; (iii) 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 (iv) an explanation of the Agreement’s claims review procedure as set forth below. The claimant may appeal the denial of his claim to Company for a full and fair reviewplace. A claimant (or his duly authorized representative) may request a review by filing a written application for review with the Administrator at any time within 60 days after receipt by the claimant of written notice of the denial of his claim. The claimant or his duly authorized representative may request, upon written application shall be entitled to Company, inspect all pertinent Plan documents and to review pertinent documents, and submit issues and comments in writing. The decision on If only a review is requested, the claimant shall be made by the Administrator, who may, in its or his/her discretion, hold a hearing on the denied claim; the Administrator shall make this decision promptly, and not later than have 60 days after Company receives the filing a request for reviewreview to submit additional written material in support of the claim. After such review and/or hearing, unless special circumstances require extension the Administrative Committee shall promptly determine whether such denial of time for processing, the claim was correct and shall notify such claimant in which case a decision shall be rendered as soon as possible, but not later than 120 writing of its determination with 60 days after such review and/or hearing or after receipt of the request for review. If such an extension of time for review is required, written notice of the extension (including the special circumstances requiring the extension of time) shall be furnished to the claimant prior to the commencement of the extension. In the event that the decision on review is not furnished within the time period set forth in this paragraph, the claim shall be deemed denied on review. The decision on review shall be in writing and shall include reasons for the decision, written in a manner calculated to be understood by the claimant, and specific references to the pertinent provisions in the relevant documents on which the decision is basedany additional information submitted.
Appears in 1 contract
Sources: Supplemental Executive Retirement Plan (Hughes Supply Inc)