Common use of Initiation – Written Request Clause in Contracts

Initiation – Written Request. To initiate the review, the claimant, within 60 days (180 days with respect to a claim for benefits due to a claimant’s Disability) after receiving the Plan Administrator’s notice of denial, must file with the Plan Administrator a written request for review (or the Appeals Fiduciary, as described in Section 6.3 hereof) with respect to a claim for benefits due to a claimant’s Disability) a written request for review. With respect to a claim for Disability benefits, in deciding an appeal of any denial based in whole or in part on a medical judgment (including determinations with regard to whether a particular treatment, drug, or other item is experimental, investigational, or not medically necessary or appropriate), the Appeals Fiduciary shall: (a) consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment; and (b) identify the medical and vocational experts whose advice was obtained on behalf of the Plan Administrator in connection with the denial without regard to First Security Group, Inc. and FSGBANK, National Association Salary Continuation Agreement whether the advice was relied upon in making the determination to deny the claim. Notwithstanding the foregoing, the health care professional consulted pursuant to this Subsection 6.2.1 shall be an individual who was not consulted with respect to the initial denial of the claim that is the subject of the appeal or a subordinate of such individual.