Manner and Content of Denial of Initial Claims Sample Clauses
The "Manner and Content of Denial of Initial Claims" clause defines how an insurer or responsible party must communicate the denial of a claim to the claimant. It typically requires that denials be provided in writing and include specific reasons for the denial, referencing relevant policy provisions or factual findings. This ensures that claimants receive clear, detailed explanations for why their claims were not approved, promoting transparency and enabling claimants to understand their rights or pursue further action if necessary.
Manner and Content of Denial of Initial Claims. If the Plan Administrator denies a claim, it must provide to the Claimant, in writing or by electronic communication:
(A) The specific reasons for the denial;
(B) A reference to the Plan provision or insurance contract provision upon which the denial is based;
(C) A description of any additional information or material that the Claimant must provide in order to perfect the claim;
(D) An explanation of why such additional material or information is necessary;
(E) Notice that the Claimant has a right to request a review of the claim denial and information on the steps to be taken if the Claimant wishes to request a review of the claim denial; and
(F) A statement of the participant's right to bring a civil action under ERISA section 502(a) following a denial on review of the initial denial. In addition, in the case of a denial of disability benefits on the basis of the Plan Administrator's independent determination of the Participant's disability status, the Plan Administrator will provide a copy of any rule, guideline, protocol, or other similar criterion relied upon in making the adverse determination (or a statement that the same will be provided upon request by the Claimant and without charge).
Manner and Content of Denial of Initial Claims. If the Corporation denies a claim, it must provide to the Claimant, in writing or by electronic communication:
(i) The specific reasons for the denial;
(ii) A reference to the provision of the Agreement upon which the denial is based;
(iii) A description of any additional information or material that the Claimant must provide in order to perfect the claim;
(iv) An explanation of why such additional material or information is necessary;
(v) Notice that the Claimant has a right to request a review of the claim denial and information on the steps to be taken if the Claimant wishes to request a review of the claim denial; and
(vi) 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 amended (“ERISA”), following a denial on review of the initial denial.
Manner and Content of Denial of Initial Claims. If the Bank denies a claim, it must provide to the Claimant, in writing or by electronic communication:
(A) The specific reasons for the denial;
(B) A reference to the Agreement provision or insurance contract provision upon which the denial is based;
(C) A description of any additional information or material that the Claimant must provide in order to perfect the claim;
(D) An explanation of why such additional material or information is necessary;
(E) Notice that the Claimant has a right to request a review of the claim denial and information on the steps to be taken if the Claimant wishes to request a review of the claim denial; and
(F) A statement of the Executive’s right to bring a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974, as amended (“ERISA”) following a denial on review of the initial denial. In addition, in the case of a denial of Disability benefits on the basis of the Bank’s independent determination of the Executive’s Disability status, the Bank will provide a copy of any rule, guideline, protocol, or other similar criterion relied upon in making the adverse determination (or a statement that the same will be provided upon request by the Claimant and without charge).
Manner and Content of Denial of Initial Claims. If the Employer, administrator or other delegate denies a claim, it must provide to the Claimant, in writing or by electronic communication:
a. The specific reasons for the denial;
b. A reference to the Plan provision or insurance contract provision upon which the denial is based;
c. A description of any additional information or material that the Claimant must provide in order to perfect the claim;
d. An explanation of why such additional material or information is necessary;
e. Notice that the Claimant has a right to request a review of the claim denial and information on the steps to be taken if the Claimant wishes to request a review of the claim denial; and
f. A statement of the participant’s right to bring a civil action under ERISA §501(a) following a denial on review of the initial denial. In addition, in the case of a denial of Disability benefits on the basis of the Employer’s Administrator’s or other delegate’s independent determination of the Participant’s Disability status, the Employer, Administrator or other delegate, as applicable, will provide a copy of any rule, guideline, protocol, or other similar criterion relied upon in making the adverse determination (or a statement that the same will be provided upon request by the Claimant and without charge).