2003-01-08 CC Packet - Laserfiche WebLink

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Section 6.2 Claims Procedure. The Plan Sponsor shall notify a person within thirty (30) days of receipt of a written claim for benefits of that person's eligibility or non-eligibility for benefits under the Plan. If it is determined that a person is not eligible for benefits or for full benefits, the notice shall set forth (1) the specific reasons for the denial, (2) a specific reference to the provision of the Plan on which the denial is based, (3) a description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why it is needed, and (4) an explanation of the Plan's claims review procedure and other appropriate information as to the steps to be taken if the Participant wishes to have the claim reviewed, including the Participant's right to review (on request and at no charge) relevant documents and other information. If the Employer determines that there are special circumstances requiring additional time to make a decision, which are beyond the control of the Employer (including cases where a claim is incomplete), the Employer shall notify the Participant in writing of the special circumstances and the date by which a decision is expected to be made, and may extend the time for up. to.an additional fifteen (15) days. Where a claim is incomplete, this extension notice will specifically describe the additional information that is required and will allow the Participant forty-five (45) days from the date the request is received to provide the specified information. The time for making a decision on the claim will be suspended until the information is provided. If a Participant is determined by the Employer not to be eligible for benefits, or if the Participant believes that he is entitled to greater or different benefits, the Participant shall have the opportunity to have the claim reviewed by the Employer by filing a petition for review within one hundred eighty (180) days after receipt by the Participant of the notice issued by the Employer. That petition shall state the specific reasons the Participant believes he is entitled to benefits or greater or different benefits and should include any additional facts or documents to support the claim and all other information relevant to the claim. The Participant will have the opportunity to ask additional questions, make written comments and review (upon request and at no charge) documents and other information relevant to the appeal. The Employer shall review and make a decision on the appeal within a reasonable time not longer than sixty (60) days after it is submitted. The Employer may hold a hearing for the review of your claim if you request and it decides such a hearing is necessary. The review and 20