Example ContractsClausesAppeal of Claims That Are Denied or Partially Denied
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Appeal of Claims That Are Denied or Partially Denied. The claimant may request review of the Claims Administrator's denial or partial denial of a claim for Plan benefits. Such request must be made in writing within sixty (60) days after claimant has received notice of the Claims Administrator's decision and shall include with the written request for an appeal any and all documents, materials, or other evidence which claimant believes supports his claim for benefits. The written request for an appeal, together with all documents, materials, or other evidence which claimant believes supports his claim for benefits should be addressed to the Claims Administrator, who will be responsible for submitting the appeal for review to the Claims Appeal Administrator.

Appeal of Claims that Are Denied or Partially Denied. 16

Within a reasonable period of time after the denial of the claim, but in any event, not to be more than sixty (60) days, the claimant or his/her duly authorized representative may make written application to the Committee for a review of such denial. The claimant or his/her representative, may, upon request and free of charge, review or receive copies of documents, records and other information relevant to the claimant’s claim for benefits, and may submit written comments, documents, records and other information relating to the claim for benefits.

an explanation of the procedure for review of the denied or partially denied claim set forth below, including the claimant’s right to bring a civil action

an explanation of the procedure for review of the denied or partially denied claim set forth below, including the claimant’s right to bring a civil action under ERISA [section 502(a)] following an adverse benefit determination on review.

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If a Participant’s appeal is denied, in whole or in part, he or she will be notified in writing of the specific reason(s) for the denial and the exact Plan provision(s) on which the decision was based. If a Participant is not notified within the 60-day (or 120-day, if so extended) period, he or she may consider the appeal as denied. Notwithstanding anything contained herein to the contrary, no Participant may file a lawsuit until these procedures have been exhausted, it being understood that these claims procedures shall not prevent a Participant from filing a lawsuit after the claims procedures have been exhausted.

A claimant who has a claim denied wholly or partially under [Section 9.2] may appeal to the Administrator for reconsideration of that claim. A request for reconsideration under this Section must be filed by written notice within sixty (60) days (one-hundred and eighty (180) days if the claim is on account of Disability) after receipt by the claimant of the notice of denial under [Section 9.2].

Express One asserted claims against the Parties in a lawsuit captioned [Express One Parties:Organization] v. , et al., in the Third Judicial District Court, Salt Lake County, Utah, Case No. 140905615. The Parties denied liability on the claims, and and asserted counterclaims in the Utah Lawsuit against the Express One Parties (collectively, the “Utah Lawsuit”). The Express One Parties denied liability on the counterclaims.

Restricted Subsidiaries That Are Not Excluded Subsidiaries. In the event that any Person becomes a direct or indirect Restricted Subsidiary of a Loan Party (other than an Excluded Subsidiary) or ceases to constitute an Excluded Subsidiary or Unrestricted Subsidiary or if any Excluded Subsidiary shall guarantee any Indebtedness of the Borrower or any other Loan Party in excess of the Threshold Amount during any fiscal quarter, promptly thereafter, and in any event on or prior to the date the next Compliance Certificate is required to be delivered pursuant to [Section 6.02(b)] in respect of such fiscal quarter (such date, as it may be extended by the Administrative Agent in its sole discretion, a “Quarterly Reporting Date”) # cause such Person to execute and deliver a Joinder Agreement and such other documents as the Administrative Agent shall reasonably request, # pledge and maintain a pledge of one hundred percent (100%) of the Equity Interests of such Subsidiary (subject to no Liens, other than Permitted Liens); (it being understood that, in the event the owner of such Equity Interests is not a Loan Party, such owner shall execute a deliver a Joinder Agreement and such other documents as the Administrative Agent shall reasonably request), and # deliver, and cause such Person to deliver, to the Administrative Agent documents of the types referred to in [[Sections 4.01(a)(iii), 4.01(a)(iv), 4.01(a)(viii), 4.01(a)(x) and 4.01(a)(ix)])])])])]])])], and, to the extent requested by the Administrative Agent, documents of the types referred to in [Section 4.01(a)(xi)], and favorable opinions of counsel to the Borrower and such Subsidiary (which shall cover, among other things, the legality, validity, binding effect and enforceability of the documentation executed pursuant to this [Section 6.11(a)]), all in form, content and scope reasonably satisfactory to the Administrative Agent.

Mortgage Capture — is calculated based on all closings net of cash sales and Mt. Laurels. In addition, certain denied or specialty loans that K. Hovnanian American Mortgage ("KHAM") cannot offer may be excluded from the capture rate provided that KHAM's conditions for backing out denied/specialty loans are met. The Mortgage Capture Award is evaluated and paid annually on the scheduled payout date,

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