Example ContractsClausesClaims for Benefits
Claims for Benefits
Claims for Benefits contract clause examples

Claims for Benefits. Claims for benefits under the Plan may be filed with the Plan Administrator on forms supplied by the Employer. For the purpose of this procedure, “claim” means a request for a Plan benefit by a Participant or a Beneficiary of a Participant. If the basis of the claim includes documentation not a part of the records of the Plan or of the Employer, all such documentation must be included with the claim.

Claims for Benefits. Claims for benefits under the Plan may be filed with the Plan Administrator on forms supplied by the Employer. For the purpose of this procedure, “claim” means a request for a Plan benefit by a Participant or a Beneficiary of a Participant. If the basis of the claim includes documentation not a part of the records of the Plan or of the Employer, all such documentation must be included with the claim.

Claims for Benefits. Claims for benefits or to enforce or clarify rights under the Plan, under any provision of law, whether statutory or not, may be filed with the Plan Administrator using forms supplied by the Employer. For the purpose of this procedure, “claim” means a request for a Plan benefit or to enforce or clarify rights under the Plan, under any provision of law, whether statutory or not, by a Participant or a Beneficiary of a Participant. If the basis of the claim includes documentation not a part of the records of the Plan or of the Employer, all such documentation must be included with the claim.

If the Participant or the Participant’s beneficiary (hereinafter referred to as the “Claimant”) is denied all or a portion of any expected benefit under this Plan for any reason, he may file a claim with the Committee. The Committee shall notify the Claimant within ninety (90) days of receipt of the claim of allowance or denial of the claim, unless the claimant receives written notice from the Committee prior to the end of the 90-day period stating the special circumstances requiring an extension of time for decision and the date by which a final decision shall be made. If a decision is not provided within 90 days, the claim is deemed denied, and the Claimant may proceed to request a review of the claim as described in subsection # below. The notice of a denial of benefits shall be in writing, sent by mail to Claimant’s last known address, and shall contain the following information: the specific reasons for the denial; specific reference to pertinent provisions of the Plan on which the denial is based; if applicable, a description of any additional information or material necessary to perfect the claim and an explanation of why such information or material is necessary; and explanation of the review procedure.

Claims for Benefits under this Plan. A condition precedent to receipt of severance benefits is the execution of an unaltered release of claims in form and substance prescribed by the Corporation. If an Eligible Officer believes that an individual should have been eligible to participate in the Plan or disputes the amount of benefits under the Plan, such individual may submit a claim for benefits in writing to the Committee within sixty 60 days after the individual’s termination of employment. If such claim for benefits is wholly or partially denied, the Committee will within a reasonable period of time, but no later than 90 days after receipt of the written claim, notify the individual of the denial of the claim. If an extension of time for processing the claim is required, the Committee may take up to an additional 90 days, provided that the Committee sends the individual written notice of the extension before the expiration of the original 90-day period. The notice provided to the individual will describe why an extension is required and when a decision is expected to be made. If a claim is wholly or partially denied, the denial notice: # will be in writing, # will be written in a manner calculated to be understood by the individual, and # will contain # the reasons for the denial, including specific reference to those plan provisions on which the denial is based; # a description of any additional information necessary to complete the claim and an explanation of why such information is necessary; # an explanation of the steps to be taken to appeal the adverse determination; and # a statement of the individual’s right to bring a civil action under [section 502(a)] of ERISA following an adverse decision after appeal. The Committee will have full discretion consistent with their fiduciary obligations under ERISA to deny or grant a claim in whole or in part. If notice of denial of a claim is not furnished in accordance with this section, the claim will be deemed denied and the claimant will be permitted to exercise his rights to review pursuant to [Sections 5.02 and 5.03]3].

Appeals of Denied Claims for Benefits. In the event that any claim for benefits is denied in whole or in part, the Participant, Beneficiary or Alternate Payee whose claim has been so denied shall be notified of such denial in writing or electronically by the Committee (or a person named by the Committee to receive claims under the Plan). For purposes of this Section, the person or persons designated to determine initial claims shall be referred to as the "Claims Fiduciary" and the person or persons designated to determine appeals shall be referred to as the "Named Appeals Fiduciary," and any references to the Claims Fiduciary or Named Appeals Fiduciary in this [Section 13.02] shall mean the Committee (and references to the Committee shall also mean the Claims Fiduciary or Named Appeals Fiduciary) as the context so provides. The Claims Fiduciary will review such request and respond within a reasonable time after receiving the claim. The notice advising of the denial shall be furnished to the Participant, Beneficiary or Alternate Payee within 90 days of receipt of the benefit claim by the Committee, unless special circumstances require an extension of time to process the claim. If an extension is required, the Claims Fiduciary shall provide notice of the extension prior to the termination of the applicable period. In no event may the extension exceed a total of 180 days from the date of the original receipt of the claim. The notice advising of the denial shall specify the reason or reasons for denial, make specific reference to pertinent Plan provisions, describe any additional material or information necessary for the claimant to perfect the claim (explaining why such material or information is needed), and shall advise the Participant, Beneficiary or Alternate Payee, as the case may be, of the procedure for the appeal of such denial and the time limits applicable to such procedures, including a statement of the claimant's right to bring a civil action under [section 502(a)] of ERISA following an adverse benefit determination on review. All appeals shall be made by the following procedure:

A person entitled to indemnification under [Section 16.1 or 16.2]2] (an “Indemnified Party”) shall give prompt written notification to the person from whom indemnification is sought (the “Indemnifying Party”) of the commencement of any action, suit or proceeding relating to a Third Party claim for which indemnification may be sought or, if earlier, upon the assertion of any such claim by a Third Party.

Time For Claims. Except in the case of any fraud or intentional misrepresentation by a Party: # no claim may be made or suit instituted alleging breach or seeking indemnification pursuant to Article 15 (Indemnification) for any breach of, or inaccuracy in, any representation or warranty contained in [Section 14.1] (Mutual Representations, Warranties and Covenants), [Section 14.2] (Representations, Warranties and Covenants of ITEOS), and [Section 14.3] (Representations, Warranties and Covenants of GSK) unless a written notice is provided to the Indemnifying Party at any time prior to the date that is ​ following the Effective Date, and # after such ​ period, no Party may bring any claim against the other Party arising from or relating to such other Party’s breach of such representations and warranties.

Procedures for Claims. A Participant or Beneficiary (the “Claimant”) shall have the right to request any benefit under the Plan by filing a written claim for any such benefit with the Named Fiduciary on a form provided or approved by the Named Fiduciary for such purpose. The Named Fiduciary (or a claims fiduciary appointed by the Named Fiduciary) shall give such claim due consideration and shall either approve or deny it in whole or in part. The following procedure shall apply:

I acknowledge and agree that the Settlement Amount includes full compensation for the loss of any and all employment benefits and insurance coverage directly or indirectly contributed to, sponsored by or provided by the Employer, and I hereby waive any and all rights to the coverage, benefit or extent of coverage or extent of benefit under or from any such program which existed including, without limitation, any rights whatsoever to coverage under or benefits from any insurance or short-term or long-term disability plan. I acknowledge that I have been fully informed of my eligibility to convert certain life insurance coverage I may have which is provided by or sponsored by the Employer to a personal policy (up to a maximum of $200,000) within 31 days of the Termination Date.

Next results

Draft better contracts
faster with AllDrafts

AllDrafts is a cloud-based editor designed specifically for contracts. With automatic formatting, a massive clause library, smart redaction, and insanely easy templates, it’s a welcome change from Word.

And AllDrafts generates clean Word and PDF files from any draft.