Example ContractsClausesClaims Procedures
Claims Procedures
Claims Procedures contract clause examples

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:

Claims Procedures Mandatory. The internal claims procedures set forth in this ARTICLE 10 are mandatory. If a Claimant fails to follow these claims procedures, or to timely file a request for appeal in accordance with this ARTICLE 10, the denial of the Claim shall become final and binding on all persons for all purposes.

Claims Procedures. Any Participant, former Participant or Beneficiary may file a written claim with the Administrative Committee setting forth the nature of the benefit claimed, the amount thereof, and the basis for claiming entitlement to such benefit. The Administrative Committee shall determine the validity of the claim and communicate a decision to the claimant promptly and, in any event, not later than ninety (90) days after the date of the claim. The claim may be deemed by the claimant to have been denied for purposes of further review described below in the event a decision is not furnished to the claimant within such ninety (90) day period. If additional information is necessary to make a determination on a claim, the claimant shall be advised of the need for such additional information within forty-five (45) days after the date of the claim. The claimant shall have up to one hundred and eighty (180) days to supplement the claim information, and the claimant shall be advised of the decision on the claim within forty-five (45) days after the earlier of the date the supplemental information is supplied or the end of the one hundred and eighty (180) day period. Every claim for benefits which is denied shall be denied by written notice setting forth in a manner calculated to be understood by the claimant # the specific reason or reasons for the denial, # specific reference to any provisions of the Plan (including any internal rules, guidelines, protocols, criteria, etc.) on which the denial is based, # description of any additional material or information that is necessary to process the claim, and # an explanation of the procedure for further reviewing the denial of the claim and shall include an explanation of the claimant’s right to bring a civil action under ERISA [Section 502(a)] in the event of an adverse determination on review.

Claims Procedures. As to any claims falling within the scope of the foregoing indemnifications: # each party agrees promptly to notify the other of and keep the other fully advised with respect to such claims and the progress of any suits in which the other party is not participating; # each party will have the right to assume, at its sole expense, the defense of a claim or suit made or filed against the other party; # each party will have the right to participate, at its sole expense, in any suit instituted against it and to approve any attorneys selected by the other party to defend it, which approval will not be unreasonably withheld or delayed; and # a party assuming the defense of a claim or suit against the other party will not settle such claim or suit without the prior written approval of the other party, which such approval will not be unreasonably withheld or delayed.

Claims Procedures Mandatory. The internal claims procedures set forth in this [Section 16] are mandatory. If a Claimant fails to follow these claims procedures, or to timely file a request for appeal in accordance with this [Section 16], the denial of the Claim shall become final and binding on all persons for all purposes.

Claims Procedures. A Participant may appeal to the Committee, in writing, any decision or action which the Participant believes adversely affects him in accordance with the Claims Procedure attached as [Exhibit A].

Claims Procedures Mandatory. The internal claims procedures set forth in this Section 12.01 are mandatory. If a Claimant fails to follow these claims procedures, or to timely file a request for appeal in accordance with this Section 12.01, the denial of the Claim shall become final and binding on all persons for all purposes.

Claims Procedures Mandatory. The internal claims procedures set forth in this Section 8.1 are mandatory. If a Claimant fails to follow these claims procedures, or to timely file a request for appeal in accordance with this Section 8.1, the denial of the Claim shall become final and binding on all persons for all purposes.

Claims Procedures. A Participant may appeal to the Committee, in writing, any decision or action which the Participant believes adversely affects him in accordance with the Claims Procedure attached as [Exhibit A].

Claims Procedures Mandatory. The internal claims procedures set forth in this [Section 12.01] are mandatory. If a Claimant fails to follow these claims procedures, or to timely file a request for appeal in accordance with this [Section 12.01], the denial of the Claim shall become final and binding on all persons for all purposes.

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