Example ContractsClausesdecision upon reviewVariants
Decision Upon Review
Decision Upon Review contract clause examples

Request for Review. Within sixty (60) days after receipt of an initial adverse benefit determination notice, the claimant may file with the Plan Administrator a written request for a review of the adverse determination and may, in connection therewith submit written comments, documents, records and other information relating to the claim benefits. Any request for review of the initial adverse determination not filed within sixty (60) days after receipt of the initial adverse determination notice shall be untimely.

Review of Claim. Any Claimant who receives an Adverse Benefit Determination or who has not received a response within sixty (60) days may request a review by notice given in writing to the Administrator. Such request must be made within sixty (60) days after receipt by the Claimant of the written notice of Adverse Benefit Determination, or in the event Claimant has not received a response sixty (60) days after receipt by the Administrator of Claimant's claim or request. The claim or request shall be reviewed by the Administrator which may, but shall not be required to, grant the Claimant a hearing. On review, the Claimant may have representation, examine pertinent documents, and submit issues and comments in writing relating to the claim for benefits.

Claim on Review. If the claim, upon review, is denied in whole or in part, the Plan Administrator shall notify the claimant of the adverse benefit determination within sixty (60) days after receipt of such a request for review.

Claim on Review If the claim, upon review, is denied in whole or in part, the Plan Administrator shall notify the claimant of the adverse benefit determination within sixty (60) days after receipt of such a request for review

Within sixty days after the receipt by the claimant of an adverse benefit determination, the claimant may appeal such denial by filing with the Committee a written request for a review of the claim. If such an appeal is filed within the sixty day period, the Committee, or a duly appointed representative of the Committee, shall conduct a full and fair review of such claim that takes into account all comments, documents, records and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. The claimant shall be entitled to submit written comments, documents, records and other information relating to the claim for benefits and shall be provided, upon request and free of charge, reasonable access to, and copies of all documents, records and other information relevant to the claimant’s claim for benefits. If the claimant requests a hearing on the claim and the Committee concludes such a hearing is advisable and schedules such a hearing, the claimant shall have the opportunity to present the claimant’s case in person or by an authorized representative at such hearing.

14.6Appeal and Review. A claimant for benefits whose claim has been denied in whole or in part, or the duly authorized representative of such claimant, may within sixty (60) days after receipt of written notice of such denial request an appeal of such determination. The claimant (or authorized representative) may submit written comments, documents, records and other information relating to the claim. The claimant (or authorized representative) shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claim (as determined pursuant to [Section 503] of ERISA). The review by the Committee will take into account all comments, documents, records and other information submitted by the claimant (or authorized representative) relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. The Committee will then render its final decision in writing and will transmit such written decision to the claimant within a reasonable period of time, but not later than sixty (60) days after receipt of such request for review unless # the time for such decision is postponed by agreement, or # the Committee # determines that special circumstances (such as the need to hold a hearing) require an extension (for no more than a single additional sixty (60) day period) of time for reviewing the claim, and # furnishes the claimant written notice of such extension before the termination of the initial sixty (60) day period, such notice to indicate the special circumstances requiring an extension of time and the date by which the Committee expects to render the determination on review. The Committee shall provide the claimant written notification of its determination on review. In the case of an adverse benefit determination, such notice shall set forth, in a manner calculated to be understood by the claimant, # the specific reason or reasons for the adverse determination, # references to the specific Plan provision on which the benefit determination is based, # a statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and

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.