Reso 2010-068 - Laserfiche WebLink

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C. If an extension of time is necessary, the Claimant must be given a written notice to this effect prior to the expiration of the initial ninety (90) day period, and the notice must indicate the special circumstances requiring the extension and the date by which a decision will be made. D. If a claim is denied in whole or in part, the Administrator's notice denying such claim shall set forth, in a manner calculated to be understood by the Claimant, the following: The specific reason or reasons for the denial; 2. Specific refierence to pertinent Plan provisions on which the denial is based; 3. A description of any additional material or information necessary for the Claimant to perfect the claim and an explanation of why such material information is necessary; and 4. An explanation of the Plan's claim review procedures. E. If notice of the granting or denying of a claim is not furnished in accordance with the preceding provisions, the claim shall be deemed denied and the Claimant shall be permitted to exercise the Claimant`s right to review pursuant to the Claims Appeals section, below. 12.05. Claims A^pgeals. A. If a Claimant wishes to appeal a denial of a claim, the Claimant or the Claimant's duly authorized representative: May request a review upon written application to the Administrator; 2. May submit written comments, documents, records and other information relating to-the claim; and 3. May obtain, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant (determined in accordance with Department of Labor regulations section 2560.503-1(m){8) as if it applied to this Plan) to the Claimant's claim for benefits. B. The written request for review must be received by the Administrator no later than sixty (60) days after the Claimant receives notice that the Claimant's claim for Plan benefits has been denied. C. The decision on the review shall be made by the Administrator, who may, in its discretion, hold a hearing on the denied claim. D. The Administrator shall make its decision promptly, and not later than sixty (60) days after the Administrator's receipt of the request for a review, unless the Administrator determines that special circumstances require an extension of time for processing the claim. If the Administrator determines that an extension of time for processing is required, this period may be extended no more than sixty (60) days from the end of the initial sixty (60) day period, in which case the Administrator shall. give the Claimant a written notice to this effect prior to the expiration of the initial sixty (60) day period and the notice shall indicate the special circumstances requiring the extension of time and the date by which a decision will be made on review. 32