TO THE EMPLOYEE.
THE CORPORATION IS HEREBY DESIGNATED AS THE NAMED FIDUCIARY OF THIS AGREEMENT
FOR PURPOSES OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED,
AND SHALL BE RESPONSIBLE FOR ITS OVERALL SUPERVISION AND MANAGEMENT, ALL
QUESTIONS RELATING TO THE INTERPRETATION OF THIS AGREEMENT AND ALL DECISIONS
PERTAINING TO THE REVIEW OF DENIALS OF BENEFIT CLAIMS.
SECTION 15.
CLAIMS PROCEDURE.
[A]
FILING A CLAIM FOR BENEFITS. ANY BENEFICIARY OF A POLICY SHALL
MAKE A CLAIM FOR THE BENEFITS PROVIDED UNDER SUCH POLICY AND THIS AGREEMENT BY
CONTACTING THE PLAN ADMINISTRATOR AT THE FOLLOWING ADDRESS:
Financial Designs, Ltd.
1775 Sherman Street, Suite 1800
Denver, Colorado 80203
Telephone:
303-832-6100
Facsimile:
303-832-7100
Upon receipt of any such claim, the Plan Administrator shall contact the
applicable Insurer and take all reasonable and necessary actions to assist the
beneficiary of such Policy under this Agreement in filing a claim.
5
[B]
CLAIM DENIAL.
WITH RESPECT TO A CLAIM FOR BENEFITS UNDER A
POLICY, THE APPLICABLE INSURER SHALL BE THE ENTITY THAT REVIEWS AND MAKES
DECISIONS ON CLAIM DENIALS ACCORDING TO THE TERMS OF THE POLICY.
[C]
NOTIFICATION TO CLAIMANT OF DECISIONS.
WITHIN 90 DAYS AFTER THE
FILING OF A CLAIM, THE APPLICABLE INSURER SHALL NOTIFY THE CLAIMANT IN A WRITTEN
INSTRUMENT THAT MEETS THE REQUIREMENTS OF SECTION 15[D] BELOW, WHETHER THE CLAIM
IS UPHELD OR DENIED IN WHOLE OR IN PART OR SHALL FURNISH THE CLAIMANT A WRITTEN
NOTICE DESCRIBING THE SPECIFIC CIRCUMSTANCES REQUIRING A SPECIFIED AMOUNT OF
ADDITIONAL TIME (BUT NOT MORE THAN 180 DAYS FROM THE DATE THE CLAIM WAS FILED)
TO REACH A DECISION ON THE CLAIM.
[D]
CONTENT OF NOTICE.
THE INSURER SHALL PROVIDE, TO ANY CLAIMANT WHO
IS DENIED A CLAIM FOR BENEFITS, WRITTEN NOTICE SETTING FORTH, IN A MANNER
CALCULATED TO BE UNDERSTOOD BY THE CLAIMANT, THE FOLLOWING:
[1]
THE SPECIFIC REASON OR REASONS FOR THE
DENIAL;
[2]
SPECIFIC REFERENCE TO PERTINENT POLICY
PROVISION OR PROVISIONS OF THIS AGREEMENT 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 OR INFORMATION IS NECESSARY; AND
[4]
AN EXPLANATION OF THE AGREEMENT'S CLAIM
REVIEW PROCEDURE, AS SET FORTH IN SECTIONS 15 [D] AND [E] BELOW.
[E]
CLAIMS REVIEW PROCEDURE.
THE PURPOSE OF THE REVIEW PROCEDURE SET
FORTH IN THIS SECTION 15[E] AND THE FOLLOWING SECTION 15[F] IS TO PROVIDE A
METHOD BY WHICH A CLAIMANT UNDER A POLICY MAY HAVE A REASONABLE OPPORTUNITY TO
APPEAL AND OBTAIN A FULL AND FAIR REVIEW OF THE DENIAL OF A CLAIM. TO ACCOMPLISH
THAT PURPOSE, THE CLAIMANT OR "GENDER_PRONOUN" DULY AUTHORIZED REPRESENTATIVE:
[1]
MAY REQUEST A REVIEW UPON WRITTEN
APPLICATION TO THE INSURER;
[2]
MAY REVIEW PERTINENT POLICY AND AGREEMENT
DOCUMENTATION AS PROVIDED IN SECTION 18; AND
[3]
MAY SUBMIT ISSUES AND COMMENTS IN WRITING.
A claimant or "Gender_Pronoun" duly authorized representative shall request a
review by filing a written application for review at any time within 60 days
after