Res 1999-134 - Laserfiche WebLink

Home Browse Search

SECTION IV Procedure For Application And Payment Of Benefits From The Plan 4.1 Any eligible participant, on behalf of the participant or an eligible dependent, may make application for benefits from the Plan by completing the claim form prescribed by the Claims Administrator. The applicant shall supply such pertinent information from personal or professional sources as may be required by the Claims Administrator. 4.2 The Claims Administrator shall accept any application for benefits made in the appropriate manner, and shall determine eligibility of such application for benefits in accordance with the Plan Document. If the Claims Administrator determines that the applicant is entitled to receive payment of benefits from the Plan, the Claims Administrator shall determine the amount payable by the Plan, and arrange for the payment of such amount. If the Claims Administrator determines that the applicant is not eligible for benefits from the Plan or any portion thereof is denied or reduced, the Claims Administrator shall notify the applicant and the Company as to the reasons for denial, or reduction of such claims. The Claims Administrator may compromise or adjust any claim, application, or application previously denied or reduced in whole or part, as the Claims Administrator believes may be in the best interests of the Plan. The Claims Administrator shall be responsible for the initial review of all disputed claims and the Plan Administrator shall review all subsequent written requests from plan participants for review of the Claims Administrator's decision. The Claims Administrator shall process claims submitted by participants of the Plan and periodically notify the Plan Administrator as to the dollar amount of total claims processed for the period. As soon as the necessary funds are in the Plan to fund the aforementioned claims, the Claims Administrator will immediately release claim payments to the appropriate claimants. The Claims Administrator will provide documentation of claim payments to the Plan Administrator. The Claims Administrator shall adjudicate claims no later than the 90th day after the date on which valid proof ofloss is received by the Claims Administrator, unless special circumstances require more than ninety (90) days for processing the claim. In that event, the Claims Administrator will notify the participant, in writing, within ninety (90) days of the filing, of the special circumstances that make an extension necessary and indicate when the final decision is expected. This extension may be for a period of up to ninety (90) days. 8