Ask additional questions;
Request to receive reasonable access (free of charge) to copies of all documents, records, and other information relevant to your claim; and
Ask for a review that takes into account all comments, documents, records, and other information you have timely submitted, whether or not it was submitted or considered in the initial determination of your claim. The review of your appeal will not give deference to the initial decision on your claim. The individual who decides your appeal will not be the same individual who decided your initial claim denial and will not be that individual’s subordinate. If your appeal is based in whole or in part on a medical judgment, the reviewer will consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment. The identity of any medical or vocational expert consulted in connection with your appeal will be provided. Before your appeal is decided, the Plan Administrator will provide you, free of charge, with any new or additional evidence considered, relied upon, or generated by the STD Plan, the Plan Administrator, or other person making the benefit determination in connection with the claim, as well as any new or additional rationale. You will be provided this new or additional evidence or rationale as soon as possible to give you a reasonable opportunity to respond before your claim is decided. If your appeal is denied in whole or in part, you will receive a written notice within 45 days of the date that it was received, unless the Plan Administrator determines that special circumstances require an extension of time for processing your claim. If the Plan Administrator determines that an extension of time for processing is required, written notice of the extension will be furnished to you prior to the termination of the initial 45-day period. The extension notice will indicate the special circumstances requiring an extension of time and the date by which the Plan Administrator expects to render the determination on review.
A notice that your request on appeal is denied will be culturally and linguistically appropriate and will contain the following information:
the specific reason(s) for the determination;
a reference to the specific STD Plan provision(s) on which the determination is based;
a statement that you are entitled to receive upon request, and without charge, reasonable access to or copies of all documents, records or other information relevant to the determination.
A discussion of the decision, including an explanation of the basis for disagreeing with or not following:
- The views you presented to the STD Plan of health care professionals who treated who and vocational professionals who evaluated you;
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