SUMMARY PLAN DESCRIPTION (Continued)
What If Your Claim Is Denied? Liberty's notice of denial shall include: 1. The specific reason or reasons for denial with reference to those specific Plan provisions on which the denial is based; 2. A description of any additional material or information necessary to perfect the claim and an explanation of why that material or information is necessary; 3. A description of the Plan's appeal procedures and time frames, including a statement of the claimant's right to bring a civil action under ERISA following an adverse decision on appeal; 4. If applicable, any internal rule, guideline, protocol, or other similar criterion relied upon in making the adverse decision, or a statement that such a rule, guideline, protocol, other similar criterion was relied upon and a copy thereof will be provided free of charge upon request; and 5. If the adverse decision was based on a medical necessity, experimental treatment, or similar exclusion or limit, an explanation of the scientific or clinical judgment for the adverse decision, or a statement that such explanation will be provided free of charge upon request. What Do You Do To Appeal A Claim Denial? You, or your authorized representative, may appeal a denied claim within 180 days after you receive Liberty's notice of denial. You have the right to: 1. Submit to Liberty, for review, written comments, documents, records, and other information relating to the claim; 2. Request, free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your claim; 3. A review that takes into account all comments, documents, records, and other information submitted by you, without regard to whether such information was submitted or considered in the initial claim decision; 4. A review that does not afford deference to the initial adverse decision and which is conducted neither by the individual who made the adverse decision nor the person’s subordinate; 5. If the appeal involves an adverse decision based on medical judgment, a review of your claim by a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment, and who was neither consulted in connection with the adverse decision nor the subordinate of any such individual; and 6. The identification of medical or vocational experts, if any, consulted in connection with the claim denial, without regard to whether the advice was relied upon in making the decision.
Made with FlippingBook - professional solution for displaying marketing and sales documents online