SUMMARY PLAN DESCRIPTION (Continued)
Applicable to All Claims, except Waiver of Premium Claims: (Continued)
What Do You Do To Appeal A Claim Denial? You or your authorized representative may appeal a denied claim within 60 days after you receive Lincoln's notice of denial. You have the right to: 1. Submit, for review, written comments, documents, records and other information relating to the claim to Lincoln; 2. Request, free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim; and 3. A review on appeal 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. Lincoln will make a full and fair review of your appeal and may require additional documents as it deems necessary or desirable in making such a review. A final decision on the review shall be made within a reasonable period of time, but not later than 60 days following receipt of the written request for review, unless Lincoln determines that special circumstances require an extension. In such case, a written extension notice will be sent to you before the end of the initial 60 day period. The extension notice must indicate the special circumstances and the date by which Lincoln expects to render the appeal decision. The extension cannot exceed a period of 60 days. The appeal time frames begin when an appeal is filed, without regard to whether all the information necessary to make an appeal decision accompanies the filing. If an extension is necessary because you failed to submit necessary information, the days from the date of the extension notice until you respond to the request for additional information are not counted as part of the appeal determination period. Lincoln's notice of denial shall include: 1. The specific reason or reasons for denial with reference to those Plan provisions on which the denial is based; 2. A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of all documents, records, and other information relevant to your claim; and 3. A statement describing any voluntary appeal procedures offered by the Plan and your right to obtain the information about such procedures, and a statement of your right to bring an action under ERISA.
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