|
|
 | | | |
- close
- close
- close
- close
| |||||||||
This excerpt taken from the JBLU 8-K filed Jun 28, 2007. Section 14. Claims
Procedure.
(a) General. In the event that an Eligible Employee believes he or she is not receiving benefits to which he or she is entitled under the Plan, such Eligible Employee or his or her authorized representative (hereinafter called the “Claimant”) may make a claim for benefits in the manner hereinafter provided. (b) Claims. All claims for benefits under the Plan shall be made in writing and shall be signed by the Claimant. Claims shall be submitted to the Plan Administrator. If the Claimant does not furnish sufficient information with the claim for the Plan Administrator to determine the validity of the claim, the Plan Administrator shall indicate to the Claimant any additional information which is necessary for the Plan Administrator to determine the validity of the claim. (c) Review of Claims. Each claim hereunder shall be acted on and approved or disapproved by the Plan Administrator within 90 days following the receipt by the Plan Administrator of the information necessary to process the claim. If special circumstances require an extension of the time needed to process the claim, this 90-day period may be extended to 180 days after the claim is received. The Claimant shall be notified before the end of the original
8
period if an extension is necessary, the reason for the extension and the date by which it is expected that a decision will be made. In the event the Plan Administrator denies a claim for benefits, in whole or in part, the Plan Administrator shall notify the Claimant in writing of the denial of the claim and notify the Claimant of his right to a review of the Plan Administrator’s decision by the Committee. Such notice by the Plan Administrator shall also set forth, in a manner calculated to be understood by the Claimant, the specific reason for such denial, the specific provisions of the Plan on which the denial is based, and a description of any additional material or information necessary to perfect the claim with an explanation of the Plan’s appeals procedure as set forth in this Section 14. (d) Appeals. Any applicant whose claim for benefits is denied in whole or in part may appeal to the Committee for a review of the decision by the Plan Administrator. Such appeal must be made within 60 days after the applicant has received actual or constructive notice of the denial as provided above. An appeal must be submitted in writing within such period and must:
(e) Review of Appeals. The Committee shall act upon each appeal within 60 days after receipt thereof unless special circumstances require an extension of the time for processing, in which case a decision shall be rendered by the Committee as soon as possible but not later than 120 days after the appeal is received by it. If such an extension of time for processing is required because of special circumstances, written notice of the extension shall be furnished prior to the commencement of the extension describing the reasons an extension is needed and the date when the determination will be made. The Committee may require the Claimant to submit such additional facts, documents or other evidence as the Committee in its discretion deems necessary or advisable in making its review. The Claimant shall be given the opportunity to review pertinent documents or materials upon submission of a written request to the Committee, provided that the Committee finds the requested documents or materials are pertinent to the appeal. (f) Final Decisions. On the basis of its review, the Committee shall make an independent determination of the Eligible Employee’s eligibility for benefits under the Plan. The decision of the Committee on any appeal of a claim for benefits shall be final and conclusive upon all parties thereto. (g) Denial of Appeals. In the event the Committee denies an appeal in whole or in part, it shall give written notice of the decision to the Claimant, which notice shall set forth, in a manner calculated to be understood by the Claimant, the specific reasons for such denial and
9
which shall make specific reference to the pertinent provisions of the Plan on which the Committee’s decision is based. (h) Statute of Limitations. A Claimant wishing to seek judicial review of an adverse benefit determination under the Plan, whether in whole or in part, must file any suit or legal action, including, without limitation, a civil action under Section 502(a) of ERISA, within three (3) years of the date the final decision on the adverse benefit determination on review is issued or should have been issued under Section 14(f) or lose any rights to bring such an action. If any such judicial proceeding is undertaken, the evidence presented shall be strictly limited to the evidence timely presented to the Committee. Notwithstanding anything in the Plan to the contrary, a Claimant must exhaust all administrative remedies available to such Claimant under the Plan before such Claimant may seek judicial review pursuant to Section 502(a) of ERISA.
|
| |||||||
