RTN » Topics » Claims Procedure

This excerpt taken from the RTN 10-K filed Feb 25, 2009.

Claims Procedure

9.1 Claims Submission.

(a) All claims for Benefits under the Plan, regardless of the nature of the claim, shall be submitted to the Plan Administrator in writing on a form provided by the Plan Administrator, or in any other manner designated by the Plan Administrator. Except as otherwise provided by the Plan Administrator, claims for Benefits should be sent to the Benefits Department, Raytheon Company, at the address provided by the Plan Administrator.

(b) Claims for Benefits shall be submitted within a reasonable period of time after the date such Benefits were purported to be available to the Participant or Beneficiary, with such determination of reasonableness to be made by the Plan Administrator in its sole discretion. All claims must adequately state the basis for the claim including a statement of all pertinent facts, except to the extent expressly waived by the Plan Administrator. The Plan Administrator may prescribe additional procedural requirements for claims, not inconsistent herewith.

(c) In the event that a Participant or beneficiary does not receive any Plan benefit that is claimed, such Participant or beneficiary shall be entitled to consideration and review as provided in this Article. Such consideration and review shall be conducted in a manner designed to comply with section 503 of ERISA.

(d) Failure by a Participant or beneficiary to follow the requirements of this Article shall result in the denial of the claim submitted. The Participant or Beneficiary submitting such deficient claim shall be deemed to have not exhausted his or her administrative remedies under the Plan.

9.2 Initial Benefit Determination.

(a) Upon receipt of any properly submitted claim for Benefits, the Plan Administrator shall give due consideration to the claim presented.

(b) Timing and Notification of Benefit Determination. The Plan Administrator shall notify the claimant, in accordance with subsection (c) below, of the Plan’s benefit determination within a reasonable time period after receipt of the claim, but not later than 90 days after the Plan’s receipt of the claim. This period may be extended by the Plan for up to 90 days, provided that the Plan Administrator both determines that such an extension is necessary and notifies the claimant, prior to the expiration of the initial 90-day period, of the circumstances requiring the extension of time and the date by which the Plan expects to render a decision. In the case of any extension, the notice of extension shall specifically explain the standards on which entitlement to a benefit is based and the unresolved issues that prevent a decision on the claim. If the extension is necessary due to the failure of the claimant to submit the information necessary to decide the claim, the notice of extension must specifically describe the required information needed to resolve the issue. The claimant shall have 60 days from receipt of the notice within which to provide the specified information.

 

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(c) Manner and Content of Notification of Benefit Determination. If the claim is denied to any extent by the Plan Administrator, the Plan Administrator shall provide a claimant with written or electronic notification of any adverse benefit determination; except that if no such notification is provided within the applicable time limit prescribed in subsection (b), the initial claim for benefits shall be deemed to be denied as of the expiration of such time limit. Any electronic notification shall comply with DOL Regulations section 2520.104b-1(c)(1)(i), (iii) and (iv). The notification shall set forth, in a manner calculated to be understood by the claimant:

(1) The specific reasons for the adverse determination;

(2) Reference to the specific Plan provisions on which the determination is based;

(3) A description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; and

(4) A description of the Plan’s review procedures and the time limits applicable to such procedures, including a statement of the claimant’s right to bring a civil action under ERISA section 502(a) following an adverse benefit determination on review.

9.3 Appeal of Adverse Benefit Determinations

(a) Claimants shall have a reasonable opportunity to appeal an adverse benefit determination to the Raytheon Benefits Appeals Committee, which shall involve a full and fair review of the claim and adverse benefit determination which includes the following:

(1) Upon receipt of an adverse benefit determination, the claimant has up to sixty (60) days to file an appeal with the Raytheon Benefits Appeals Committee. Except as otherwise provided by the Plan Administrator, a request to appeal an adverse benefit determination should be sent to the Benefits Department, Raytheon Company, at the address provided by the Plan Administrator.

(2) The claimant may submit written comments, documents, records, and other information relevant to the claim for benefits along with the claimant’s appeal.

(3) The claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant’s claim for benefits.

(4) The review shall take into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination.

(b) Timing of Notification of Benefit Determinations on Review. The Raytheon Benefits Appeals Committee shall notify a claimant in accordance with subsection (c) of the Plan’s benefit determination on review within a reasonable period of time, but not later

 

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than 60 days after receipt of the claimant’s request for review by the Plan, unless the Raytheon Benefits Appeals Committee determines that special circumstances require an extension of time for processing the claim. If the Raytheon Benefits Appeals Committee determines that an extension of time for processing the claim is required, written notice of the extension shall be furnished to the claimant prior to the termination of the initial 60-day period. In no event shall such extension exceed a period of 60 days from the end of the initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date by which the Plan expects to render the determination on review.

(c) Manner and Content of Notification of Benefit Determination On Review. The Raytheon Benefits Appeals Committee shall provide a claimant with written or electronic notification of the Plan’s benefit determination on review; except that if no such notification is provided within the applicable time limit prescribed in subsection (b), the appeal of the adverse benefit determination shall be deemed to be denied as of the expiration of such time limit. Any electronic notification shall comply with DOL Regulations section 2520.104b-1(c)(1)(i), (iii) and (iv). In case of an adverse benefit determination, the notification shall set forth, in a manner calculated to be understood by the claimant:

(1) The specific reasons for the adverse determination;

(2) Reference to the specific Plan provisions on which the determination is based;

(3) A statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claimant’s claim for benefits; and

(4) A statement of the claimant’s right to bring a civil action under ERISA section 502(a).

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