MoneyGram 2005 Annual Report Download - page 117
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(c) a description of any additional material or information necessary to perfect the claim and an explanation of why such material or information is
necessary; and
(d) a description of the claim and review procedures, including the time limits applicable to such procedure, and a statement of the claimant's right to
bring a civil action under ERISA section 502(a) following an adverse determination on review.
10.3.3. Request for Review. Within sixty (60) days after receipt of an initial adverse benefit determination notice, the claimant may file with MGI a
written request for a review of the adverse determination and may, in connection therewith submit written comments, documents, records and other
information relating to the claim benefits. Any request for review of the initial adverse determination not filed within sixty (60) days after receipt of the initial
adverse determination notice shall be untimely.
10.3.4. Claim on Review. If the claim, upon review, is denied in whole or in part, MGI shall notify the claimant of the adverse benefit determination
within sixty (60) days after receipt of such a request for review.
(a) The sixty (60) day period for deciding the claim on review may be extended for sixty (60) days if MGI determines that special circumstances require
an extension of time for determination of the claim, provided that MGI notifies the claimant, prior to the expiration of the initial sixty (60) day
period, of the special circumstances requiring an extension and the date by which a claim determination is expected to be made.
(b) In the event that the time period is extended due to a claimant's failure to submit information necessary to decide a claim on review, the claimant
shall have sixty (60) days within which to provide the necessary information and the period for making the claim determination on review shall be
tolled from the date on which the notification of the extension is sent to the claimant until the date on which the claimant responds to the request for
additional information or, if earlier, the expiration of sixty (60) days.
(c) MGI's review of a denied claim 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.
10.3.5. Notice of Adverse Determination for Claim on Review. A notice of an adverse determination for a claim on review shall set forth in a manner
calculated to be understood by the claimant:
(a) the specific reasons for the denial; -15-