NetSpend 2011 Annual Report Download - page 156

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within 120 days after such receipt, in a case where there are special circumstances requiring extension of time for reviewing
the appealed claim). If an extension of time for reviewing the appeal is required because of special circumstances, written
notice of the extension shall be furnished to the Claimant prior to the commencement of the extension. The notice will
indicate the special circumstances requiring the extension of time and the date by which the Appeals Committee expects to
render the determination on review. The review will take into account 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.
(c)
Contents of Notice. If a benefits claim is completely or partially denied on review, notice of such denial shall be in writing
and shall set forth the reasons for denial in plain language.
The decision on review shall set forth: (i) the specific reason or reasons for the denial, (ii) specific references to the pertinent
Plan provisions on which the denial is based, (iii) a statement that the Claimant is entitled to receive, upon request and free of
charge, reasonable access to and copies of all documents, records, or other information relevant (as defined above) to the
Claimant’s claim, and (iv) a statement describing any voluntary appeal procedures offered by the plan and a statement of the
Claimant’s right to bring an action under Section 502(a) of ERISA.
(d)
The Appeals Committee shall have the exclusive authority at the appeals stage to interpret the terms of the Plan and resolve
appeals under the Claims Procedure.
12.3
Legal Action. A Claimant may not bring any legal action, including commencement of any arbitration, relating to a claim for benefits
under the Plan unless and until the Claimant has followed the claims procedures under the Plan and exhausted his or her
administrative remedies under such claims procedures. Any such legal action must be commenced within one year of a final
determination hereunder with respect to such claim.
12.4
Discretion of Appeals Committee. All interpretations, determinations and decisions of the Appeals Committee with respect to any
claim shall be made in its sole discretion, and shall be final and conclusive.
12.5
Arbitration. If any claim or controversy between a Participating Employer and a Participant or Beneficiary is not resolved through the
claims procedure set forth in Article XII, such claim shall be submitted to and resolved exclusively by expedited binding arbitration by
a single arbitrator.
(a)
Except as provided in Section 12.5(c) below, Arbitration shall be conducted in accordance with the following procedures:
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