Amgen 2013 Annual Report Download - page 177

(b) that the Claims Reviewer has reached a conclusion contrary, in whole or in part, to the Claimant’s requested
determination, and such notice must set forth in a manner calculated to be understood by the Claimant:
(i) the specific reason(s) for the denial of the claim, or any part of it;
(ii) specific reference(s) to pertinent provisions of the Plan upon which such denial was based;
(iii) 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
(iv) an explanation of the claim review procedure set forth in Section 13.3 below, including the Claimant’s right to
bring a civil action under Section 502(a) of ERISA following an adverse determination on review.
13.3 Review of a Denied Claim. Within 90 days after receiving a notice from the Claims Reviewer that a claim has been denied, in
whole or in part, a Claimant (or the Claimant’s duly authorized representative) may file with the Senior Vice President, Human
Resources of Amgen Inc. (“Appeals Reviewer”) a written request for a review of the denial of the claim. In addition, the
Claimant (or the Claimant’s duly authorized representative):
(a) may, upon request and free of charge, have reasonable access to, and copies of, all documents, records and other
information relevant to the claim;
(b) may submit written comments or other documents; and/or
(c) may request a hearing, which the Appeals Reviewer, in its sole discretion, may grant.
13.4 Decision on Review. The Appeals Reviewer shall render its decision on review promptly, using an abuse of discretion standard
of review, and shall render its decision not later than 60 days after the filing of a written request for review of the denial, unless
a hearing is held or other special circumstances require additional time, in which case the Appeals Reviewer’s decision must be
rendered within 120 days after such date. Such decision must be written in a manner calculated to be understood by the
Claimant, and it must contain:
(a) specific reasons for the decision;
(b) specific reference(s) to the pertinent Plan provisions upon which the decision was based;
(c) 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 claim; and
(d) a statement of the Claimant’s right to bring a civil action under Section 502(a) of ERISA.
13.5 Legal Action. A Claimant’s compliance with the foregoing provisions of this Article 13 is a mandatory prerequisite to a
Claimant’s right to commence any legal action with respect to any claim for benefits
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