More About The LTD Plan

If Your Claim Is Denied

If your claim is denied, the insurance company will notify you of the adverse decision within a reasonable period of time, but not later than 45 days after receiving the claim. This 45-day period may be extended for up to 30 days, if the insurance company: (1) determines the extension is necessary because of matters beyond the Plan’s control, and (2) notifies you, before the end of the 45-day period, why the extension is needed and the expected decision date. If, before the end of the first 30-day extension, the insurance company determines, due to matters beyond the Plan’s control, a decision cannot be rendered within that extension period, the determination period may be extended for up to an additional 30 days, provided the insurance company notifies you, before the end of the first 30-day extension period, why the extension is needed and the expected decision date.

The notice of extension shall explain: (1) the standards on which benefit entitlement is based, (2) the unresolved issues that prevent a claim decision, and (3) the additional information needed. You have at least 45 days to provide the information.

The claim determination time frames begin when a claim is filed, without regard to whether all the information necessary to make a claim determination accompanies the filing.

If an extension is necessary because you failed to submit necessary information, the days from the date insurance company sends you the extension notice until you respond to the request for additional information are not counted as part of the claim determination period.

The written notice of denial will include:

• The specific reasons for the denial,

• Reference to the specific plan provision on which the denial is based,

• A description of any additional material or information necessary for you to complete your claim and an explanation of why such material or information is necessary,

• Steps required for you to appeal the decision, including a statement of your right to bring a civil action under ERISA following an adverse decision on the appeal,

• If applicable, any internal rule, guideline, protocol, or other similar criterion relied upon in making the adverse decision, or a statement that such a rule, guideline, protocol, or other similar criterion was relied upon and a copy thereof will be provided free of charge upon request, and

• If he adverse decision was based on a medical necessity, experimental treatment, or similar exclusion or limit, an explanation of the scientific or clinical judgment for the adverse decision, or a statement that such explanation will be provided free of charge upon request.

Appeals

If you disagree with the determination made on your claim, you have the right to request a thorough review of the decision. If you do not request an appeal in writing on time, you will lose your right to appeal your denial or to file a suit in court.

You or you authorized representative, may appeal a denied claim within 180 days after you receive the Insurance company’s notice of denial. You have the right to:

• Submit to the insurance company, for review, written comment, documents, records and other information relating to the claim;

• Request, free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your claim;

• A review that takes into account all comments, documents, records and other information submitted by you, without regard to whether such information was submitted or considered in the initial claim decision;

• A review that does not afford deference to the initial adverse decision and which is conducted neither by the individual who made the adverse decision nor that person’s subordinate;

• If the appeal involves an adverse decision based on medical judgment, a review of your claim by a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment, and who was neither consulted in connection with the adverse decision nor the subordinate of any such individual; and

• The identification of medical or vocational experts, if any, consulted in connection with the claim denial, without regard to whether the advice was relied upon in making the decision.

The insurance company will make a full and fair review of your appeal and may require additional documents as it deems necessary in making such a review.

A final decision on review will be made within a reasonable period of time but no later than 45 days following receipt of the written request for review unless it determines that special circumstances require an extension. In such a case, a written extension notice will be sent to you before the end of the initial 45-day period. The extension notice shall indicate the special circumstances and the date by which the insurance company expects to render the appeal decision. The extension cannot exceed a period of 45 days from the end of the initial period.

The appeal time frames begin when an appeal is filed, without regard to whether all the information necessary to make an appeal decision accompanies the filing. If an extension is necessary because you failed to submit necessary information, the days from the date the insurance company sends you the extension notice until you respond to the request for additional information are not counted as part of the appeal determination period.

The insurance company’s notice of denial shall include:

• The specific reason or reasons for denial with reference to those Plan provision on which the denial is based;

• A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of all documents, records, and other information relevant to your claim; and

• A statement describing any voluntary appeal procedures offered by the Plan and your right to obtain the information about such procedures, and a statement of your right to bring an action under ERISA.

• If applicable, any internal rule, guideline, protocol, or other similar criterion relied upon in making the adverse decision, or a statement that such a rule, guideline, protocol, or other similar criterion was relied upon and a copy thereof will be provided free of charge upon request; and

• If he adverse decision was based on a medical necessity, experimental treatment, or similar exclusion or limit, an explanation of the scientific or clinical judgment for the adverse decision, or a statement that such explanation will be provided free of charge upon request

You and your Plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency.

Claim Payments

The Insurance Company generally pays claims when it receives proof of a claim and has determined you are disabled and eligible for benefits. You will receive monthly benefit payments while you continue to be disabled, up to the period specified under How Long LTD Benefits Last

All benefits are payable to you. However, if any payments are owed at your death, these may be paid to your estate. If any payment is owed to your estate, an individual who is a minor, or an individual who is not legally competent, the Insurance Company reserves the right to pay up to $2,000 to any of your relatives whom it considers entitled to payment.

If you are making a claim, the Insurance Company also has the right to request that you undergo a physical examination.

Misstatement Of Facts

If material facts about you are not stated accurately, your premium may be adjusted and the true facts will be used to determine if, and for what amount, coverage should have been in force. However, no statement you make relating to your insurability will be used to contest your coverage after the coverage has been in force for two years, as long as the statement is in writing and signed by you.

Legal Action

While we do not anticipate your needing to take legal action as a result of a claim for disability, you should know that this right is available to you after you have exhausted the Plan's appeal process. Details on appealing denied claims is provided under Appeals above.

However, you should know that you may start legal action only if...

• 60 days have passed since you gave proof of your disability to the Insurance Company, and

• It is less than one year since the date the Insurance Company required proof of your disability.

Workers' Compensation

Workers' Compensation insurance pays the medical expenses and provides temporary disability benefits for any illness or injury that occurs as a result of your work. If you are an eligible employee (as outlined under Who Is Eligible.), you are automatically covered by Workers' Compensation.

The important thing for you to remember is that if you become injured on the job (or suffer a job-related illness), be sure to contact your manager. He or she will arrange medical care for you and report the incident. Then, if you miss time away from work, you may be eligible for compensation through the Workers' Compensation program.

In general, you cannot receive disability benefits for any day for which you receive Workers' Compensation benefits. However, if the Workers' Compensation benefits are less than what you would otherwise receive from the disability plans, the disability plans will pay the difference.