If a claim for short-term disability benefits provided through Standard Life Insurance is denied in whole or in part by Standard Life Insurance, you will be notified in writing within forty-five days of receipt of your claim. In special circumstances, an additional period of thirty days may be required for consideration of your claim. If additional time or information is needed, you will be notified in writing of the reasons before the initial 45-day period expires. A second 30-day extension of time to consider your claim may be obtained by Standard Life Insurance if you are notified in writing, before the end of the first 30-day extension, that additional time is necessary to make a decision upon your claim. Notice of any extension of time needed by Standard Life Insurance to decide your claim will include a description of the rules of the Plan, the unresolved issues which prevent Standard Life Insurance from making a decision and the additional information you must submit to Standard Life Insurance. You will have forty-five days to submit this additional information to Standard Life Insurance. In no case will the extension exceed seventy-five days from the date your claim was received by Standard Life Insurance.
The notice of decision on your claim will contain specific reasons for the decision and a specific reference to the provisions of the Plan or policy on which the decision is based. The notice will also describe any additional information you must provide to perfect your claim and explain why this information is necessary. You will have forty-five days to provide any additional information requested by Standard Life Insurance.
An employee whose claim for short-term disability benefits has been denied in whole or in part by Standard Life Insurance may appeal the decision to the Appeals Committee of the Board of Trustees of the Fund. An appeal to the Appeals Committee must be in writing, submitted to the Chief Executive Office of the Fund within one hundred eighty days of the initial denial of the claim, accompanied by a statement giving the reasons the denial is believed to be incorrect. You will be given full access by Standard Life Insurance to all documents or other information that relate to your claim for this purpose, including the identity of any medical or vocational professionals who were consulted by Standard Life Insurance.
A decision by the Appeals Committee shall be made with forty-five days after receipt of your appeal. An additional forty-five days may be required under special circumstances. If additional time or information is needed, you will be notified in writing of the reasons and the date by which the Committee expects to reach a final decision before the 45-day period expires. In no case will the extension exceed ninety (90) days from the date your appeal was received. The notice of the decision will contain specific reasons for the decision and a specific reference to the provisions of the Plan or policy on which the decision is based.
The decision of the Appeals Committee on your claim is final. If you disagree with the decision, you have the right to bring a legal action against the Fund and its Trustees in Federal Court. See Your Rights Under ERISA.