internal claims procedure process and exhaustion of that process is a prerequisite to bringing a lawsuit under ERISA.
If your claim is denied in whole or in part, the claims administrator will provide you written notice within 90 days, unless there are special circumstances. In some instances, more than 90 days may be required to make a decision. In this case, the claims administrator must notify you that more time (up to 90 additional days) is needed and explain the reasons.
The claims administrator’s written notice that a claim is denied will include the following:
•the specific reason(s) for the adverse decision;
•the specific Plan provisions on which the decision is based;
•a statement of your right to review (on request at no charge) relevant documents and other information; and
•a description of the Plan’s review procedures and the time limits applicable to such procedures, including a statement about your right to bring a civil action under ERISA following an adverse determination.
WHAT IF A CLAIM IS DENIED?
If you disagree with a notice of denial of benefits, you have the right to file a written petition for review with the claims administrator within 60 days of receiving the notice. You or your representative must state the specific reasons for appealing the claim.
You or your representative may review pertinent documents and records to help you in appealing your claim.
Within 60 days after receiving your written petition for review, the claims administrator will notify you in writing of the final decision and the reasons for reaching this decision.
If your claim is denied on review, you will be furnished with a written notice of adverse benefit determination on review setting forth:
•the specific reason(s) for the adverse decision on review;
•the specific Plan provisions on which the decision is based;
•a statement of your right to review (on request and at no charge) relevant documents and other information;
•a statement describing any voluntary appeal procedures and your right to obtain information about such procedures; and
•a statement of your right to bring a lawsuit under
§ 502(a) of ERISA.
If you do not appeal within the Plan’s required time period, you will lose the right to appeal and you will have failed to exhaust the Plan’s internal administrative appeal process, which is a prerequisite to bringing a lawsuit under ERISA.
STATUTE OF LIMITATIONS/LAWSUITS
No claimant may begin any legal action to recover Plan benefits, to enforce or clarify rights under the Plan, under ERISA or under any other provision of law, whether or not statutory, until the claims procedures described in this summary have been exhausted in their entirety. Legal action must be commenced in the proper forum before the earlier of 30 months after the claimant knew or reasonably should have known of the principal facts on which the claim is based, or 12 months after the claimant exhausts the claims procedures under the Plan.
Knowledge of all facts that you knew or reasonably should have known will be imputed to every claimant who is or claims to be entitled to benefits or rights by reference to you or your dependents for the purpose of applying the time periods. In any legal action brought relating to the Plan all explicit and implicit determinations by the claims administrator, MiniMed and any other fiduciary (including determinations as to whether the claim, or a request for a review of a denied claim, was timely filed) will be given the maximum deference permitted by law.
Any review of a final decision or action of the persons reviewing a claim will be based only on the evidence presented to or considered by those persons at the time they made the decision that is the subject of review.
NON-ASSIGNMENT OF BENEFITS
Benefits under the Plan may not be sold, transferred, pledged or assigned, and any attempt to do so will be null and void.
ADMINISTRATIVE INFORMATION
Official Plan Name
MiniMed Severance Pay Plan for Executives, also commonly referred to in this summary as the Plan.