Benefits Handbook

For all other matters not covered by the Plan Administrator Appeal process described above, including if you disagree with the Claims Administrator's determination as to whether you have a serious health condition, the duration of the benefits as a result of a serious health condition, whether you qualify to receive benefits under the STD Benefits Payroll Policy, or regarding the Claims Administrator's disability review process (as described in this policy), you must appeal the Claim Administrator's determination in writing to the Claims Administrator within 30 calendar days of the Claims Administrator's determination. Appeal request received after 30 days will not be considered.

The written appeal should be sent to:

You may submit any additional clinical information from your health care provider as part of the appeal request. The Claims Administrator will review the original determination of STD Benefits eligibility and confirm or modify the determination.

You will be advised of the appeal decision, when practicable, in writing, by the Claims Administrator's Appeal Coordinator within 60 days of the appeal request. The Claims Administrator's decision on any Claims Administrator appeal (as described above) will be final, binding and conclusive with respect to all interested persons.

If the original period of approved STD Benefits ends during the appeal process, STD Benefits will cease and you will be placed on an unpaid status pending the appeal process.

If your appeal is approved, you will receive STD Benefits retroactively for the period approved by the Claims Administrator for which you have not yet been paid.

If your appeal is denied, you will be notified in writing by the Claims Administrator that your appeal was denied, and will be given one (1) additional week to return to work. If you fail to return to work, you will be deemed to have voluntarily resigned your employment, and Marsh McLennan will treat the termination accordingly. In addition, if you have been paid for time out of work that was not approved by the Claims Administrator, Leave Management will apply any accrued unused paid time off (e.g., vacation, PTO, Sick Days) to offset this overpayment and you will be required to repay any remaining overpayment.