MMC Benefits Handbook
Life Insurance, Accident Insurance and Legal Assistance Plans
This section applies to the following plans:
- Marsh & McLennan Companies Basic Life Insurance Plan
- Marsh & McLennan Companies Group Variable Universal Life Insurance Plan
- Marsh & McLennan Companies Business Travel Accident Insurance Plan
- Marsh & McLennan Companies Voluntary AD&D Plan
- Marsh & McLennan Companies Legal Assistance Plan
Timing of Notification of Benefits Determination
In the case of a claim, the Claims Administrator will notify you of the benefit determination (whether adverse or not) no later than 90 days after your claim was received. If an extension of time for processing is required due to special circumstances, this time may be extended for an additional 90 days. You will receive notice prior to the extension that indicates the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a determination.
Timing of Appeal of Benefits Determination
If you believe your claim for benefits under a plan was denied improperly, you may file a written claim for the unpaid amount within 60 days of receipt of the denial. The written claim should specify the amount of the claim and include any other written comments, documents, records or other information that may be pertinent. The claim should be sent to the Claims Administrator. The first level appeal will be conducted, and you will be notified by the Claims Administrator of the decision within 60 days from receipt of a request for appeal of a denied claim. If the Claims Administrator determines that an extension is necessary due to special circumstances, this time may be extended for an additional 60 days. You will receive notice prior to the extension that indicates the special circumstances requiring the extension and the date by which the Claims Administrator expects to render a determination.
If you are not satisfied with the first level appeal decision of the Claims Administrator, you have the right to request a second level appeal from the Claims Administrator as the Plan Administrator. Your second level appeal request must be submitted to the Claims Administrator within 180 days from receipt of the first level appeal decision. The second level appeal will be conducted, and you will be notified by the Claims Administrator of the decision within 60 days from receipt of a request for review of the first level appeal decision.
Notice of Determination
If your claim or appeal is in part or wholly denied, you will receive notice of an adverse benefit determination that will:
- state specific reason(s) of the adverse determination
- reference specific plan provision(s) on which the benefit determination is based
- describe additional material or information, if any, needed to perfect the claim and the reasons such material or information is necessary (initial claim only)
- describe the plan's claims review procedures and the time limits applicable to such procedures (initial claim only)
- include a statement of your right to bring a civil action under section 502(a) of ERISA following appeal
- state 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 the claim for benefits (appeal only)
- describe any voluntary appeal procedures offered by the plan and your right to obtain information about such procedures (appeal only).