Page 44 - PWH 2018 Plan Documents

if necessary due to circumstances beyond the control of the Insurer. The Insurer will notify Claimant within
the timeframe of the reason for the extension and the date by which the Insurer expects to render its
decision. If, prior to the end of the first 30-day extension period, the Insurer determines that, due to
matters beyond its control, a decision cannot be made within that extension period, the Insurer may extend
the review period for an additional 30 days. Any notice of extension under this Section IV.2.6 shall
specifically explain the standards on which entitlement to a benefit is based, the unresolved issues that
prevent decision in the Claim, and the additional information needed to resolve those issues.

Claimant will be given at least 45 days from receipt of the notice to provide the required information. The
Administrator has 15 days from the date of receiving such information to render its decision.

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