HII Newport News Operations Summary Plan ... - Benefits Connect

• The decision on the appeal will be made by a person or persons at the claim
administrator who is not the person who made the initial claim decision and who
is not a subordinate of that person. In making the decision on the appeal, the
claims administrator will give no deference to the initial claim decision.
If the determination is based in whole or part on a medical judgment, the claims
administrator will consult with a health care professional who has appropriate training
and experience in the field of medicine involved in the medical judgment. The health care
professional will not be the same individual who was consulted (if one was consulted)
with regard to the initial claim decision and will not be a subordinate of that person.
At both the initial claim level, and on appeal, you may have an authorized representative
submit your claim for you. In this case, the administrator may require you to certify that
the representative has permission to act for you. The representative may be a health care
or other professional. However, even at the appeal level, neither you nor your
representative has a right to appear in person before the claims administrator or the
review panel.
During the entire review process, the applicant may review pertinent documents at the
Employee Benefits Office during regular business hours.
Your Rights
You have certain legal rights which are explained in the description of ―ERISA‖ rights in
the Administrative Information section of this Employee Handbook.
Business Travel Accident Insurance Plan
April 2011
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