Claims Review Procedure
If you receive a written notice of denial, you or your duly authorized representative may request a review of the claim by giving written notice to LINA. This request for a review must be made to LINA within 60 days of the receipt of denial. If the request is not made within 60 days, you will be deemed to have waived your right to a review by LINA.
Once LINA receives a request for a review, a prompt review of the claim must take place. You or your authorized representative have the right to review documents that might have a bearing on the claim, including the documents which establish and control the Plan, and to submit issues and comments that you feel might affect the outcome of the review.
Upon completion of a full and complete review, LINA will notify you in writing of the results, citing plan provisions that control the decision. LINA has 60 days to notify you of its decision unless special circumstances require an extension of time. If an extension is required, LINA shall notify you of the need for an extension before the end of the initial 60-day period for completing the review procedure. This means that LINA will have an additional 60 days to notify you of the decision on your denied claim.
LINA is the final authority for approving or denying a claim.
Legal Actions
No legal action can be brought until after 60 days following the date written proof of loss is given to LINA. No action can be brought after three years (five years in Kansas and six years in South Carolina) from the date written proof is required.