Post-Service Claim
Ordinarily, you will be notified of the decision on your
Post-Service Claim within 30 days from receipt of the
claim by the Claim Administrator responsible for paying
the claim. This period may be extended one time by the
applicable Claim Administrator for up to 15 days if the
extension is necessary due to matters beyond the control of
the Claim Administrator. If an extension is necessary, you
will be notified before the end of the initial 30-day period,
of the circumstances requiring the extension of time and
the date by which the Claim Administrator expects to
render a decision. If an extension is needed because the
Claim Administrator needs additional information from
you, the extension notice will specify the information
needed. In that case you will have 45 days from receipt of
the notification to supply the additional information. If
the information is not provided within that time, your
claim will be denied.
During the period in which you are allowed to supply
additional information, the normal period for making a
decision on the claim will be suspended. The deadline is
suspended from the date of the extension notice either for
45 days or until the date you respond to the request
(whichever is earlier). The Claim Administrator responsible
for paying the claim will then have 15 days to make a
decision on a Post-Service Claim and notify you of the
determination.
