15.16 CLAIMS REVIEW PROCESS
A claim for benefits under the Plan arises only if you have filed a written request for a benefit determination with the Administrative Office. The following sets forth the Plan’s timelines for deciding your claim, and your appeal rights if your claim for benefits is denied. Please note that what follows are separate claim procedure rules that apply depending on whether your claim is for medical benefits, disability benefits, or non-medical welfare benefits. Moreover, if your claim is for medical benefits, different claim procedures apply based on whether your claim is for prior approval of a benefit before the service or treatment is obtained, or is after service or treatment. In addition, the Plan Administrator may, outside of the timelines set forth herein, reconsider an initial claim or appeal determination at any time if facts that were not within the control of the Plan Administrator become known subsequent to the initial determination.