Section 14-51-51 - Appeals procedure(a) Any employee or the duly authorized representative of such employee, whose application for enrollment or change in enrollment is denied, in whole or in part, or whose enrollment is canceled, may appeal for a review of the decision by submitting within thirty-one days after receiving written notice of the denial, a written statement:(1) Requesting a review of the application for enrollment or change in enrollment or the cancellation of enrollment by the plan administrator;(2) Setting forth all of the reasons upon which the request for review is based and all facts in support thereof; and(3) Setting forth any other issues or comments which the employee deems relevant to the application. The plan administrator shall act upon each such appeal within sixty days after either receipt of the employee's request for review by the plan administrator or receipt of any additional materials reasonably requested by the plan administrator from such employee, whichever occurs later.
(b) The plan administrator shall make a full and fair review of each application and any materials submitted by the employee or the employee's duly authorized representative in connection therewith and may require the employer or the employee to submit within thirty days following a written notice from the plan administrator such additional facts, documents, or other evidence as is deemed necessary or advisable in the sole discretion of the plan administrator in making such a review.(c) On the basis of the review, the decision of the plan administrator shall be final and conclusive upon all persons. If the plan administrator sustains the denial or cancellation of the application, in whole or in part, the plan administrator shall give written notice of the decision to the employee setting forth the specific references to the pertinent plan provisions on which the plan administrator's decision is based. Such written notice shall be given within one hundred twenty days of the date the appeal was filed.[Eff. DEC 15 1989] (Auth: SLH 1989, Act 63) (Imp: SLH 1989, Act 63)