Step 3: Filing an Appeal to the Claims Administrator/Plan Administrator if an Initial Claim for Benefits Is Denied

If you have filed a claim for benefits and your claim is denied, you have the right to appeal the decision. JPMorgan Chase is not involved in deciding appeals for any denied benefit claim under the:

Medical Plan, including Prescription Drug Plan;

Preferred Dentist Program (PDP); Dental Maintenance Organization (DMO) Option; and Dental Health Maintenance Organization (DHMO) Option;

Vision Plan;

Health Care Spending Account;

Long-Term Disability Plan, including Group LTD and Individual Disability Insurance;

Short-Term Disability Plan;

Life and AD&D Insurance Plans;

Business Travel Accident Insurance Plan;

Group Legal Services Plan; and

Employee Assistance Program.

The plan administrators delegate all fiduciary responsibility and decisions about a claim for a denied benefit under the above listed plans to the applicable claims administrator.

Appeals related to denied claims under the Health & Wellness Centers Plan and Back-Up Child Care Plan are determined by the plan administrator or its delegate.

Under certain plans, final appeals for denied claims will be heard by a review panel that is independent of both the company and the Medical Plan claims administrators. The independent review panel will hear appeals for the following plans:

Medical Plan;

Prescription Drug Plan; and

Health & Wellness Centers Plan.

Please Note: Appeals related to denied claims under the Short-Term Disability Plan are determined by Sedgwick. Employees who work in New Jersey have the right to appeal to the Division of Temporary Disability Insurance for the State Temporary Disability Insurance portion of the JPMorgan Chase Short Term Disability Plan. You have one year from the date your disability began to file this appeal.

Send your written appeal to:

Division of Temporary Disability Insurance Private Plan Operations
Claims Review Unit
P.O. Box 957
Trenton, NJ 08625-0957

Telephone: (609) 292-6135

If your initial claim for benefits is denied, you — or your authorized representative — may file an appeal of the decision with the applicable claims administrator or plan administrator within the time frames indicated below, after receipt of the claim denial.


Plan	Timing for Filing an Appeal of a Denial of Benefits Claim
Medical Plan and Prescription Drug Plan	180 days
Dental Plan
Vision Plan
Health Care Spending Account
Long-Term Disability, including Individual Disability Insurance
Short-Term Disability Plan
Business Travel Accident Insurance Plan
Employee Assistance Program
Health & Wellness Centers Plan
Life and AD&D Insurance Plans	60 days
Group Legal Services Plan	60 days
Back-up Child Care Plan	180 days

In your appeal, you have the right to:

Submit written comments, documents, records, and other information relating to your claim.

Request, free of charge, reasonable access to, and copies of, all documents, records, and other information that:

Was relied upon in denying the benefit.

Was submitted, considered, or generated in the course of denying the benefit, regardless of whether it was relied on in making this decision.

Demonstrates compliance with the administrative processes and safeguards required in denying the benefit.

For health care: constitutes a policy statement or plan guideline concerning the denied benefit regardless of whether the policy or guideline was relied on in denying the benefit.

If your appeal is for health care, you also have the right to receive:

A review that does not defer to the initial benefit denial and that is conducted by someone other than the person who made the denial or that person's subordinate.

For a denied benefit based on medical judgment (including whether a particular treatment, drug, or other item is experimental or unproven), a review in which the plan fiduciary/claims administrator consults with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment, and who was not consulted in connection with the initial benefits denial, nor the subordinate of this person.

The identification of medical or vocational experts whose advice was obtained in connection with denying the benefit, regardless of whether the advice was relied on in making this decision.

In the case of an urgent care claim where the life of a claimant could be jeopardized, an expedited review process in which:

You may submit a request (orally or in writing) for an expedited appeal of a denied benefit.

All necessary information, including the decision on your appeal, will be transmitted between the plan fiduciary/claims administrator and you by telephone, facsimile, or other available similarly prompt method.