Citi Benefits Handbook
Claims and Appeals
Claims Procedure
If you do not receive Plan benefits to which you believe you are entitled, or if your application for benefits is denied in whole or in part, you may file a written claim with the Plan Administrator. The Corporate Benefits Department or its delegate(s) will investigate your claim on behalf of the Plan Administrator and you will receive its decision.
Benefit claim determinations will be made in accordance with the Plan document, and the Plan provisions will be applied consistently for similarly situated participants. If your claim is denied, you will receive a written explanation within 90 days after receipt of your claim (180 days if special circumstances apply and written notice is provided within the initial 90-day period indicating the special circumstances and the expected benefit determination date).
Such explanation will include the following:
  • The specific reasons for the denial;
  • References in the Plan documentation that support these reasons;
  • When appropriate, the additional information you must provide to improve your claim and the reasons why that information is necessary; and
  • A description of the Plan's claims review procedures for filing an appeal with the Plan Administrator (including time limits) and a statement of your right to bring a civil action under Section 502(a) ERISA if the Plan Administrator's final decision is to deny the benefits requested in your appeal.
Appeals Procedure
You have a right to appeal a denied claim by filing with the Plan Administrator a written request for additional review of your claim within 180 days after you have received notification that your claim has been denied. The Plan Administrator will conduct a full and fair review of your appeal. You and your representative may review Plan documents and submit written comments with your appeal.
You will be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim. The Plan Administrator's review will take into account all comments, documents, and other information submitted by you relating to the claim without regard to whether such information was submitted or considered in the initial benefit determination. The Plan Administrator, in its discretion, may grant to you the opportunity to present your case by telephone at a teleconference scheduled by the Plan Administrator.
The Plan Administrator will make a final decision on your claim no later than the first available meeting date of the Plan Administrator following the date on which you filed your appeal provided that any request for review filed within 30 days preceding any such meeting date will be decided at the second available meeting date.
The Plan Administrator holds regularly scheduled meetings quarterly. If special circumstances require an additional extension of time for processing, a decision will be made no later than the third available meeting date of the Plan Administrator following the date on which you filed your appeal.
In the case of an extension, you will receive written notice prior to the beginning of the extension that describes the special circumstances and the date as of which the benefit determination will be made. The Plan Administrator will reply to your appeal in writing regarding its decision on its review no later than five days after the decision has been made.
The reply will include:
  • The specific reasons for the denial;
  • References in the Plan documentation that support these reasons;
  • A statement that you are entitled to receive, upon request and free of charge reasonable access to, and copies of, all documents, records, and other information relevant to your claim for benefits; and
  • A statement of your right to bring a civil action under ERISA.
To file a claim or appeal with the Plan Administrator, you must complete the form designated by the Plan Administrator in accordance with the Plan's procedures.
No suit or action for benefits under the Plan will be sustainable in any court of law or equity unless you complete the appeals procedure. By participating in the Plan, participants and beneficiaries are deemed to agree that they cannot begin a legal action, in any forum, more than 12 months after the Plan Administrator's final decision on appeal or, if earlier, within two years from the date on which the claimant was aware, or should have been aware, of the claim at issue in the legal action. The two-year limitation will be increased by any time a claim or appeal on the issue is under consideration by the appropriate fiduciary.