29.404—Initial benefit determinations and reconsideration by the Benefits Administrator.
(a)
(b)
3]Initial benefit
determinations. The Benefits Administrator
will process applications for Federal Benefit
Payments and determine the eligibility for and the
amount and form of Federal Benefit Payments. All
initial benefit determination decisions which may
reasonably be construed as a denial (in whole or
part) of a claim for Federal Benefit Payments must
be in writing, must advise claimants of their
right to request reconsideration under paragraph
(b), of this section and must state the time
limits applicable to such a request.
(b)
Claimant's right to
reconsideration of benefit denials. (1) Except
as provided in paragraph (b)(2) of this section,
claimants who disagree with the amount or form of
a Federal Benefit Payment determination and wish
to contest the determination must first request
the Benefits Administrator to reconsider its
determination.
(c)
Form and timing of requests for
reconsideration. (1) A request for
reconsideration must be in writing, must include
the claimant's name, address, date of birth and
claim number, if applicable, and must state the
basis for the request.
(2)
A request for reconsideration must be
received by the Benefits Administrator within 30
calendar days from the date of the written notice
of the initial benefit determination.
(d) Reconsideration decisions.
A
reconsideration decision by the Benefits
Administrator denying (in whole or part) a claim
for a Federal Benefit Payment must—
(2)
Provide adequate notice of such denial,
setting forth the specific reason for the denial
in a manner calculated to be understood by the
average participant; and
(3)
Provide notice of the right to appeal the
Benefit Administrator's decision to the
Department, the address to which such an appeal
must be submitted, and the time limits applicable
to such an appeal.
(e)
Appeal of reconsideration
decisions. The Department will review an
appeal of a reconsideration decision under §
29.405.