NFL PLAYER DISABILITY & NEUROCOGNITIVE BENEFIT PLAN
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The Disability Board ordinarily will make a
decision on your request for review at its next
meeting, or at its second meeting following
receipt of your request for review if your request
is received less than 30 days before the next
meeting. However, if special circumstances exist,
such as the need to obtain further clarifying
information, the review may be delayed but will
be made by no later than the third Disability
Board meeting following receipt of your request
for review. The Disability Board will notify you in
writing of its decision on review. If the decision
on review is adverse to you in whole or in part,
the written notice will:
1. state the specic reason(s) for the adverse
determination;
2. reference the specic Plan provision(s) on
which the adverse determination is based;
3. state 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
the claim for benets;
4. state that you have the right to bring an
action under ERISA section502(a) and
identify the statute of limitations applicable
to such action, including the calendar date
on which the limitations period expires;
5. disclose any internal rule, guidelines,
or protocol relied on in making the
determination (or state that such rules,
guidelines, protocols, standards, or
other similar criteria do not exist); if the
determination was based on a scientic
or clinical exclusion or limit, contain an
explanation of the scientic or clinical
judgment for the determination, applying
the terms of the Plan to your circumstances
(or state that such explanation is available
free of charge upon request); and
6. discuss the decision, including an
explanation of the basis for disagreeing
with or not following the views expressed
in (a) reports presented by you of medical
professionals treating you and vocational
professionals who evaluated you, (b) reports
of medical or vocational experts whose
advice was obtained on behalf of the Plan
in connection with your adverse benet
determination, without regard to whether
the advice was relied upon in making the
benet determination, or (c) Social Security
Administration disability determinations
presented by you to the Plan.
You may request a written explanation of any
alleged violation of these claims procedures.
Any such request should be submitted to the
Plan in writing; it must state with specicity the
alleged procedural violations at issue; and it
must be received by the Plan no more than 30
days following your receipt of a decision on the
pending application or appeal, as applicable.
The Plan will provide an explanation within 10
days of the request.
Limitation on actions
You may not commence a legal action in a
court on a benet claim denial or partial denial
more than 42 months from the date of the nal
decision on your claim. With respect to all other
types of claims, you may not commence a legal
action in a court after the earlier of –
• six years after the date of any omission,
violation, or breach of any responsibility, duty,
or obligation imposed by the Disability Plan or
applicable laws, or
OTHER INFORMATION