Minutes of a Regular Meeting, June 22-23, 2004 - Digital Collections

REGENTS’ POLICY MANUALSECTION 3—GENERAL POLICIESUnder the agreements creating the terms of the Policy, the University has sole authority to make finaldeterminations regarding any application for Benefits, the interpretation of the Policy, and anyadministrative rules adopted by the University. Benefits under this Policy will be paid only if and whenthe University or persons to whom such decision-making authority has been delegated by the University,in their sole discretion, decide the Eligible Employee or beneficiary is entitled to Benefits under the termsof the Policy. The University decisions in such matters are final and binding on all persons dealing withthe Policy or claiming a Benefit from the Policy. If a decision is challenged in court, it is the intention ofthe University that the decision is to be upheld unless it is determined to be arbitrary or capricious by thecourt or an arbitrator having jurisdiction over such matters.APPEAL OF DENIED CLAIMThe Eligible Employee may ask the Policy Administrator to review decisions involving requests forclaims for Benefits. Depending on the nature of the particular appeal, some or all of the following threelevels of review will be available to the Eligible Employee:• Level 1: Administrative Review• Level 2: Director of the Office of Human Resources Review• Level 3: Claims Appeal CommitteeTo request any level of review, Eligible Employee may contact the Policy Administrator, who will bethe final initial contact and is primarily responsible for the overall review process. Send requests to:Director of the Office of Human Resources905 Asp Avenue, Room 225Norman, Oklahoma 73019The notices and decision letters will contain the name, title, address, telephone number, and faxnumber of the person who is responsible for processing the Eligible Employee’s particular request forreview. The Eligible Employee should contact that person with any questions regarding review.If the Eligible Employee decides to file an appeal, he or she must give the person who will beresponsible for processing the appeal any material justification or documentation for the appeal at thetime the appeal is filed. The Eligible Employee must also give that person the address and phone numberwhere the Eligible Employee can be contacted.Level 1: Administrative ReviewWithin 60 days after the Eligible Employee receives notice of a claim denial, or if the EligibleEmployee disagrees with a determination under the Policy, the Eligible Employee may make a writtenrequest for an Administrative Review. The Eligible Employee must submit his/her written request to:Director of the Office of Human Resources905 Asp Avenue, Room 225Norman, Oklahoma 73019The written request should state the reason why the claim should be reconsidered and include copiesof any relevant documentation, including related background information, that the claimant feels justifiesa reversal of the claim denial. The Eligible Employee may also request an inspection of designated,pertinent documents on file related to the claim.THE UNIVERSITY OF OKLAHOMA 207