Process for formal benefit claims

When a claimant files a claim, the claims administrator will notify the claimant of the determination within 30 days after receiving the request. However, if more time is needed to make a determination due to matters beyond the claims administrator’s control, the claims administrator will notify the claimant within 30 days after receiving the request. This notice will include the date a determination can be expected, which will be no more than 45 days after receipt of the request. If more time is needed because necessary information is missing from the request, the notice will also specify what information is needed. The claimant must provide the specified information to the claims administrator within 45 days after receiving the notice. The determination period will be suspended on the date the claims administrator sends such a notice of missing information, and the determination period will resume on the date the claimant responds to the notice.

If you do not agree with the decision, you may choose to file a formal appeal. See below for more information on the appeals process.

 

Publication date: April 2021

 

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