SHORT-TERM DISABILITY (STD) PLAN

IQVIA Benefits Handbook

If you wish to file a claim for benefits, you should follow the claim procedures described in the section of this SPD that describes the STD benefits. To complete your claim filing, Lincoln must receive the claim information it requests from you (or your authorized representative), your attending physician and IQVIA. If you or your authorized representative has any questions about what to do, you or your authorized representative should contact Lincoln directly.

Claim Procedures

You will receive a written notice of an initial decision on your claim as soon as possible after the claims evaluator receives your completed claims forms (but generally within 45 days). This 45-day period may be extended for two additional 30-day periods provided that, prior to any extension period, the claims administrator or plan administrator notifies you in writing that an extension is necessary due to matters beyond the control of the plan. Extension notices will generally explain all of the following:

The circumstances requiring the extension.

The standards for eligibility.

Any unresolved issues that prevent a decision.

Any information needed to resolve those issues.

The date by which the plan expects to render its decision.

If an initial decision on your claim is extended due to your failure to submit information necessary to decide your claim, you will be given at least 45 days to provide the necessary information and the time for decision shall be tolled from the date on which the notification of extension and request for additional information is sent to you.

If a claim for benefits is wholly or partly denied, the claims administrator or plan administrator will furnish you with written notification of the decision. This written notice will provide all of the following:

The specific reason(s) for the decision.

Specific references to the plan provision(s) on which the denial is based.

A description of any additional material or information necessary for you to perfect the claim and an explanation of why such material or information is necessary.

An explanation of the plan's review procedures and the steps to take if you wish to appeal the denial and applicable time limits for such an appeal.

An explanation of your right to bring a civil action under Section 502(a) of ERISA if you appeal the plan's decision and still receive a final denial.

If an internal rule, guideline, protocol or other similar criterion was relied upon in making the denial, either the specific rule, guideline, protocol or similar criterion, or information on how to obtain a copy of the rule or protocol free of charge.

If denial was based on medical judgment, either an explanation of the scientific or clinical judgment for the determination (applying the terms of the plan to your medical circumstances), or information on how an explanation can be obtained free of charge.

An explanation of the decision, including an explanation of the basis for disagreeing with or not following:

The views presented by the claimant to the plan of health care professionals treating the claimant and vocational professionals who evaluated the claimant;

The views of medical or vocational experts whose advice was obtained on behalf of the plan in connection with a claimant's adverse benefit determination, without regard to whether the advice was relied upon in making the benefit determination; and

A disability determination regarding the claimant presented by the claimant to the plan made by the Social Security Administration.

Except as specifically provided otherwise, all determination notices may be provided in written or electronic form. Determination notices based on a determination of disability must be provided in a culturally and linguistically appropriate manner.

Appeal Procedures

On any wholly or partially denied claim for benefits, you or your representative may appeal to the plan administrator for a full and fair review of the claim denial. You may do any or all of the following:

Request a review upon written application within 180 days of the claim denial.

Request, free of charge, copies of all documents, records and other information relevant to your claim.

Submit written comments, records and other information relating to your claim.

Upon receipt of a request for review, your claim will be reviewed by the plan administrator without deference to the initial decision by the claims evaluator and a final written decision will be provided to you or your representative within 45 days after the request is received, unless special circumstances exist that require an extension of time to process the appeal. The plan administrator may receive one 45-day extension to provide you a final decision, if necessary, provided the plan administrator notifies you of the circumstances requiring such extension and the date a decision will be rendered before the expiration of the initial 45-day deadline.

Where an appeal is based on a medical judgment, the plan administrator must consult with a properly trained health care professional. Upon concluding its review on appeal, the plan administrator will provide a written notice of its final decision on appeal. If it is determined that additional benefits are due to you as a result of the final decision, proper benefit adjustments will be made and paid directly to you. If, however, the appeal has been denied, the notice of the final decision will provide you all of the following:

The specific reason(s) for the denial.

The plan provision(s) on which the denial is based.

The extent to which an internal rule or protocol was relied on in making a determination and your right to receive a copy of such rule or protocol free of charge.

If the decision was based on medical necessity, experimental treatment or a similar exclusion or limit, a statement explaining the scientific or clinical judgment supporting the decision or instructions on how the claimant can receive such information free of charge.

An explanation of the decision, including an explanation of the basis for disagreeing with or not following:

The views presented by the claimant to the plan of health care professionals treating the claimant and vocational professionals who evaluated the claimant;

A disability determination regarding the claimant presented by the claimant to the plan made by the Social Security Administration.

The plan cannot deny disability benefits on appeal based on new or additional evidence that was not included when the disability benefit was denied at the claims stage, without giving you notice and a fair opportunity to respond. Your claim on appeal will be reviewed without deference to the initial adverse decision by an appropriate fiduciary of the plan who is neither the individual who made the initial decision regarding your claim nor a subordinate of such individual. In addition, if the initial adverse benefits determination was based in whole or in part on a medical judgment (including a determination with regard to whether a particular treatment, drug, or other item is experimental, investigational, or not medically necessary or appropriate), the fiduciary reviewing your claim on appeal will consult with a healthcare professional with appropriate training and experience in the field of medicine involving the medical judgment. Finally, the fiduciary reviewing your claim on appeal must identify the medical or vocational experts who were used in making the initial decision regarding your benefits, and the fiduciary reviewing your claim on appeal may not rely on such experts or their subordinates in making a decision on appeal.

When an appeal has been denied, you and the Plan Administrator may have other voluntary alternative dispute resolution options, such as mediation. Contact your local U.S. Department of Labor Office for details.

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