IQVIA Benefits Handbook
DETERMINING PAYMENT OF BENEFITS
The plan administrator has generally delegated to the claims administrators the discretionary authority to:
- Make decisions regarding the interpretation or application of plan provisions.
- Make determinations, including factual determinations, as to the rights and benefits of employees and participants under a plan.
- Make claims determinations under a plan.
- Decide appeals of denied claims.
Plan benefits will be paid only if the plan administrator, or its delegate, decides in its discretion that the claimant is entitled to them. The decision of the plan administrator or its delegate, as applicable, is final and binding.