[Ord. No. 1014, 6/8/2020]
1.
The Administrator shall have full power and authority to do whatever,
in its judgment, shall be reasonably necessary to effectuate the proper
administration and operation of the plan. The interpretation or construction
placed upon any term or provision of the plan by the Administrator,
or any action of the Administrator taken in good faith, shall be final
and conclusive upon all parties hereto, except with regard to the
power of Council provided in § 651 hereof. The authority
of the Administrator shall include, in conjunction with Council (where
appropriate) and outside consultants, but shall not be limited to:
A.
Interpretation of the plan;
B.
Determination of all questions affecting the eligibility of any employee
of the Borough to participate herein;
C.
Computation of the amount and the source of any benefit payable hereunder
to any member or beneficiary, as applicable;
D.
Authorization of any and all disbursements of benefits;
E.
Prescription of any procedure to be followed by any participant or
other person, as applicable, in filing any application or election
hereunder;
F.
Preparation and distribution of information explaining the plan as
may be required by law or as the Administrator deems appropriate;
G.
Requisition of information necessary from the Borough or any member
for the proper administration of the plan; and
H.
Appointment and retention of any individual to assist in the administration
of the plan, including such legal, clerical, accounting, and actuarial
services as may be required by any applicable law or laws.
2.
The Administrator shall have no authority to add to, subtract from,
or modify the terms of the plan or to change or add to any benefits
provided by the plan, or to waive or fail to apply any requirements
of eligibility for benefits under the plan. Further, the Administrator
shall have no power to adopt, amend, or terminate the plan, to select
or appoint any actuary; and/or to select or appoint any insurance
company to hold any Contracts, or to determine or require any contributions
to the plan, said powers being exclusively reserved to Council.
[Ord. No. 1014, 6/8/2020]
To the full extent permitted by law, no member of Council, the
Chief Administrative Officer, the Administrator, nor any other person
involved in the administration of the plan shall be liable to any
person on account of any act or failure to act which is taken or omitted
to be taken in good faith in performing their respective duties under
the terms of this plan. To the extent permitted by law, the Borough
shall, and hereby does agree to, indemnify and hold harmless the Administrator
and each successor and each individual's heirs, executors and administrators,
and the Administrator's delegates and appointees (other than any person
or entity independent of the Borough who renders services to the plan
for a fee) from any and all liability and expenses, including counsel
fees, reasonably incurred in any action, suit, or proceeding to which
he is or may be made a party by reason of being or having been the
Administrator or a delegate or appointee of the Administrator, except
in matters involving criminal liability, or intentional or willful
misconduct. If the Borough purchases insurance to cover claims of
a nature described above, then no right of indemnification shall exist
except to the extent of any deductible amount under the insurance
coverage or to the extent of the amount the claims exceed the insured
amount.
[Ord. No. 1014, 6/8/2020]
1.
Any person whose application for benefits is denied, who questions
the amount or timing of any benefit paid, or who has some other claim
arising under the plan (the "claimant"), shall first seek a resolution
of such claim under the procedure hereinafter set forth.
A.
The claimant shall first file a notice of claim with the Administrator
which notice shall fully describe the nature of the claim. The Administrator
shall review the claim and make an initial determination approving
or denying the claim and shall mail notice of the determination within
90 days (or such other period as may be established by applicable
law) from the time the application is received. Such ninety-day period
may be extended by the Administrator, if special circumstances so
require, for up to 90 additional days by the Administrator's delivering
notice of such extension to the claimant within the first ninety-day
period. Any notice hereunder shall, if it is a notice of denial, set
forth:
B.
Upon receipt of notice denying the claim, the claimant shall have
the right to request a full and fair review by Council of the initial
determination. Such request for review must be made by written notice
to Council within 60 days of mailing of the notice of denial. During
such review, the claimant or a duly authorized representative shall
have the right to review any pertinent documents and to submit any
issues or comments in writing. Council shall, within 60 days after
receipt of the notice requesting such review, (or in special circumstances,
such as where Council in its sole discretion holds a hearing, within
120 days of receipt of such notice), submit its decision in writing
to the person or persons whose claim has been denied. The decision
shall be written in a manner calculated to be understood by the claimant
and shall contain specific references to the pertinent plan provisions
upon which the decision is based. The claimant shall have the right
to appeal the decision of Council pursuant to the Local Agency Law,
2 Pa. C.S.A. § 101. If not so appealed, the decision shall
be final, conclusive and binding on all parties.
C.
Any notice of claim questioning the amount of a benefit in pay status
shall be filed by the claimant with the Administrator within 90 days
following the date of the first payment which would be adjusted if
the claim is granted, unless the Administrator allows a later filing
for good cause shown.
D.
A claimant who does not submit a notice of a claim or a notice requesting
a review of a denial of a claim within the time limitations specified
above shall be deemed to have waived such claim or right to review.
